Abstract
The aim of this study was to evaluate the morbidity after sentinel node biopsy (SNB) and axillary dissection with (AD-NS) or without sparing the intercostobrachial nerve (AD-NOS). A prospective cohort study was performed on 108 patients divided into three groups: SNB (n=35), AD-NS (n=36) and AD-NOS (n=37). We evaluated the incidence of sensory loss, pain, lymphedema, seroma formation and infection in the arm homolateral to the breast surgery. Semmes-Weinstein monofilaments were used to assess the sensory loss; brachial perimetry was used to evaluate presence of lymphedema and a pain questionnaire was administered. ANOVA and Kruskal-Wallis statistical tests were used. Bivariate and Multivariate analyses were performed. After surgery at least one complication was reported by 45/108 (41.7%) patients. Pain was the outcome more often reported by patients. In the three groups a significant difference was observed only regarding sensory loss (p=0.04). Pain, lymphedema, and sensory loss were more frequently found in the AD-NOS group. No significant difference was observed between SNB and AD-NS groups. Semmes-Weinstein monofilaments showed preservation of cutaneous sensitivity in 28/35 patients from the SNB group, in 25/36 patients from AD-NS group but in only 10/37 patients from AD-NOS group (p<0.001). The ICB section is associated with higher sensory loss, with statistically significant difference between the groups that were not shown to be significant with the others complications.
Highlights
The aim of this study was to evaluate the morbidity after sentinel node biopsy (SNB) and axillary dissection with (AD-NS) or without sparing the intercostobrachial nerve (AD-NOS)
We evaluated the incidence of sensory loss, pain, lymphedema, seroma formation and infection in the arm homolateral to the breast surgery
Lymphedema, and sensory loss were more frequently found in the AD-NOS group
Summary
BEATRIZ PIFANO SOARES FERREIRA, MÔNICA DUARTE PIMENTEL, LUIZ CLÁUDIO DOS SANTOS, WALACE DI FLORA, HELENICE GOBBI* Trabalho realizado na Universidade Federal de Minas Gerais, Belo Horizonte, MG. O objetivo deste estudo foi avaliar a morbidade cirúrgica pós-biópsia de linfonodo sentinela (BLS) ou dissecção axilar com (DA-NP) e sem preservação do nervo intercostobraquial (DA-NS). A dissecção axilar (DA) foi durante anos técnica padrão para a maioria dos casos, e ainda é muito útil em grande número de pacientes afetadas pelo câncer de mama. No final dos anos 90, a introdução da biópsia do linfonodo sentinela (BLS) revolucionou a cirurgia para estadiamento axilar por câncer de mama. Data, tipo de cirurgia, estado civil, nível de instrução, lateralidade, estadiamento clínico TNM, status menopausal, estadio, número de linfonodos dissecados, dados do exame anatomopatológico, número de linfonodos acometidos, preservação ou não do nervo intercostobraquial, presença ou ausência de seroma e infecção pós-operatória foram obtidos a partir dos prontuários médicos das pacientes selecionadas e que aceitaram participar do estudo. Tabela 1 - Tipos de cirurgia, tamanho do tumor, status dos linfonodos, número de linfonodos dissecados e número de linfonodos comprometidos em 108 pacientes de acordo com o grupo
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