![]() 5 Its recent closure due to slow accrual ensures that ALND will continue to play a significant role in the management of patients with breast cancer. First, it is designed to serve as a source of model operative dictations that may be individualized and used as templates. Common opening and terminating sequences (for example, how to enter and close the abdomen) in all laparotomy dictations are included. The ACOSOG Z0011 trial was designed to study whether ALND after identification of a positive sentinel lymph node is associated with a survival benefit compared with observation alone. Finally, a template operative dictation is provided. 3, 4 The role of ALND in current practice is limited to women with locally advanced breast cancer and a subset of women with early breast cancer: in patients with clinically or radiologically apparent nodal disease at the time of presentation, in patients in whom a sentinel lymph node cannot be identified at the time of mapping, and in patients who have undergone a sentinel lymph node biopsy and were found to have an involved lymph node. However, since the advent of sentinel lymph node mapping, ALND is no longer the preferred staging procedure in patients with small, clinically node-negative breast cancer. ALND has been the traditional means of staging the axilla in patients with breast cancer.
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