Researchers from Heidelberg University Hospital and the University of Lucerne, along with international scientists, patient representatives, and European cancer societies, actively collaborated to combine scientific data and their expert knowledge on the surgical management of lymph nodes in breast cancer. The objective of the recommendations is to prevent the unnecessary removal of lymph nodes and spare patients from chronic lymphedema. The team has published their findings in the open access journal eClinicalMedicine.

By administering preoperative chemotherapy for breast cancer, medical professionals can effectively reduce the size of tumors and metastatic lymph nodes before performing surgery. This approach has the potential to minimize the need for complete removal of axillary lymph nodes during breast surgery, thereby reducing the risk of distressing side effects like arm lymphedema.

A collaborative consortium of European cancer societies, international medical institutions (including those associated with Heidelberg), and patient representatives actively tackled the complexities associated with managing clinical axillary lymph nodes in early breast cancer cases. Prominent experts participated in voting on crucial matters and devised practical recommendations for implementation in clinical settings.

We developed a total of five work packages that actively follow the patient's journey from diagnosis to local axillary therapy and effectively address specific clinical scenarios.

Professor Dr. Peter Dubsky, head of the Breast Center at the Hirslanden Klinik St. Anna in Lucerne, titular professor at the University of Lucerne and lead investigator of the consortium reports -

"The benefits of preoperative chemotherapy in breast cancer are not always sufficiently realized. Published data describe that mastectomies and complete lymph node removal are still performed too frequently. Reduced surgical removal of lymph nodes is only partially implemented even with good preoperative results."

Dr. André Pfob of Heidelberg University Hospital (UKHD) and joint first author of the publication with Dr. Orit Kaidar - Person of Tel Aviv, Israel further emphasized -

"Removing fewer lymph nodes in the axilla reduces the risk of harming lymphatic drainage from the arm," he said. To complement existing guidelines, the international working group has therefore created a new medical concept with practical recommendations to prevent unnecessary surgical removal of lymph nodes that can be quickly integrated into clinical practice."

During a conference held in Lucerne in September 2022, we successfully achieved unity in a previously contentious debate and actively developed a comprehensive practical guide. Subject matter experts who participated in the conference actively voted on 72 statements, reaching a consensus (with an agreement of 75% or more) in 52.8% of the cases, a majority agreement (ranging from 51% to 74%) in 43.1% of the cases, and no decision in 4.2% of the cases.

Dr. Pfob further added, summarizing the results -

"According to the voting results, imaging and standardized pathology of the lymph nodes should be a prerequisite for planning local and systemic therapy in breast cancer patients. Removal of all axillary lymph nodes could be replaced by targeted removal of a few lymph nodes, such as the sentinel lymph nodes, in the majority of scenarios discussed in the consortium."

The outcome of lymph node surgery has complex implications for subsequent radiation and chemotherapy or hormone therapy. These should be tailored to the individual patient. To actively monitor the effectiveness of the recommendations for each individual woman, we record and evaluate the risk of cancer recurrence and side effects.