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Study background: Axillary Lymph Node Dissection (ALND) maintains therapeutic value in high-risk Breast Cancer (BC), while sentinel lymph node biopsy is the standard for staging early-stage, clinically node-negative cases to forecast prognosis. Skin sparing oncologic resection, breast lift and ipsilateral ALND of Oncoplastic Surgery (OPS) should cause proactive enlargement of cancer affected breast creating balanced symmetry. The objectives of study were (1) to observe the long-term outcomes of this ethically sound novel ALND-OPS model to evaluate efficacy and long-term outcome of this surgical technique, (2) to observe power of assessment of stratification and prognosis of pathological Node (pN) stages and Lymph Node Ratio (LNR) subgroups.
Methods: This single-center unique prospective cohort study was conducted on 51 consecutively treated BC patients. Three BC patients treated with novel ALND- OPS model were included where their long-term follow-up data were collected for analysis. The data collected of 51 cases were total and positive axillary node counts, patient distribution as per pN stages and Lymph Node Ratio (LNR) subgroups, and survival functions of Disease Free Survival (DFS) and Overall Survival (OS) at follow-up date focusing on the most severe cases where all patients eventually died to understand their full survival journey.
Results: Novel skin sparing ALND model OPS indicated recurrence-free, balanced, healthy, and symmetrical breasts after > 6 years follow-up. The median DFS and OS were 49.23 and 52.63 months respectively. Significant difference of patients stratification between pN and LNR subgroups (p = 0.000001) observed. Significant difference was observed of estimated mean survival time of DFS between low- and high-risk (p < 0.001), and intermediate- and high-risk LNR (p < 0.001), and of OS between low- and high-risk (p < 0.001), and intermediate- and high-risk LNR (p < 0.001) subgroups.
Conclusions: Ipsilateral axillary dissection model oncoplastic surgery is a novel ethically/surgically sound proactive procedure. Axillary dissection is a powerful independent predictor of breast cancer prognosis