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(Reuters Health) – For women with early-stage bad cancer, many surgeons recommend significant removal of lymph nodes under the armpits, although recent evidence shows that this is not the case. does not improve survival or recurrence. study found.
Nearly half of the bad cancer surgeons surveyed said they would recommend the procedure, known as axillary lymph node dissection, despite modern recommendations that advise against.
Women have 20 to 40 lymph nodes under their armpits. When cancer surgeons remove an early stage bad tumor, they also remove some "sentinel lymph nodes" because they are the first lymph nodes to which cancer cells are most likely to spread from the initial tumor.
In the past, when sentinel lymph nodes contained cancer cells, surgeons routinely cut most or all of the remaining ganglia to prevent cancer from spreading or reproducing. But based on the most recent evidence, the American Society of Clinical Oncology changed its guidelines in 2014 to say that women with one or two positive sentinel lymph nodes who are planning to have a lumpectomy plus radiation may 39 do not need axillary surgery of the knot.
"Breast cancers are unlikely to have multiple lymph nodes, so removal of sentinel lymph nodes removes most of the cancer in the lymph nodes," said lead author of the new study, Dr. Monica Morrow. at the Memorial Sloan Kettering Cancer Center in New York.
"Studies have shown that any cancer remaining in the lymph nodes is treated with standard radiation (conservative bad surgery) and pharmacotherapy (chemotherapy and / or hormone therapy) that is part of the management of" women with cancer in one or two sentinel nodes, Morrow said by email.
The study team interviewed 376 bad surgeons about how they would treat women with tumors that progressed to one or two sentinel lymph nodes.
Forty-nine percent of surgeons said that they would definitely or probably dissect axillary lymph nodes if women had cancer in a single sentinel node. And 63% had the same approach when women had cancer cells in two sentinel lymph nodes.
Surgeons who did more bad cancer procedures were less likely to advise women with early-stage tumors to get all axillary nodes removed, the researchers report in JAMA Oncology.
Axillary lymph node dissection can lead to persistent problems, including an inflated arm, stiffness or disturbances of arm or shoulder movement, and changes in sensation, such as pain or lightheadedness. numbness.
The approach of not removing all lymph nodes only applies to women who do not have suspicious lymph nodes at the physical examination, which provide treatment with lumpectomy and radiotherapy and who did not receive preoperative chemotherapy.
For these women, "if the surgeon says that he will remove the sentinel lymph nodes, examine them under the microscope during surgery and proceed directly to the complete removal of the lymph nodes if cancer cells are present , a second opinion on the necessity as this should be obtained from another surgeon, "advised Mr. Morrow.
One of the limitations of the study is that the researchers only questioned that Surgeons in the state of Georgia and in the city of Los Angeles, and that the models of practice could be different elsewhere, acknowledge the researchers.It is also not known whether the responses of surgeons reflect what is wrong. they would do in the operating room.
Nevertheless, the findings bring new evidence that new therapeutic strategies are not always immediately adopted, "said Dr. Benjamin Anderson, author of an accompanying editorial and professor of surgery and global health at the University of Washington in Seattle.
"Sometimes there is skepticism that new studies are correct," Anderson said by email. "Other times, surgeons may not be fully informed, especially when it comes to doing less than doing more."
Long-term evidence suggests that advanced tumors with large amounts of cancer in the lymph nodes require a tumor may be more than radiation and drug therapy can control, Anderson said. The most recent studies show that when the amount of disease in the ganglia is minimal and microscopic, surgical removal is not necessary as long as radiotherapy and drug treatments are given.
"The point where we can move away from the surgical removal of cancer in the ganglia is what we are studying today," said Mr. Anderson. "The goal is to do less when it's safe to do it."
SOURCE: bit.ly/2v4Jbtj and bit.ly/2LEMDoP JAMA Oncology, online July 12, 2018.
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