In the surgical treatment of breast cancer, "de-escalating" is becoming more popular, especially in the treatment of axilla. Axillary sentinel lymph node biopsy has become a routine treatment for axillary-negative breast cancer patients because it can effectively reduce the occurrence of upper limb lymphedema, so that some patients with sentinel lymph node negative can be exempted from axillary lymph node dissection. However, in recent years, several international clinical studies, such as AMAROS trial, explored the use of radiotherapy instead of dissection when 1 to 2 sentinel lymph nodes were positive. The results showed that radiotherapy can reduce the incidence of upper limb edema by nearly 50% compared with dissection. How to interpret the results of such non-inferiority studies, and how to treat the impact of axillary dissection and axillary radiotherapy on the occurrence of lymphedema? Based on the review of literature in recent 10 years, the incidence and hazard ratio of edema related to the two axillary treatments were compared. The conclusion is the hazard ratios are close to each other, around 3 for both arms. The results of clinical studies such as radiotherapy instead of axillary dissection need to be carefully interpreted. At the same time, axillary dissection is still suitable for some patients at current stage, and the corresponding prevention of upper limb lymphedema still needs attention.
乳腺癌外科治疗尤其是腋窝处理方式中的"减法"理念日益获得关注和实践。腋窝前哨淋巴结活检因可有效降低上肢淋巴水肿的发生，成为临床腋窝阴性乳腺癌患者的常规处理方式，部分前哨淋巴结阴性的患者得以免除腋窝淋巴结清扫。近年来几项国际临床研究聚焦于当前哨淋巴结1~2枚阳性时以放疗代替清扫，结果显示，放疗相较于清扫可以将上肢水肿发生率降低近50%。为了理性解读上述非劣效性研究结果，正确看待腋窝淋巴结清扫和腋窝放疗对上肢淋巴水肿发生的影响，本文在复习近10年来相关文献的基础上，比较分析了两种腋窝处理方式的水肿发生率及风险比，结果显示二者接近，风险比约为3。对于以放疗取代腋窝淋巴结清扫的临床研究结果尚需审慎解读。腋窝淋巴结清扫在现阶段依然适用于部分患者，相应的上肢淋巴水肿的预防也依然需要给予关注。.
Keywords: Axilla; Breast neoplasms; Lymph node excision; Lymphedema; Radiotherapy; Sentinel lymph node biopsy.