Second axillary lymphadenectomy in case of ipsilateral breast cancer recurrence

Background: In case of ipsilateral recurrence, the interest of a new surgery is sure but the interest of a new axillary surgery is not established. A second axillary lymphadenectomy (SAL) was proposed to patients with ipsilateral recurrence in order to check in a surgical way the absence of axillary involvement. The principal objective is to examine the current state of this practice. The secondary objective is to define the rate of nodal involvement concomitant of ipsilateral recurrence. Methods : It is a mono centric retrospective study realized at theToulouse University Cancer Institute-Oncopole (IUCT - Oncopole) included patients with ipsilateral infiltrative breast cancer recurrence with past history of axillary lymphadenectomy from January 2015 to December 2017. Results: 74 patients got an indication of SAL. The mean period between the 1st cancer and recurrence was 19,2 years [2,6-35,2]. At the time of 1st cancer, the mean number of removed nodes was 13 [6-27]. For the pre-operative check-up, 79,7% of the patients had a axillary ultrasound, 75,7% a thoraco-abdomino-pelvic CTscan, and 6,8% a PET-CT. A pre-operative axillary sampling had been performed for 5 patients (6,8%) and 2 patients had a pathologic result. About the surgery, in the operative report, it was noted in 94,6% of the patients an opening of the axillary space, in 54,4% the identification of the anatomic marks. A surgical sample was realized in 64,9% (n=48) of cases. Histologic mean tumoral size was 15mm [0.0: 75.0] with 67,5% of tumors classed as a pT1. For 82,4% (n= 42), it was a no special type carcinoma and 81,7% (n= 58) of tumors was histologic -type luminal (RH+/HER2-). In 47,9% (n= 23) of sampling of SAL, there was no lymph node. The mean number of harvested node was 1 [0-12]. Among the harvested nodes, none was involved. The 2 pre-operative axillary involvements were involvement of lateral upper part of breast. Post-operative complications occurred for 50% (n= 37) of patients : 29,7% (n= 22) had seroma, 10,8%(n= 8) infection, 9,5%(n= 7) delayed wound healing, 4,2%(n= 3) lymphoedema, 4,1%(n= 3) chronic pains. Mean follow-up was 21,1 months (95%CI[14,95;25,20]). Two patients had a nodal recurrence: one axillary, one supraclavicular but both had a synchronous metastatic disease. Conclusion : This cohort confirms the low rate of axillary recurrence after axillary lymphadenectomy. SAL does not show axillary recurrence concomitant to breast recurrence. And it does not provide us information to adapt adjuvant treatment. An optimal pre-operative assessment of axilla should be done to avoid complications of this diagnostic surgery. Citation Format: Gabrielle Selmes, Marine Bachelier, Miassa Hessas, Charlotte Vaysse, Eleonora De Maio, Jean-Louis Lacaze, Mony Ung, Eva Jouve, Florence Dalenc. Second axillary lymphadenectomy in case of ipsilateral breast cancer recurrence [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-18.