Abstract
BackgroundFor patients with axillary lymph node metastases from breast cancer, performance of a complete axillary lymph node dissection (ALND) is the standard approach. Due to the rich lymphatic network in the axilla, it is necessary to carefully dissect and identify all lymphatic channels. Traditionally, these lymphatics are sealed with titanium clips or individually sutured. Recently, the Harmonic Focus®, a hand-held ultrasonic dissector, allows lymphatics to be sealed without the utilization of clips or ties. We hypothesize that ALND performed with the Harmonic Focus® will decrease operative time and reduce post-operative complications.MethodsRetrospective review identified all patients who underwent ALND at a teaching hospital between January of 2005 and December of 2009. Patient demographics, presenting pathology, treatment course, operative time, days to drain removal, and surgical complications were recorded. Comparisons were made to a selected control group of patients who underwent similar surgical procedures along with an ALND performed utilizing hemostatic clips and electrocautery. A total of 41 patients were included in this study.ResultsOperative time was not improved with the use of ultrasonic dissection, however, there was a decrease in the total number of days that closed suction drainage was required, although this was not statistically significant. Complication rates were similar between the two groups.ConclusionIn this case-matched retrospective review, there were fewer required days of closed suction drainage when ALND was performed with ultrasonic dissection versus clips and electrocautery.
Highlights
For patients with axillary lymph node metastases from breast cancer, performance of a complete axillary lymph node dissection (ALND) is the standard approach
For patients with no clinical evidence of axillary metastases, this information is obtained via sentinel node biopsy[1]
The recent results of ACOSOG Z0011 trial suggest that patients with T1/T2 tumors undergoing breast conserving therapy do not require completion axillary dissection, patients with more advanced lesions, patients undergoing total mastectomy and patients with palpable nodes continue to require ALND for staging
Summary
For patients with axillary lymph node metastases from breast cancer, performance of a complete axillary lymph node dissection (ALND) is the standard approach. Due to the rich lymphatic network in the axilla, it is necessary to carefully dissect and identify all lymphatic channels. These lymphatics are sealed with titanium clips or individually sutured. The recent results of ACOSOG Z0011 trial suggest that patients with T1/T2 tumors undergoing breast conserving therapy do not require completion axillary dissection, patients with more advanced lesions, patients undergoing total mastectomy and patients with palpable nodes continue to require ALND for staging. The frequency of these complications can vary from 385% for seroma formation and 5-49% for lymphedema [6,7,8,9,10,11,12]
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