Role of Axillary Surgery After Neoadjuvant Chemotherapy

Abstract

At the 2019 ASCO Annual Meeting, the optimal approach to axillary surgery for women who received neoadjuvant chemotherapy (NACT) was discussed. If residual axillary disease is detected, patients with triple-negative tumors and human epidermal growth factor receptor 2 (HER2) overexpression can be selected for additional adjuvant treatment with capecitabine or trastuzumab emtansine (T-DM1), respectively.1,2 Failure to identify patients with residual disease can negatively affect their clinical outcome. Techniques proposed to optimize patient selection include placing clips on metastatic lymph nodes before NACT or performing axillary dissection even after a clinical complete response (CR). Does this really make sense? What role does axillary surgery play in patients for whom NACT is indicated?