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PubMed2003

Squamous cell carcinoma of the lower lip and supra-omohyoid neck dissection.

PURPOSE: The aim of this study is to evaluate our approach to patients with squamous cell carcinoma of lower lip. PATIENTS AND METHODS: This study includes 31 lower lip squamous cell carcinomas followed up between 1994 and 2000. Primary treatment was applied to 28 patients of whom 23 were in stages I-II and five in stages III-IV. Three patients presented locoregional recurrence. Neck dissection was performed during primary lip resection in patients with palpable cervical lymph node involvement. Patients with unpalpable cervical lymph nodes were divided into two subgroups: one was submitted to elective neck dissection (n = 11) and the other had isolated lip resection (n = 8). Unilateral or bilateral selective supra-omohyoid neck dissection (SOHND) was performed according to the localisation of the disease. Radical dissection was performed in a secondary intervention, when SOHND revealed lymph node metastases. Radiotherapy and chemotherapy were applied for curative and/or adjuvant treatment in addition to surgery in patients with locoregional recurrence and metastatic lymph nodes or with perineural involvement. RESULTS: Occult cervical metastasis within a single lymph node was found in one of the 11 No patients who underwent elective neck dissection. Delayed neck metastasis developed in one of the eight patients in whom isolated lip resection (without neck exploration) was performed. Chemoradiotherapy was administered to this patient, but he died. Neck metastasis was established histologically in four of five patients in stages III-IV. Postoperative radiotherapy was used on these patients. One of the patients in this group died due to inoperable local recurrence in the neck, another died because of distant metastasis. Local mandibular recurrence was seen in one of these patients after three years. COMMENT: Six patients (19%) died due to lower lip carcinoma in this series. Our findings show the importance of elective neck dissection and intact surgical resection margins.

Adult↗

PubMed2005

Colon dissection: a new three-dimensional reconstruction tool for computed tomography colonography.

PURPOSE: To improve the sensitivity of computed tomography (CT) colonography in the detection of polyps by comparing the 3D reconstruction tool "colon dissection" and endoluminal view (virtual colonoscopy) with axial 2D reconstructions. MATERIAL AND METHODS: Forty-eight patients (22 M, 26 F, mean age 57 +/- 21) were studied after intra-anal air insufflation in the supine and prone positions using a 16-slice helical CT (16 x 0.625 mm, pitch 1.7; detector rotation time 0.5 s; 160 mAs und 120 kV) and conventional colonoscopy. Two radiologists blinded to the results of the conventional colonoscopy analyzed the 3D reconstruction in virtual-endoscopy mode, in colon-dissection mode, and axial 2D slices. RESULTS: Conventional colonoscopy revealed a total of 35 polyps in 15 patients; 33 polyps were disclosed by CT methods. Sensitivity and specificity for detecting colon polyps were 94% and 94%, respectively, when using the "colon dissection", 89% and 94% when using "virtual endoscopy", and 62% and 100% when using axial 2D reconstruction. Sensitivity in relation to the diameter of colon polyps with "colon dissection", "virtual colonoscopy", and axial 2D-slices was: polyps with a diameter >5.0 mm, 100%, 100%, and 71%, respectively; polyps with a diameter of between 3 and 4.9 mm, 92%, 85%, and 46%; and polyps with a diameter < 3 mm, 89%, 78%, and 56%. The difference between "virtual endoscopy" and "colon dissection" in diagnosing polyps up to 4.9 mm in diameter was statistically significant. CONCLUSION: 3D reconstruction software "colon dissection" improves sensitivity of CT colonography compared with the endoluminal view.

Colon↗

PubMed2001

Superficial inguinal and radical ilioinguinal lymph node dissection in patients with palpable melanoma metastases to the groin--an analysis of survival and local recurrence.

The present study addresses the question whether an extended ilioinguinal dissection as compared to an only superficial inguinal dissection improves survival and/or local tumour control after the appearance of palpable melanoma metastases to the groin. We retrospectively analysed the data of 104 patients with 69 ilioinguinal and 35 superficial inguinal dissections (median follow up 127 months). Prognostic factors of survival and groin recurrence were assessed using Kaplan-Meier estimation and Cox proportional hazards model. By multifactorial analysis, metastatic involvement of two lymph nodes or less was associated with a significantly better survival rate than involvement of > 2 or pelvic nodes (p = 0.0002). After radical ilioinguinal dissection, patients with extremity-located primaries had a better prognosis than patients with truncal primaries (p = 0.03). Tumour infiltration of the ilio-obturator compartment was found to be an independent factor of poor prognosis (p = 0.0009). The probability of recurrence in the dissected groin paralleled the number of positive nodes and significantly increased if intransits were observed (p = 0.0002). The extent of surgery, Breslow thickness, epidermal ulceration, sex, age and adjuvant chemotherapy neither significantly influenced survival nor local control rates. In summary, when metastatic inguinal nodes become palpable, the presence of pelvic metastases indicates systemic disease. After therapeutic groin dissection, local recurrence and survival depend rather on regional tumour burden than on the extent of surgery.

Female↗

PubMed2000

Is extended lymph node dissection necessary for gastric cancer in elderly patients?

OBJECTIVE: To compare the outcome after limited and extended gastric resections to find out whether extended lymph node dissection is indicated for gastric cancer in elderly patients. DESIGN: Retrospective study. SETTING: University hospital, Japan. SUBJECTS: 182 patients over 75 years of age with gastric cancer who had gastric resections from 1980 to 1995. INTERVENTIONS: 161 patients had limited lymph node dissection (limited group) and 21 had extended lymph node dissection (extended group). MAIN OUTCOME MEASURES: Histopathological features, morbidity, mortality, and long-term survival. RESULTS: Postoperative morbidity was 27% (n = 44) in the limited group and 57% (n = 12) in the extended group, and postoperative mortality was 1% (n = 2) in the limited group and 10% (n = 2) in the extended group; these differences are significant (p = 0.005 and p = 0.002). The 5-year survival did not differ significantly between the two groups. Only the T classification and presence of lymph node metastases had a significant influence on the outcome of gastric cancer in elderly patients. CONCLUSIONS: The presence of lymph node metastases is a critical factor in the prognosis of gastric cancer, and extended lymph node dissection has therefore been recommended. However, extended lymph node dissection in elderly patients did not influence the 5-year survival; in addition, the mortality and morbidity in the extended group were higher than in the limited group. Extended lymph node dissection is therefore usually not indicated for gastric cancer in elderly patients.

Gastrectomy↗

PubMed1993

Comparison of results of KTP/532 laser versus monopolar electrosurgical dissection in laparoscopic cholecystectomy.

A total of 641 laparoscopic cholecystectomies performed between January 1, 1991 and December 31, 1991 were reviewed to compare the results of Potassium Titanyl Phosphate (KTP/532) laser versus monopolar electrosurgery in laparoscopic cholecystectomy. KTP laser dissection was used alone in 199 cases (31%), and monopolar cautery was used in 442 (69%). During this same time period, 41 additional procedures were excluded because of conversion to open cholecystectomy. Procedures in which both modalities (N = 24) were used were also excluded from the study. Modality choice was dependent upon operating surgeon's preference. Data were analyzed with student t-test, chi-square with Yates correction, stepwise linear regression analysis, and correlation matrices. Five (2.5%) patients had five major complications when KTP laser dissection was used and 34 (7.7%) patients had 42 major complications when monopolar electrosurgical dissection was used (p < 0.05). Postoperative hospital stay with the KTP/532 laser dissection group was 1.4 +/- 0.06 days and for the monopolar electrosurgical dissection group it was 1.7 +/- 0.08 days (p < 0.05). The duration of the procedures was identical with either modality. The use of the KTP laser for dissection of the gallbladder during laparoscopic cholecystectomy may be a safer procedure with significantly decreased complication rates and savings in length of hospital stay. Although initially a more expensive procedure, the savings in length of hospital stay and treatment of complications may offset the initial expenditure and be worthwhile.

Cholecystectomy, Laparoscopic↗

PubMed1992

The concept of lymph node dissections in patients with malignant melanoma.

Therapeutic lymph node dissections in patients with grossly palpable metastatic melanoma are performed to control regional disease, to salvage a small percentage of patients, and to obtain staging information. Patients with malignant melanoma may undergo elective lymph node dissections, when the basin is clinically negative, for three reasons. There is some evidence based on large retrospective studies that survival is increased in patients with intermediate thickness melanoma if elective lymph node dissections are performed as part of the initial treatment of the primary melanoma. Second, in a small percentage of patients, a previous elective lymph node dissection may have helped control disease in the regional lymphatics, so that more extensive procedures, including amputations, are not necessary. Another important reason is to obtain staging and prognostic information for the patient because most adjuvant protocols are based on the presence or absence of disease in the regional basin. During a 3-year period, 115 patients have undergone a regional nodal dissection at the Moffitt Cancer Center and James Haley VA Hospital as part of their surgical treatment. With a follow-up of 3 years, patients with 1 node positive do significantly better than those with more than 1 node positive in their dissection (p = 0.06). The percentage of nodes positive is also important. Those patients who have less than 10% of their nodes involved with metastatic melanoma have a better survival than those patients whose percentage is greater than 10% (p = 0.07).

Adolescent↗

PubMed1999

Complications of level I and II axillary dissection in the treatment of carcinoma of the breast.

OBJECTIVE: To assess the complications of level I and II axillary lymph node dissection in the treatment of stage I and II breast cancer, with breast-conservation surgery and mastectomy. SUMMARY BACKGROUND DATA: The role of axillary dissection for staging, and as an effective means of controlling regional nodal disease, has long been recognized. As small and low-grade lesions have been detected more frequently, and as its therapeutic impact has been questioned, axillary dissection has increasingly been perceived as associated with significant complications. METHODS: Two hundred patients, 112 of whom had breast-conservation surgery with axillary dissection and 88 of whom had total mastectomy with axillary dissection, were evaluated 1 year or more after surgery for arm swelling as well as nonedema complications. All patients had arm circumference measurements at the same four sites on both the operated and nonoperated sides. RESULTS: No patient had an axillary recurrence. The mean difference in circumference on the nonoperated versus operated side was 0.425 cm +/- 1.39 at the midbiceps (p < 0.001), 0.315 cm +/- 1.27 at the antecubital fossa (p < 0.001), 0.355 cm +/- 1.53 at the midforearm (p < 0.005), and 0.055 cm +/- 0.75 at the wrist (n.s.). Seven patients (3.5%) had mild swelling of the hand. Heavy and obese body habitus were the only significant predictors of edema on multivariate analysis. One hundred fifty-three (76.5%) patients had numbness or paresthesias of the medial arm and/or axilla after surgery; in 125 (82%) of these, the problem had lessened or had resolved on follow-up assessment. CONCLUSIONS: The characterization of a level I and II axillary dissection as a procedure with significant complications does not appear justified based on this experience.

Adult↗

PubMed2000

Controlling advanced neck disease: efficacy of neck dissection and radiotherapy.

OBJECTIVE: Neck dissection remains the standard method of treating cervical metastasis from head and neck squamous cell carcinoma. In light of recent trends to modify the classic radical neck dissection (RND) for early neck disease, we reviewed our experience with radical and modified RND (MRND) plus radiotherapy as treatment for N2/N3 neck disease in head and neck squamous cell carcinoma. METHODS: We retrospectively reviewed our clinical records from July 1989 to June 1996 to identify 43 neck dissections in 39 patients who were found to have pathologically N2 or N3 neck disease treated primarily by neck dissection and postoperative radiotherapy. All patients had head and neck squamous cell carcinoma with a minimum follow-up of 24 months. RESULTS: Nine percent (4/43) of the dissected necks were pathologically N2a, 72% (31/43) were N2b, 7% (3/43) were N2c, and 12% (5/43) were N3. Of these, 28% (12/43) underwent a RND and 72% (31/43) underwent a MRND. The most common modification of RND was preservation of the spinal accessory nerve. All patients underwent postoperative radiotherapy with a mean dose of 55 Gy. Only 4 of 43 dissected necks had isolated treatment failure, for a regional control rate of 91%. CONCLUSIONS: The combination of RND or MRND and radiotherapy is highly effective in controlling neck disease in the absence of persistent or recurrent local disease. Also, in our experience, MRND appears to be as effective as RND in controlling even advanced neck disease, which supports preservation of the spinal accessory nerve whenever oncologically feasible.

Carcinoma, Squamous Cell↗

PubMed2002

Elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck: analysis of 1444 patients from 1970 to 1998.

OBJECTIVE: The purpose of this article is to evaluate the effects on survival, disease-free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck. STUDY DESIGN AND METHODS: A retrospective computer-aided analysis was performed comparing 1444 patients treated from 1970 to 1998 at Duke University Medical Center. A total of 446 of the 1444 (32%) of patients with head and neck melanoma underwent some form of lymph node dissection. Survival, disease-free interval, and recurrence rates for patients having 1) no initial lymph node dissection (no LND), 2) elective lymph node dissection (ELND) within 2 months of date of diagnosis, 3) therapeutic lymph node dissection (TLND) for metastatic regional disease at diagnosis, or 4) delayed lymph node dissection (DLND) for patients developing regional lymph node metastasis later than 3 months from the date of diagnosis were compared. RESULTS: A total of 246 patients undergoing ELND demonstrated 11% with occult disease. DLND for regional lymph node recurrence was reported at a median time interval of 1.2 years from diagnosis. Multivariate analysis indicated a significant improvement in survival for DLND when compared with patients undergoing ELND plus sign in circle or TLND (P =.01). Distant metastasis was the site of first recurrence in 12% of patients undergoing no initial LND. Five-year survival after DLND and TLND was 56% and 36%, respectively. CONCLUSION: Patients undergoing DLND had an overall better survival than patients undergoing TLND or ELND with positive nodes. The progression of metastatic disease following regional node disease occurred in 35% to 45% of cases, underscoring the need for effective adjunctive therapy.

Adult↗

PubMed2003

Arteriovenous crossing dissection without separation of the retina vessels for treatment of branch retinal vein occlusion.

PURPOSE: To evaluate visual outcome after arteriovenous (AV) crossing dissection for the treatment of branch retinal vein occlusion (BRVO) and secondary macular dysfunction in which difficulty separating the retinal vessels was experienced. METHODS: A pars plana vitrectomy and dissection of the involved AV crossing site were performed consecutively in 20 eyes of 20 patients with BRVO and vision loss. The overlying retinal artery was dissected free from the retinal surface, and separation of the artery and vein at the crossing site was attempted. RESULTS: In 19 of 20 eyes, the retinal artery was dissected around the crossing site, but a marked adhesion between the artery and vein precluded separation. After a mean follow-up of 10.5 months, VA improved by at least two lines in 16 eyes (80%), remained unchanged in three eyes (10%), and worsened by at least two lines in three eyes (10%). Mean change (+/- SE) in logMAR acuity was -0.28 +/- 0.11 (two or three lines of improvement, P = 0.016) at 1 to 2 months' follow-up and -0.44 +/- 0.14 (three or four lines of improvement, P = 0.008) at the final follow-up. Cataract formation or progression occurred in 88%. CONCLUSIONS: A surgically important adhesion between the retinal artery and vein at proximal AV crossings was encountered in all eyes undergoing AV crossing dissection, correlating with previous histologic and cadaver eye studies. Cataract formation or worsening was a frequent complication. Visual improvement may occur after vitrectomy and AV crossing dissection without separation of the retinal vessels.

Adult↗

PubMed2006

Laser bleb reduction for bleb dissection with krypton green laser: technique and outcomes.

PURPOSE: Lasers have been used to treat dysfunctional blebs, but the laser remodeling of blebs that dissect into the palpebral fissure has not been reported. We describe the unique use of krypton green laser to treat dissected blebs and discuss treatment outcomes. PATIENTS AND METHODS: Retrospective review of consecutive patients undergoing laser bleb reductions (LBRs) over a 6-year period. Failure was defined as persistent dissection and/or symptoms or loss of intraocular pressure (IOP) control despite medications. RESULTS: Sixteen patients underwent a total of 23 LBRs and were followed-up for a mean of 12.4 months (median = 9.5 mo). Ten patients (63%) were treated successfully, and 6 patients (37%) failed treatment. Persistent dissection and/or symptoms were the most common reasons for failure (5/6), whereas 1 patient lost IOP control. Three (30%) of those treated successfully required the reintroduction of ocular hypotensive medications for pressure control. The mean IOP increased from 9.1 +/- 5.2 mm Hg before treatment to 11.7 +/- 8.1 mm Hg after treatment (P = 0.02). Common complications included intraoperative discomfort (26%), conjunctival injection (22%), postoperative discomfort (13%), and dissection into the untreated side (9%). In the failure group, more laser spots (P = 0.05) and higher power levels (P = 0.00001) were used. CONCLUSIONS: Krypton LBR may be a useful initial treatment modality for symptomatic bleb dissection. Success rates may be modest, but most adverse effects are mild and/or transient; however, significant loss of IOP control can occasionally occur.

Aged↗

PubMed2004

Lymphedema after complete axillary node dissection for melanoma: assessment using a new, objective definition.

OBJECTIVES: The objectives of this study were to define appropriate criteria for assessing the presence of lymphedema, and to report the prevalence and risk factors for development of upper limb lymphedema after level I-III axillary dissection for melanoma. SUMMARY BACKGROUND DATA: The lack of a consistent and reliable objective definition for lymphedema remains a significant barrier to appreciating its prevalence after axillary dissection for melanoma (or breast carcinoma). METHODS: Lymphedema was assessed in 107 patients (82 male, 25 female) who had previously undergone complete level I-III axillary dissection. Of the 107 patients, 17 had also received postoperative axillary radiotherapy. Arm volume was measured using a water displacement technique. Change in volume of the arm on the side of the dissection was referenced to the volume of the other (control) arm. Volume measurements were corrected for the effect of handedness using corrections derived from a control group. Classification and regression tree (CART) analysis was used to determine a threshold fractional arm volume increase above which volume changes were considered to indicate lymphedema. RESULTS: Based on the CART analysis results, lymphedema was defined as an increase in arm volume greater than 16% of the volume of the control arm. Using this definition, lymphedema prevalence for patients in the present study was 10% after complete level I-III axillary dissection for melanoma and 53% after additional axillary radiotherapy. Radiotherapy and wound complications were independent risk factors for the development of lymphedema. CONCLUSIONS: A suggested objective definition for arm lymphedema after axillary dissection is an arm volume increase of greater than 16% of the volume of the control arm.

Adult↗

PubMed2007

Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection.

OBJECTIVE: To identify the parameters related to the effective selection of patients who could receive prognostic benefit from lateral pelvic node dissection. BACKGROUND: Accurate preoperative diagnosis of lateral nodal involvement (LNI) remains difficult, and the indications for lateral lymph node dissection have been controversial. PATIENTS AND METHODS: A total of 244 consecutive patients who underwent potentially curative surgery with lateral dissection for advanced lower rectal cancer (1985-2000) were reviewed. Patients were stratified into groups based on various parameters, and the therapeutic value index for survival benefit was compared among groups. The therapeutic index of lateral dissection was calculated by multiplying the frequency of metastasis to the lateral area and the cancer-related 5-year survival rate of patients with metastasis to the lateral area, irrespective of metastasis to other areas (mesorectal, superior rectal artery [SRA], and inferior mesenteric artery [IMA] areas). RESULTS: LNI was observed in 41 patients (17%); and 88% of them had nodal involvement in the region along the internal iliac/pudendal artery or in the obturator region ("vulnerable field"). The cancer-related 5-year survival rate among the patients with LNI was 42%; the therapeutic index for lateral dissection was calculated as 7.0 patients, which was much higher than that of lymphadenectomy of the SRA area (1.6 patients) and the IMA area (0.4 patients), and almost comparable to that of lymphadenectomy of the upward mesorectal area (6.9 patients). Although it was possible to select groups at high and low risk for LNI based on several parameters related to tumor aggressiveness, such as tumor differentiation in biopsy specimens, the therapeutic value index was not significantly different between these groups. Unlike these parameters, the diameter of the largest lymph node in the "vulnerable field," which was positively correlated with the rate of LNI but irrelevant to the prognosis, was able to successfully stratify patients by therapeutic index. CONCLUSIONS: Advanced lower rectal cancer patients having LNI in the lateral pelvic area are likely to receive prognostic benefit from lymphadenectomy. The most efficient means of determining the effectiveness of lateral dissection preoperatively is to estimate the nodal diameter in the "vulnerable" lateral regions by diagnostic imaging.

Disease-Free Survival↗

PubMed1992

Laparoscopic pelvic lymph node dissection for carcinoma of the prostate and bladder.

Improvements in instruments and camera systems have allowed the development of operative techniques for laparoscopic pelvic lymph node dissection. A series of dissections in 20 patients is reported. The mean operation time was 1 h and 40 min. When the nodes appeared malignant, a node biopsy was sent for frozen section. If this was positive, the dissection went no further. In three patients it was necessary to complete the operation by open surgery. A mean number of five lymph nodes was dissected per side. After laparoscopic dissection, all patients were discharged the morning after surgery. The operation is possible without making great demands on hospital bed occupancy and the patient has a comfortable and speedy return to normal activity. Using laparoscopic techniques, node dissection becomes a more appealing option as an investigation and staging procedure.

Carcinoma↗

PubMed1991

Outcome of extensive coronary artery dissection during coronary angioplasty.

A total of 32 (3.6%) patients of 880 undergoing coronary angioplasty during a nine year period at one hospital had extensive dissection (defined as a dissection extending beyond the limits of the dilated angioplasty balloon) in the coronary artery in which the angioplasty procedure was performed. Two (6.25%) of the 32 patients (both of whom were undergoing angioplasty because of unstable angina that was refractory to medical treatment) died as a consequence of the coronary artery dissection. Twelve (38%) needed immediate coronary artery bypass surgery and 11 (34%) had a myocardial infarction, which in four was minor in extent. During follow up, 20 of the 32 patients were successfully managed by medical treatment; only two needed further angioplasty procedures. There were no late deaths. Extensive coronary artery dissection is a serious complication of coronary angioplasty, with a high early mortality and a high incidence of infarction and requirement for bypass surgery. None the less, patients with extensive dissection who are free from the manifestations of acute ischaemia at the end of the procedure can be managed conservatively and have a good immediate and medium term outlook. Attempts should be made to stabilise extensive dissection during coronary angioplasty so that surgical intervention can be delayed or avoided altogether if possible.

Adult↗

PubMed1985

Fatal intracranial arterial dissection: clinical pathological correlation.

The clinical pathological features of fatal arterial dissection confined to the intracranial vessels are described. Three patients with anterior circulation dissections presented with focal ischaemic neurological deficits and pathological examination of involved vessels revealed a dissection plane between internal elastic lamina and media accompanied by intravascular thrombosis. Three of four patients with posterior circulation dissections had clinical pathological features of subarachnoid haemorrhage and at necropsy had transmural dissections. In contrast to previous reports, primary vasculopathies either degenerative or inflammatory were not identified in affected vessels. The pathogenesis of intracranial arterial dissection is discussed and the clinical features are correlated with the pathological abnormalities.

Adolescent↗

PubMed1977

Dissecting hematoma of the aorta secondary to blunt chest trauma.

Two types of dissecting aortic hematoma occasionally follow blunt chest trauma. Localized subadventitial dissecting may occasionally accompany aortic laceration or transection. This subadventitial hematoma may itself rupture, or it may compress the true aortic lumen. In the presence of arteriosclerosis, classical (medial) dissecting hematoma may occur following blunt trauma. The trauma may be considerably less than that required to cause aortic rupture. Differentiation of the two forms may have practical significance. The treatment of aortic laceration is surgical repair, whether or not there is an associated subadventitial dissection. However, medial dissection following trauma is indistinguishable from spontaneous aortic dissection, and medical therapy may sometimes be the preferred method of treatment.

Adolescent↗

PubMed1995

Omission of axillary lymph node dissection in early-stage breast cancer: effect on treatment outcome.

PURPOSE: To determine the effect omission of axillary lymph node dissection has on outcome in patients treated with breast-conserving therapy for early-stage invasive breast cancer. MATERIALS AND METHODS: The authors evaluated 492 patients with breast cancer treated with (n = 32) and without (n = 456) axillary lymph node dissection. The primary tumor characteristics of the two groups were similar, though the median age was different. All patients received whole-breast radiation (mean dose, 50 Gy); additional tumor bed boosts and nodal irradiation were used more often in patients without dissection. RESULTS: Median follow-up in patients without and with dissection was 60 and 52 months, respectively. The 5-year survival was 88% and 93%, respectively. There were no regional failures in the group treated without dissection. Crude rates of local and distant failure were similar for both groups. CONCLUSION: Omission of axillary lymph node dissection should be considered in patients whose pathologic nodal status will not influence decisions regarding adjuvant therapy.

Adult↗