EDISCIENCES

ABSTRACT

This historical surgical retrospection shows de-escalation of axil- lary surgery observed in recent decades, focusing on the unceasing efforts of researchers toward new challenges, as documented by extensive studies and trials. Axillary surgery has evolved, aiming to offer the best oncologic treatment and improve the quality of life of women. Axillary lymph-node dissection (ALND) has been re- placed by sentinel lymph- node biopsy (SLNB) in women with early clinically node-negative breast cancer, providing adequate axillary nodal staging information with minimal morbidity, and becoming the standard of care in the management of breast cancer. Systemic and radiotherapeutic treatments have gradually been optimized, offering increasingly re ned and targeted breast cancer treatment tools. Recently, the paradigm of completion ALND after a positive SLNB has been questioned, and several studies have led to rev- olutionary changes in clinical practice. Moreover, the increasingly pivotal role played by neoadjuvant chemotherapy (NAC) has had a profound effect on the extent of axillary surgery, paving the way to a more nite “targeted” procedure in women with node-positive breast cancer who convert to negative nodes clinically after NAC. The utility of SLNB itself and its subsequent omission in women with negative nodes clinically and breast conservative surgery is also under scienti c evaluation. The changes over time in the surgical approach to breast cancer have been numerous and signi cant. The novel emerging perspective characterized by recent advances in biology and genetics, in dedicated axillary ultrasound imaging and chemotherapy regimens, is the present reality that points to the future of axillary node treatment in breast cancer. Finally, we believe that a Multi- Disciplinary Meeting is mandatory to evaluate a tailored therapy for each patient.