Randomized clinical trial comparing level II and level III axillary node dissection in addition to mastectomy for breast cancer

Authors: Tominaga T.; Takashima S.; Danno M.

Source: British Journal of Surgery, Volume 91, Number 1, January 2004 , pp. 38-43(6)

Publisher: John Wiley & Sons, Ltd.

Abstract:

Background:

In addition to mastectomy, level II and level III axillary node dissection procedures are performed widely in Japan. A randomized clinical trial was performed to determine which procedure was more effective.

Methods:

One group of women had resection of the pectoralis minor muscle and dissection of level I, II and III axillary lymph nodes (level III dissection). In a second group, the pectoralis minor muscle was left intact and level III axillary lymph node dissection was not performed (level II dissection). A total of 1209 women with stage II breast cancer were enrolled in the study and randomly assigned to one of the two groups.

Results:

The 10-year cumulative survival rate was 86·6 per cent after level II and 85·7 per cent after level III axillary dissection (hazard ratio (HR) 1·02; P = 0·931, log rank test). The 10-year disease-free survival rate was 73·3 and 77·8 per cent respectively (HR 0·94, P = 0·666). Overall survival and disease-free survival rates in the two groups were similar after both procedures. The duration of surgery was significantly shorter (P < 0·001) and blood loss was significantly less (P = 0·001) after level II dissection. In a survey of patients' symptoms on follow-up, no significant differences were found between the two procedures.

Conclusion:

The addition of pectoralis minor muscle resection and level III axillary lymph node dissection to mastectomy for stage II breast cancer did not improve overall or disease-free survival rates. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Document Type: Research article

DOI: http://dx.doi.org/10.1002/bjs.4372

Affiliations: 1: Breast Cancer Centre, Toyosu Hospital, Showa University School of Medicine, 4-1-18 Toyosu, Koutou-ku, Tokyo 135-8577, Japan

Publication date: 2004-01-01

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