Axillary dissection

Axillary Lymph Node Dissection for Breast Cancer: Efficacy and Complication in Developing Countries

Purpose

Axillary lymph node dissection (ALND) frequently is performed as part of the surgical management of breast cancer as a therapeutic and prognostic index, but increasingly has been perceived as associated with significant complications. Data on efficacy and complications of ALND in Sudan are lacking. The aim of this study was to assess the efficacy and complications of ALND in patients with breast cancer treated with mastectomy and breast-conserving surgery.

Methods

We performed a prospective, hospital-based study in women with invasive breast cancer who underwent modified radical mastectomy or breast-conserving surgery with ALND between September 2014 and August 2015. The efficacy of ALND was defined as retrieval of ≥ 10 lymph nodes. Complications of ALND were assessed objectively and subjectively and defined as either present or absent.

Results

Of 96 patients with breast cancer included in the study, 40 (42%) developed postaxillary clearance complications. The median follow-up time was 18 months (range, 12 to 24 months). Numbness was reported by 21.9% of patients. Seroma was noted in 15.6% and lymphedema in 9.4%. Approximately 9% reported episodes of infection or inflammation at the surgical site. None of the studied factors were found to affect the incidence of complications significantly. Ten or more lymph nodes were retrieved in 81.3% of patients, and nodal metastasis was found in 62.5%.

Conclusion

This study shows that the prevalence of undesirable adverse effects after ALND is 42%, with paresthesia and seroma being the most prevalent. The lymphedema prevalence was low in relation to other evaluated symptoms.

Use of axillary lymph node dissection (ALND) in patients with micrometastatic breast cancer

BACKGROUND

Sentinel lymph node (SLN) biopsy is the current prognostic tool for clinically node-negative breast cancer patients. If the SLN reveals macrometastasis, axillary lymph node dissection (ALND) is recommended. However, the use of ALND in patients with micrometastasis is debated. The objective of this study was to assess the utilization of ALND in the treatment of micrometastatic breast cancer.

METHODS

An IRB approved, retrospective study of a pooled dataset of breast cancer patients with micrometastatic disease on SLN biopsy was performed. Patients diagnosed from 1999-2016 were identified via query of a single-institution National Comprehensive Cancer Network (NCCN) breast cancer database as well as a prospective tumor board.

RESULTS

A total of 91 patients were diagnosed with micrometastatic nodal disease. The median age at diagnosis was 56 y (range: 31-85); median follow-up time was 47 mo (range: 0-203 mo). 42/91(46.2%) patients had ALND of which 37/42 (88.1%) were a second operation; 3/42(7.1%) patients had additional positive nodes found at ALND. 44/91 (48.4%) patients received radiation. 7/91 (7.7%) patients had a recurrence, 5/7 local, including one axillary (2.1%; patient declined ALND).

CONCLUSIONS

Given that the risk of lymphedema after ALND ranges between 20%-53%, the morbidity of ALND may far exceed the likelihood of detecting further nodal involvement in women with micrometastatic disease: 7.1% in this series.