Gynecologie, obstetrique, fertilite & senologie · 2026
[Axillary de-escalation, oncoplastic surgery and minimally invasive mastectomy: new requirements for the breast surgeon].
Аннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Zeitoun Jérémie
Аннотация
OBJECTIVE: To describe how axillary surgical de-escalation, the rise of oncoplastic surgery and the development of minimally invasive mastectomy are reshaping breast cancer care and redefining the role of the breast surgeon.
METHODS: Narrative review based on a search of MEDLINE/PubMed and the Cochrane Library up to May 2026 (keywords: breast cancer, sentinel lymph node, axillary dissection, targeted axillary dissection, oncoplastic surgery, endoscopic or robotic mastectomy, gene expression assay), prioritising randomised trials, meta-analyses and large cohorts, supplemented by international and French guidelines.
RESULTS: In patients with limited nodal involvement or very low axillary risk, axillary dissection, and even sentinel node biopsy, can be omitted without compromising overall survival or locoregional control, provided appropriate radiotherapy and systemic therapy are delivered (Z0011, AMAROS, IBCSG 23-01, SENOMAC, SOUND, INSEMA). Targeted axillary dissection allows initially node-positive patients who become ycN0 after neoadjuvant chemotherapy to avoid completion dissection, especially in HER2-positive and triple-negative tumours. Oncoplastic surgery, immediate reconstruction and endoscopic or robotic mastectomy achieve comparable oncological outcomes with improved cosmesis, at the cost of longer operating time, a learning curve and higher cost.
CONCLUSION: This convergence represents a paradigm shift. The breast surgeon must integrate oncological decision-making, reconstructive skills and critical appraisal of trials within a multidisciplinary setting. Dedicated training pathways and formal recognition of breast surgery as a subspecialty are essential.
METHODS: Narrative review based on a search of MEDLINE/PubMed and the Cochrane Library up to May 2026 (keywords: breast cancer, sentinel lymph node, axillary dissection, targeted axillary dissection, oncoplastic surgery, endoscopic or robotic mastectomy, gene expression assay), prioritising randomised trials, meta-analyses and large cohorts, supplemented by international and French guidelines.
RESULTS: In patients with limited nodal involvement or very low axillary risk, axillary dissection, and even sentinel node biopsy, can be omitted without compromising overall survival or locoregional control, provided appropriate radiotherapy and systemic therapy are delivered (Z0011, AMAROS, IBCSG 23-01, SENOMAC, SOUND, INSEMA). Targeted axillary dissection allows initially node-positive patients who become ycN0 after neoadjuvant chemotherapy to avoid completion dissection, especially in HER2-positive and triple-negative tumours. Oncoplastic surgery, immediate reconstruction and endoscopic or robotic mastectomy achieve comparable oncological outcomes with improved cosmesis, at the cost of longer operating time, a learning curve and higher cost.
CONCLUSION: This convergence represents a paradigm shift. The breast surgeon must integrate oncological decision-making, reconstructive skills and critical appraisal of trials within a multidisciplinary setting. Dedicated training pathways and formal recognition of breast surgery as a subspecialty are essential.