Implementation of the Findings from The American College of Surgeons Oncology Group Z0011 Study in Axillary Management in Patients with Invasive Breast Cancer: A Cohort Study in A Brazilian Public University Hospital

Background: To evaluate and compare overall survival and locoregional recurrence between patients with invasive breast tumors and sentinel node metastasis undergoing sentinel lymph node dissection (SLND) alone and those undergoing complete axillary lymph node dissection (ALND). Methods: : In this retrospective cohort study, we reviewed medical records of all consecutive patients with primary invasive breast carcinoma who had undergone conservative surgery at a public university hospital in Brazil between 2008 and 2018. We evaluated the overall survival and the onset of locoregional recurrence using Kaplan-Meier and Cox regression analyses, respectively. Results: : Overall, 97 participants underwent conservative breast surgery, 41 in the ALND group, and 56 in the SLND group. The mean age was 57.8 years. Only 17% of the patients in the ALND group had an additional biopsy-proven axillary disease, and 83% were treated with complete dissection unnecessarily. The 5-year survival rates were 80.1 and 87.5% in the SLND and ALND groups, respectively (p = 0.376). Locoregional recurrence was rare (1.8% and 7.7% in the SLND and ALND groups, respectively; p = 0.196). Intraoperative assessment was performed in 90.2% and 30.8% cases (p < 0.00001) before and after ACOSOG Z0011, respectively. Additionally, a second surgical procedure was performed in 3.8% of cases after ACOSOG Z0011 criteria adoption. Conclusions: : Overall survival and locoregional recurrence were similar between the two groups. The de-escalation of ALND to SLND in women with metastasis in the sentinel lymph node treated with conservative surgery and radiotherapy is feasible even in developing countries.