Abstract
BackgroundConventional axillary lymph node dissection (ALND) has recently become less radical. The treatment morbidity effects of reduced ALND aggressiveness are unknown. This article investigates the prevalence of the main complications of ALND: lymphedema, range-of-motion restriction, and arm paresthesia and pain.MethodsThis cross-sectional study included 200 women with invasive breast cancer who underwent breast-conserving surgery (82.5%, n = 165) or mastectomy (17.5%, n = 35) with ALND from 2007 to 2011. Arm perimetry was used to assess lymphedema, defined as a difference >2 cm in the upper arm circumference between the nonsurgical and surgical arms. Range-of-motion restriction was assessed by evaluating the degree of arm abduction. Paresthesia was measured in the inner and proximal arm regions. Arm pain was assessed by directly questioning the patients and defined as either present or absent.ResultsThe average (±SD) time between ALND and morbidity evaluation was 35 ± 18 months (range, 7-60 months). The average dissected lymph node number per patient was 14 ± 4 (range, 6-30 lymph nodes). Only 3.5% (n = 7) of the patients presented with lymphedema. Single-incision approaches to breast tumor and ALND (P = 0.04) and the presence of a postoperative seroma (P = 0.02) were associated with lymphedema in univariate analysis. Paresthesia was the most frequent side effect observed (53% of patients, n = 106). This complication was associated with increased age (P < 0.0001) and a larger dissected lymph node number (P = 0.01) in univariate and multivariate analysis. Additionally, 24% (n = 48) of patients had noticeable limited arm abduction. Among the patients, 27.5% (n = 55) experienced sporadic arm pain corresponding to the surgically treated armpit. In multivariate analysis, the pain risk was 1.9-fold higher in patients who underwent ALND corresponding to their dominant arm (95% CI, 1.0-3.7, P = 0.04).ConclusionConventional ALND in breast cancer patients can result in unwanted complications. However, the current lymphedema prevalence is lower than that of the other analyzed side effects.
Highlights
Conventional axillary lymph node dissection (ALND) has recently become less radical
ALND is primarily responsible for functional surgical treatment sequelae, including lymphedema, paresthesia, range-of-motion restriction, and pain in the arm ipsilateral to the lymph node dissection
Inclusion and exclusion criteria Women with histologically confirmed invasive breast carcinoma without distant metastases (M0) at diagnosis were included in this study
Summary
Conventional axillary lymph node dissection (ALND) has recently become less radical. The treatment morbidity effects of reduced ALND aggressiveness are unknown. Axillary lymph node dissection (ALND), controversial in specific situations, remains an integral part of surgical treatments in patients with invasive breast cancer and axillary lymph node metastases [1] This treatment is applicable in patients with tumors that are considered N1 or N2 according to the TNM staging older than 40 years [9]. Conventional ALND involves lymph node resection in levels I and II, as described by Berg [10] Such dissections serve therapeutic functions and enable disease stage and prognosis assessments [11]. ALND is primarily responsible for functional surgical treatment sequelae, including lymphedema, paresthesia, range-of-motion restriction, and pain in the arm ipsilateral to the lymph node dissection. Esthetic sequelae that are caused by partial or total surgical breast resection can be reversed or minimized by reconstructive surgery methods that include prosthetics and tissue flaps, little can be done to correct the functional sequelae [12]
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