Incorporating lymphovenous anastomosis in clinically node-positive women receiving neoadjuvant chemotherapy: A shared decision-making model and nuanced approach to the axilla in the era of clinical uncertainty

As adjuvant nodal radiation and systemic therapy continue to improve, the benefit of a cALND in patients with the limited residual disease remains unclear as we await the outcomes from clinical trials. In the era of clinical uncertainty, we propose a nuanced approach to the axilla by utilizing a shared decision model with patients, incorporating targeted SLNB with FS and completion node dissection when required and desired by the patient, coupled with LVA in a simple stepwise treatment pathway.