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    Level I-II vs III axillary dissection
    (Springer International Publishing, 2021) Atalay, Can; Mersin, Hakan; Kurukahvecioglu, Osman
    Surgery targeting the axilla in the treatment of breast cancer has changed in the last few decades from more radical procedures such as complete axillary dissection to sentinel lymph node biopsy. Axillary dissection is performed in cases with metastatic lymph nodes or when metastatic disease is proven after sentinel lymph node biopsy. Lymph node metastases of breast cancer in the axilla are thought to follow a sequential pattern from Level I to Level III lymph nodes. For this reason, limited dissections including Level I and II are warranted in the treatment of breast cancer. However, the effect of complete axillary dissection (Level III) on loco-regional recurrence and overall survival needs to be investigated in high-quality studies. The number of dissected lymph nodes is another factor that is compared between different levels of axillary dissection. The exact number of metastatic lymph nodes in the axilla is clearly important to decide on the adjuvant treatments of patients with breast cancer. Randomized controlled trials demonstrated no significant disease-free or overall survival difference depending on the level of axillary dissection. Although morbidity during surgery may increase, long-term arm and shoulder morbidity related to axillary dissection is similar after all levels of dissection. On the other hand, extent of axillary dissection plays a role in the accuracy of axillary staging. © Springer Nature Switzerland AG 2021.