Decreasing arm morbidity by refining axillary surgery in breast cancer

EDITORIAL In conclusion, we believe that any refinement in the technique of AD should be considered carefully, particu larly if it may lead to a decrease of short and long term morbidities. In the light of the limited e although not negligible e contribution of local control to the overall prognosis of breast cancer, it is imperative that breast surgeons strictly adhere to the ancient rule ‘‘primum non nocere’’. This may be accomplished by adopting the most accuratesurgical technique to excise the disease, whilst preserving healthy tissues. Nevertheless, ‘‘less surgery’’ is often not ‘‘easier surgery’’ and it may carry a greater risk of resulting ‘‘inappropriate’’ since it is technically more emanding, especially during the learning phase. This has already been demonstrated with breast conserving surgery, which is more complex than mastectomy and thus more likely to be applied inappropriately. In breast cancer patients undergoing AD, there is enough evidence supporting the benefit of ICBNs preservation, while data on the usefulness and safety of sparing the lymphatic pathway from the arm are not yet available. Therefore, the results of this and any other technical refinement must be monitored so that the contribution of surgery in obtaining breast cancer cure is not jeopardized and our improved skills can be transmitted to the surgeons of tomorrow.