Dottorato in TECNOLOGIE AVANZATE IN CHIRURGIA

Titolo della tesi: Tecnologia Avanzata SeRAD: Selective Radioassisted Axillary Dissection nelle pazienti operate per carcinoma della mammella localmente avanzato in risposta dopo trattamento neoadiuvante.

OBJECTIVES: Single-center retrospective analysis with a long follow-up to evaluate rates of axillary recurrence, Disease Free Survival (DFS), complications and re-interventions in clinically lymph node positive breast cancer patients who underwent innovative Selective Radioassisted Axillary Dissection (SeRAD) or Sentinel lymph node biopsy (SLNB) or complete axillary lymph node dissection (ALND) after neoadjuvant treatment. METHODS: we retrospectively enrolled locally advanced breast cancer patients submitted to neoadjuvant chemotherapy followed by surgery. Main inclusion criteria were age ≥ 18 years, histologically confirmed breast cancer with clinically positive axillary lymph nodes; no distant lesions, no previous radiation on chest and axilla, no previous surgery on axilla. SLNB removed sentinel and parasentinel lymph nodes (maximum three nodes) capturing the radioactive tracer. SeRAD consisted of the removal of at least four up to a maximum of nine lymph nodes, capturing the radioactive tracer. ALND included removal of at least ten axillary lymph nodes (levels I-II). RESULTS: 114 patients were included in the analysis. At the axillary level, 52 patients (46%) were treated with ALND, 42 patients (37%) were treated with SeRAD and finally 20 patients (17%) with SNLB. At a mean follow-up of 66 months (range 25-107 months), relapse of disease was observed in 28 patients: 5 in the group who received SNLB, 8 in the SeRAD group and finally 15 in the group treated with ALND. 7 patients had an axillary recurrence, all these patients have previously received ALND. At 5 years, 70% (p-value = 0.12) of patients in the SNLB group, 84% (p-value = 0.05) in the SeRAD group and 87% (p-value = 0.05) in ALND group are disease-free. The DFS is positively influenced by the achievement of the pRC (p-value = 0.032). 15 patients presented post-surgery complications: 13 patients belonging to ALND group, 1 patient who received SeRAD technique and finally 1 patient from the SNLB group. This difference is statistically significant (p-value = 0.003). Lymphedema appeared in 13 patients (11.4% of the entire sample), 12 belonged to the group treated with ALND and 1 to the SeRAD group (p-value = 0.02). CONCLUSIONS: In our analysis, SeRAD is a feasible and safe procedure in patients affected by locally advanced breast cancer who underwent neoadjuvant treatment with clinically positive axillary nodes at diagnosis. These results, albeit initial and limited, represent an opportunity for an evolution in the field of cancer surgery, further studies can confirm this new strategy. This technique aims to reduce the extent of surgery at axillary level and the risk of postoperative complications, while preserving excellent oncological results in terms of disease-free survival and long-term quality of life.