COMPLETE AXILLARY DISSECTION: A TECHNIQUE THAT STILL HAS RELEVANCE IN CONTEMPORARY MANAGEMENT OF BREAST CANCER
Identifieur interne : 002502 ( Istex/Corpus ); précédent : 002501; suivant : 002503COMPLETE AXILLARY DISSECTION: A TECHNIQUE THAT STILL HAS RELEVANCE IN CONTEMPORARY MANAGEMENT OF BREAST CANCER
Auteurs : Owen Ung ; Mona Tan ; Boon Chua ; Bruce BarracloughSource :
- ANZ Journal of Surgery [ 1445-1433 ] ; 2006-06.
Abstract
Axillary lymph node status is an important prognostic indicator for women with breast cancer and axillary dissection provides accurate information regarding nodal status. In addition, local control of axillary disease and allocation of adjuvant systemic therapy are dependent on appropriate axillary surgery. The survival benefit of an axillary dissection remains controversial. We describe a technique of complete axillary clearance that includes levels I, II and III. In our experience this technique is associated with no additional morbidity to patients and incurs minimal prolongation of operative time compared with a level II dissection. Other operative descriptions of axillary surgery generally do not adequately describe a method that clearly and consistently identifies the boundaries, anatomical landmarks and neurovascular structures that traverse the axilla. This technique, with relative ease, allows the identification and preservation of these structures in their original anatomical planes and avoids the division of the pectoralis minor muscle. The assumption that routine level III axillary clearance, as opposed to level I or level II dissection, is associated with greater morbidity warrants further evaluation. No well‐conducted randomized trials have addressed this issue.
Url:
DOI: 10.1111/j.1445-2197.2006.03765.x
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Australia</mods:affiliation></affiliation></author><author><name sortKey="Chua, Boon" sort="Chua, Boon" uniqKey="Chua B" first="Boon" last="Chua">Boon Chua</name><affiliation><mods:affiliation>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</mods:affiliation></affiliation></author><author><name sortKey="Barraclough, Bruce" sort="Barraclough, Bruce" uniqKey="Barraclough B" first="Bruce" last="Barraclough">Bruce Barraclough</name><affiliation><mods:affiliation>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:50A493C686FA88C5118FCCA7400F3163C8EFA6FE</idno><date when="2006" 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owenung@bigpond.com</mods:affiliation></affiliation></author><author><name sortKey="Tan, Mona" sort="Tan, Mona" uniqKey="Tan M" first="Mona" last="Tan">Mona Tan</name><affiliation><mods:affiliation>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</mods:affiliation></affiliation></author><author><name sortKey="Chua, Boon" sort="Chua, Boon" uniqKey="Chua B" first="Boon" last="Chua">Boon Chua</name><affiliation><mods:affiliation>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</mods:affiliation></affiliation></author><author><name sortKey="Barraclough, Bruce" sort="Barraclough, Bruce" uniqKey="Barraclough B" first="Bruce" last="Barraclough">Bruce Barraclough</name><affiliation><mods:affiliation>* New South Wales Breast Cancer 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type="abstract" xml:lang="en">Axillary lymph node status is an important prognostic indicator for women with breast cancer and axillary dissection provides accurate information regarding nodal status. In addition, local control of axillary disease and allocation of adjuvant systemic therapy are dependent on appropriate axillary surgery. The survival benefit of an axillary dissection remains controversial. We describe a technique of complete axillary clearance that includes levels I, II and III. In our experience this technique is associated with no additional morbidity to patients and incurs minimal prolongation of operative time compared with a level II dissection. Other operative descriptions of axillary surgery generally do not adequately describe a method that clearly and consistently identifies the boundaries, anatomical landmarks and neurovascular structures that traverse the axilla. This technique, with relative ease, allows the identification and preservation of these structures in their original anatomical planes and avoids the division of the pectoralis minor muscle. The assumption that routine level III axillary clearance, as opposed to level I or level II dissection, is associated with greater morbidity warrants further evaluation. No well‐conducted randomized trials have addressed this issue.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>axillary</json:string><json:string>node</json:string><json:string>axilla</json:string><json:string>axillary dissection</json:string><json:string>fascia</json:string><json:string>surg</json:string><json:string>breast cancer</json:string><json:string>morbidity</json:string><json:string>dorsi</json:string><json:string>latissimus</json:string><json:string>lateral</json:string><json:string>latissimus dorsi</json:string><json:string>dissection</json:string><json:string>axillary vein</json:string><json:string>incision</json:string><json:string>pectoral</json:string><json:string>axillary clearance</json:string><json:string>subscapular</json:string><json:string>chest wall</json:string><json:string>medial</json:string><json:string>axillary surgery</json:string><json:string>complete axillary clearance</json:string><json:string>pectoralis</json:string><json:string>royal australasian college</json:string><json:string>lateral margin</json:string><json:string>thoracodorsal nerve</json:string><json:string>angular vein</json:string><json:string>long thoracic nerve</json:string><json:string>axillary contents</json:string><json:string>sentinel lymph node biopsy</json:string><json:string>lymph</json:string><json:string>breast cancer management</json:string><json:string>lateral chest wall</json:string><json:string>local control</json:string><json:string>intercostobrachial nerve</json:string><json:string>caudal extent</json:string><json:string>lymph nodes</json:string><json:string>subscapular vein</json:string><json:string>subscapular vessels</json:string><json:string>lateral pectoral nerve</json:string><json:string>axillary disease</json:string></teeft></keywords><author><json:item><name>Owen Ung</name><affiliations><json:string>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</json:string><json:string>E-mail: owenung@bigpond.com</json:string></affiliations></json:item><json:item><name>Mona Tan</name><affiliations><json:string>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</json:string></affiliations></json:item><json:item><name>Boon Chua</name><affiliations><json:string>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</json:string></affiliations></json:item><json:item><name>Bruce Barraclough</name><affiliations><json:string>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>axillary clearance</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>axillary lymph node dissection</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>breast cancer management</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>breast surgery</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>level I–III dissection</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>sentinel lymph node biopsy</value></json:item></subject><articleId><json:string>ANS3765</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>Axillary lymph node status is an important prognostic indicator for women with breast cancer and axillary dissection provides accurate information regarding nodal status. In addition, local control of axillary disease and allocation of adjuvant systemic therapy are dependent on appropriate axillary surgery. The survival benefit of an axillary dissection remains controversial. We describe a technique of complete axillary clearance that includes levels I, II and III. In our experience this technique is associated with no additional morbidity to patients and incurs minimal prolongation of operative time compared with a level II dissection. Other operative descriptions of axillary surgery generally do not adequately describe a method that clearly and consistently identifies the boundaries, anatomical landmarks and neurovascular structures that traverse the axilla. This technique, with relative ease, allows the identification and preservation of these structures in their original anatomical planes and avoids the division of the pectoralis minor muscle. The assumption that routine level III axillary clearance, as opposed to level I or level II dissection, is associated with greater morbidity warrants further evaluation. No well‐conducted randomized trials have addressed this issue.</abstract><qualityIndicators><score>5.632</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595 x 780 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>1296</abstractCharCount><pdfWordCount>3460</pdfWordCount><pdfCharCount>20491</pdfCharCount><pdfPageCount>4</pdfPageCount><abstractWordCount>181</abstractWordCount></qualityIndicators><title>COMPLETE AXILLARY DISSECTION: A TECHNIQUE THAT STILL HAS RELEVANCE IN CONTEMPORARY MANAGEMENT OF BREAST CANCER</title><genre><json:string>article</json:string></genre><host><title>ANZ Journal of Surgery</title><language><json:string>unknown</json:string></language><doi><json:string>10.1111/(ISSN)1445-2197</json:string></doi><issn><json:string>1445-1433</json:string></issn><eissn><json:string>1445-2197</json:string></eissn><publisherId><json:string>ANS</json:string></publisherId><volume>76</volume><issue>6</issue><pages><first>518</first><last>521</last><total>4</total></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>surgery</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>surgery</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string></inist></categories><publicationDate>2006</publicationDate><copyrightDate>2006</copyrightDate><doi><json:string>10.1111/j.1445-2197.2006.03765.x</json:string></doi><id>50A493C686FA88C5118FCCA7400F3163C8EFA6FE</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/50A493C686FA88C5118FCCA7400F3163C8EFA6FE/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/50A493C686FA88C5118FCCA7400F3163C8EFA6FE/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/50A493C686FA88C5118FCCA7400F3163C8EFA6FE/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main">COMPLETE AXILLARY DISSECTION: A TECHNIQUE THAT STILL HAS RELEVANCE IN CONTEMPORARY MANAGEMENT OF BREAST CANCER</title></titleStmt><publicationStmt><publisher>Blackwell Publishing Asia</publisher><pubPlace>Melbourne, Australia</pubPlace><date type="published" when="2006-06"></date></publicationStmt><notesStmt><note type="content-type" subtype="article" source="article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</note><note type="publication-type" subtype="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="article"><analytic><title level="a" type="main">COMPLETE AXILLARY DISSECTION: A TECHNIQUE THAT STILL HAS RELEVANCE IN CONTEMPORARY MANAGEMENT OF BREAST CANCER</title><author xml:id="author-0000" role="corresp"><persName><forename type="first">Owen</forename><surname>Ung</surname></persName><affiliation>
*
†
<address><country key="AU"></country></address></affiliation><affiliation>Clinical Associate Professor Owen Ung, NSW Breast Cancer Institute, PO Box 143, Westmead, NSW 2145, Australia.
Email: owenung@bigpond.com</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Mona</forename><surname>Tan</surname></persName><affiliation>
*
†
<address><country key="AU"></country></address></affiliation><affiliation>Note: </affiliation><note type="foot">Present address: MammoCare, The Breast Clinic and Surgery, 290 Orchard Road, #07‐09 Paragon, Singapore 238859.</note></author><author xml:id="author-0002"><persName><forename type="first">Boon</forename><surname>Chua</surname></persName><affiliation>
*
†
<address><country key="AU"></country></address></affiliation></author><author xml:id="author-0003"><persName><forename type="first">Bruce</forename><surname>Barraclough</surname></persName><affiliation>
*
†
<address><country key="AU"></country></address></affiliation></author><idno type="istex">50A493C686FA88C5118FCCA7400F3163C8EFA6FE</idno><idno type="DOI">10.1111/j.1445-2197.2006.03765.x</idno><idno type="unit">ANS3765</idno><idno type="toTypesetVersion">file:ANS.ANS3765.pdf</idno></analytic><monogr><title level="j" type="main">ANZ Journal of Surgery</title><title level="j" type="alt">ANZ JOURNAL SURGERY</title><idno type="pISSN">1445-1433</idno><idno type="eISSN">1445-2197</idno><idno type="book-DOI">10.1111/(ISSN)1445-2197</idno><idno type="book-part-DOI">10.1111/ans.2006.76.issue-6</idno><idno type="product">ANS</idno><idno type="publisherDivision">ST</idno><imprint><biblScope unit="vol">76</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="518">518</biblScope><biblScope unit="page" to="521">521</biblScope><biblScope unit="page-count">4</biblScope><publisher>Blackwell Publishing Asia</publisher><pubPlace>Melbourne, Australia</pubPlace><date type="published" when="2006-06"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><p>Axillary lymph node status is an important prognostic indicator for women with breast cancer and axillary dissection provides accurate information regarding nodal status. In addition, local control of axillary disease and allocation of adjuvant systemic therapy are dependent on appropriate axillary surgery. The survival benefit of an axillary dissection remains controversial. We describe a technique of complete axillary clearance that includes levels I, II and III. In our experience this technique is associated with no additional morbidity to patients and incurs minimal prolongation of operative time compared with a level II dissection. Other operative descriptions of axillary surgery generally do not adequately describe a method that clearly and consistently identifies the boundaries, anatomical landmarks and neurovascular structures that traverse the axilla. This technique, with relative ease, allows the identification and preservation of these structures in their original anatomical planes and avoids the division of the pectoralis minor muscle. The assumption that routine level III axillary clearance, as opposed to level I or level II dissection, is associated with greater morbidity warrants further evaluation. No well‐conducted randomized trials have addressed this issue.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">axillary clearance</term><term xml:id="k2">axillary lymph node dissection</term><term xml:id="k3">breast cancer management</term><term xml:id="k4">breast surgery</term><term xml:id="k5">level I–III dissection</term><term xml:id="k6">sentinel lymph node biopsy</term></keywords><classCode scheme="tocHeading1">SURGICAL TECHNIQUE</classCode></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/50A493C686FA88C5118FCCA7400F3163C8EFA6FE/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Asia</publisherName><publisherLoc>Melbourne, Australia</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1445-2197</doi><issn type="print">1445-1433</issn><issn type="electronic">1445-2197</issn><idGroup><id type="product" value="ANS"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="ANZ JOURNAL SURGERY">ANZ Journal of Surgery</title></titleGroup></publicationMeta><publicationMeta level="part" position="06006"><doi origin="wiley">10.1111/ans.2006.76.issue-6</doi><numberingGroup><numbering type="journalVolume" number="76">76</numbering><numbering type="journalIssue" number="6">6</numbering></numberingGroup><coverDate startDate="2006-06">June 2006</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="22" status="forIssue"><doi origin="wiley">10.1111/j.1445-2197.2006.03765.x</doi><idGroup><id type="unit" value="ANS3765"></id></idGroup><countGroup><count type="pageTotal" number="4"></count></countGroup><titleGroup><title type="tocHeading1">SURGICAL TECHNIQUE</title></titleGroup><eventGroup><event type="firstOnline" date="2006-06-06"></event><event type="publishedOnlineFinalForm" date="2006-06-06"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.2 mode:FullText source:Header result:Header" date="2010-02-28"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-04"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-14"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="518">518</numbering><numbering type="pageLast" number="521">521</numbering></numberingGroup><correspondenceTo>Clinical Associate Professor Owen Ung, NSW Breast Cancer Institute, PO Box 143, Westmead, NSW 2145, Australia.
Email: <email>owenung@bigpond.com</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:ANS.ANS3765.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Accepted for publication 20 November 2005.</unparsedEditorialHistory><countGroup><count type="figureTotal" number="2"></count><count type="tableTotal" number="0"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="23"></count><count type="wordTotal" number="0"></count><count type="linksPubMed" number="0"></count><count type="linksCrossRef" number="0"></count></countGroup><titleGroup><title type="main">COMPLETE AXILLARY DISSECTION: A TECHNIQUE THAT STILL HAS RELEVANCE IN CONTEMPORARY MANAGEMENT OF BREAST CANCER</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#aff-1-1" noteRef="#fn1" corresponding="yes"><personName><givenNames>Owen</givenNames><familyName>Ung</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#aff-1-1" noteRef="#fn2 #fn5"><personName><givenNames>Mona</givenNames><familyName>Tan</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#aff-1-1" noteRef="#fn3"><personName><givenNames>Boon</givenNames><familyName>Chua</familyName></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#aff-1-1" noteRef="#fn4"><personName><givenNames>Bruce</givenNames><familyName>Barraclough</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="aff-1-1" countryCode="AU"><unparsedAffiliation>
*
<i>New South Wales Breast Cancer Institute, Westmead Hospital</i><i>, and </i>
†
<i>Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</i></unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">axillary clearance</keyword><keyword xml:id="k2">axillary lymph node dissection</keyword><keyword xml:id="k3">breast cancer management</keyword><keyword xml:id="k4">breast surgery</keyword><keyword xml:id="k5">level I–III dissection</keyword><keyword xml:id="k6">sentinel lymph node biopsy</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p>Axillary lymph node status is an important prognostic indicator for women with breast cancer and axillary dissection provides accurate information regarding nodal status. In addition, local control of axillary disease and allocation of adjuvant systemic therapy are dependent on appropriate axillary surgery. The survival benefit of an axillary dissection remains controversial. We describe a technique of complete axillary clearance that includes levels I, II and III. In our experience this technique is associated with no additional morbidity to patients and incurs minimal prolongation of operative time compared with a level II dissection. Other operative descriptions of axillary surgery generally do not adequately describe a method that clearly and consistently identifies the boundaries, anatomical landmarks and neurovascular structures that traverse the axilla. This technique, with relative ease, allows the identification and preservation of these structures in their original anatomical planes and avoids the division of the pectoralis minor muscle. The assumption that routine level III axillary clearance, as opposed to level I or level II dissection, is associated with greater morbidity warrants further evaluation. No well‐conducted randomized trials have addressed this issue.</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="n-fnt-1" numbered="no"><p> <span xml:id="fn1"><b>O. Ung</b> MB BS, FRACS</span>; <span xml:id="fn2"><b>M. Tan</b> MB BS (S’pore) FRCS (Edin)</span>; <span xml:id="fn3"><b>B. Chua</b> MB BS, PhD, FRANZCR</span>; <span xml:id="fn4"><b>B. Barraclough</b> MB BS, FRACS.</span></p></note><note xml:id="fn5"><label>‡</label><p>Present address: MammoCare, The Breast Clinic and Surgery, 290 Orchard Road, #07‐09 Paragon, Singapore 238859.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>COMPLETE AXILLARY DISSECTION: A TECHNIQUE THAT STILL HAS RELEVANCE IN CONTEMPORARY MANAGEMENT OF BREAST CANCER</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>COMPLETE AXILLARY DISSECTION: A TECHNIQUE THAT STILL HAS RELEVANCE IN CONTEMPORARY MANAGEMENT OF BREAST CANCER</title></titleInfo><name type="personal"><namePart type="given">Owen</namePart><namePart type="family">Ung</namePart><affiliation>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</affiliation><affiliation>E-mail: owenung@bigpond.com</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mona</namePart><namePart type="family">Tan</namePart><affiliation>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</affiliation><description>Note: </description><description>Present address: MammoCare, The Breast Clinic and Surgery, 290 Orchard Road, #07‐09 Paragon, Singapore 238859.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Boon</namePart><namePart type="family">Chua</namePart><affiliation>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bruce</namePart><namePart type="family">Barraclough</namePart><affiliation>* New South Wales Breast Cancer Institute, Westmead Hospital , and † Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Asia</publisher><place><placeTerm type="text">Melbourne, Australia</placeTerm></place><dateIssued encoding="w3cdtf">2006-06</dateIssued><edition>Accepted for publication 20 November 2005.</edition><copyrightDate encoding="w3cdtf">2006</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">2</extent><extent unit="references">23</extent></physicalDescription><abstract lang="en">Axillary lymph node status is an important prognostic indicator for women with breast cancer and axillary dissection provides accurate information regarding nodal status. In addition, local control of axillary disease and allocation of adjuvant systemic therapy are dependent on appropriate axillary surgery. The survival benefit of an axillary dissection remains controversial. We describe a technique of complete axillary clearance that includes levels I, II and III. In our experience this technique is associated with no additional morbidity to patients and incurs minimal prolongation of operative time compared with a level II dissection. Other operative descriptions of axillary surgery generally do not adequately describe a method that clearly and consistently identifies the boundaries, anatomical landmarks and neurovascular structures that traverse the axilla. This technique, with relative ease, allows the identification and preservation of these structures in their original anatomical planes and avoids the division of the pectoralis minor muscle. The assumption that routine level III axillary clearance, as opposed to level I or level II dissection, is associated with greater morbidity warrants further evaluation. No well‐conducted randomized trials have addressed this issue.</abstract><subject lang="en"><genre>keywords</genre><topic>axillary clearance</topic><topic>axillary lymph node dissection</topic><topic>breast cancer management</topic><topic>breast surgery</topic><topic>level I–III dissection</topic><topic>sentinel lymph node biopsy</topic></subject><relatedItem type="host"><titleInfo><title>ANZ Journal of Surgery</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1445-1433</identifier><identifier type="eISSN">1445-2197</identifier><identifier type="DOI">10.1111/(ISSN)1445-2197</identifier><identifier type="PublisherID">ANS</identifier><part><date>2006</date><detail type="volume"><caption>vol.</caption><number>76</number></detail><detail type="issue"><caption>no.</caption><number>6</number></detail><extent unit="pages"><start>518</start><end>521</end><total>4</total></extent></part></relatedItem><identifier type="istex">50A493C686FA88C5118FCCA7400F3163C8EFA6FE</identifier><identifier type="DOI">10.1111/j.1445-2197.2006.03765.x</identifier><identifier type="ArticleID">ANS3765</identifier><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Asia</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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