Axillary web syndrome after axillary dissection
Identifieur interne : 003422 ( Istex/Corpus ); précédent : 003421; suivant : 003423Axillary web syndrome after axillary dissection
Auteurs : Alexander H. Moskovitz ; Benjamin O. Anderson ; Raymond S. Yeung ; David R. Byrd ; Thomas J. Lawton ; Roger E. MoeSource :
- The American Journal of Surgery [ 0002-9610 ] ; 2001.
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- KwdEn :
Abstract
Background: Some patients undergoing axillary lymph node dissection (ALND) experience postoperative pain and limited range of motion associated with a palpable web of tissue extending from the axilla into the ipsilateral arm. The purpose of this study is to characterize the previously undescribed axillary web syndrome (AWS).Methods: To identify patients with AWS, a retrospective review was performed of all invasive breast cancer patients treated by a single surgeon (REM) between 1980 and 1996. Records were also reviewed of 4 more recent patients who developed AWS after undergoing sentinel node lymph node dissection (SLND) without ALND.Results: Among 750 sequentially treated patients, 44 (6%) developed AWS between 1 and 8 weeks after their axillary procedure. The palpable subcutaneous cords extended from the axillary crease down the ipsilateral arm, across the antecubital space, and in severe cases down to the base of the thumb. The web was associated with pain and limited shoulder abduction (≤90° in 74% of patients). AWS resolved in all cases within 2 to 3 months. AWS also occurred after SLND. Tissue sampling of webs in 4 patients showed occlusion in lymphatic and venous channels.Conclusions: AWS is a self-limiting cause of morbidity in the early postoperative period. More limited axillary surgery, with less lymphovenous disruption, might reduce the severity and incidence of this syndrome, although SLND does not eliminate its occurrence.
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DOI: 10.1016/S0002-9610(01)00602-X
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ISTEX:6FA01B0A760AE0FC9AF7EDF0F3A827364B962041Le document en format XML
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Anderson</name><affiliation><mods:affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</mods:affiliation></affiliation></author><author><name sortKey="Yeung, Raymond S" sort="Yeung, Raymond S" uniqKey="Yeung R" first="Raymond S" last="Yeung">Raymond S. Yeung</name><affiliation><mods:affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</mods:affiliation></affiliation></author><author><name sortKey="Byrd, David R" sort="Byrd, David R" uniqKey="Byrd D" first="David R" last="Byrd">David R. Byrd</name><affiliation><mods:affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</mods:affiliation></affiliation></author><author><name sortKey="Lawton, Thomas J" sort="Lawton, Thomas J" uniqKey="Lawton T" first="Thomas J" last="Lawton">Thomas J. Lawton</name><affiliation><mods:affiliation>Department of Pathology, Bio-Clinical Breast Care Program, University of Washington School of Medicine, Seattle, WA, USA</mods:affiliation></affiliation></author><author><name sortKey="Moe, Roger E" sort="Moe, Roger E" uniqKey="Moe R" first="Roger E" last="Moe">Roger E. Moe</name><affiliation><mods:affiliation>E-mail: rmoe@u.washington.edu</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:6FA01B0A760AE0FC9AF7EDF0F3A827364B962041</idno><date when="2001" year="2001">2001</date><idno type="doi">10.1016/S0002-9610(01)00602-X</idno><idno type="url">https://api.istex.fr/document/6FA01B0A760AE0FC9AF7EDF0F3A827364B962041/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">003422</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">003422</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Axillary web syndrome after axillary dissection</title><author><name sortKey="Moskovitz, Alexander H" sort="Moskovitz, Alexander H" uniqKey="Moskovitz A" first="Alexander H" last="Moskovitz">Alexander H. Moskovitz</name><affiliation><mods:affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</mods:affiliation></affiliation></author><author><name sortKey="Anderson, Benjamin O" sort="Anderson, Benjamin O" uniqKey="Anderson B" first="Benjamin O" last="Anderson">Benjamin O. Anderson</name><affiliation><mods:affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</mods:affiliation></affiliation></author><author><name sortKey="Yeung, Raymond S" sort="Yeung, Raymond S" uniqKey="Yeung R" first="Raymond S" last="Yeung">Raymond S. Yeung</name><affiliation><mods:affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</mods:affiliation></affiliation></author><author><name sortKey="Byrd, David R" sort="Byrd, David R" uniqKey="Byrd D" first="David R" last="Byrd">David R. Byrd</name><affiliation><mods:affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</mods:affiliation></affiliation></author><author><name sortKey="Lawton, Thomas J" sort="Lawton, Thomas J" uniqKey="Lawton T" first="Thomas J" last="Lawton">Thomas J. Lawton</name><affiliation><mods:affiliation>Department of Pathology, Bio-Clinical Breast Care Program, University of Washington School of Medicine, Seattle, WA, USA</mods:affiliation></affiliation></author><author><name sortKey="Moe, Roger E" sort="Moe, Roger E" uniqKey="Moe R" first="Roger E" last="Moe">Roger E. Moe</name><affiliation><mods:affiliation>E-mail: rmoe@u.washington.edu</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">The American Journal of Surgery</title><title level="j" type="abbrev">AJS</title><idno type="ISSN">0002-9610</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2001">2001</date><biblScope unit="volume">181</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="434">434</biblScope><biblScope unit="page" to="439">439</biblScope></imprint><idno type="ISSN">0002-9610</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-9610</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Axillary lymph node dissection</term><term>Axillary pain</term><term>Axillary web syndrome</term><term>Mondor’s disease</term><term>Postoperative morbidity</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Some patients undergoing axillary lymph node dissection (ALND) experience postoperative pain and limited range of motion associated with a palpable web of tissue extending from the axilla into the ipsilateral arm. The purpose of this study is to characterize the previously undescribed axillary web syndrome (AWS).Methods: To identify patients with AWS, a retrospective review was performed of all invasive breast cancer patients treated by a single surgeon (REM) between 1980 and 1996. Records were also reviewed of 4 more recent patients who developed AWS after undergoing sentinel node lymph node dissection (SLND) without ALND.Results: Among 750 sequentially treated patients, 44 (6%) developed AWS between 1 and 8 weeks after their axillary procedure. The palpable subcutaneous cords extended from the axillary crease down the ipsilateral arm, across the antecubital space, and in severe cases down to the base of the thumb. The web was associated with pain and limited shoulder abduction (≤90° in 74% of patients). AWS resolved in all cases within 2 to 3 months. AWS also occurred after SLND. Tissue sampling of webs in 4 patients showed occlusion in lymphatic and venous channels.Conclusions: AWS is a self-limiting cause of morbidity in the early postoperative period. More limited axillary surgery, with less lymphovenous disruption, might reduce the severity and incidence of this syndrome, although SLND does not eliminate its occurrence.</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>axillary</json:string><json:string>node</json:string><json:string>alnd</json:string><json:string>postoperative</json:string><json:string>lymphatics</json:string><json:string>slnd</json:string><json:string>breast cancer</json:string><json:string>axilla</json:string><json:string>surg</json:string><json:string>lymphatic</json:string><json:string>breast procedure</json:string><json:string>syndrome</json:string><json:string>metastasis</json:string><json:string>senior author</json:string><json:string>intercostobrachial nerve</json:string><json:string>american journal</json:string><json:string>axillary dissection</json:string><json:string>axillary lymph node 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breast cancer</json:string><json:string>axillary nodes</json:string><json:string>lymph node status</json:string><json:string>sentinel node biopsy</json:string><json:string>tissue sampling</json:string><json:string>brin clot</json:string><json:string>retrospective review</json:string><json:string>axillary node dissection</json:string><json:string>localized disease</json:string><json:string>lymphatic mapping</json:string><json:string>lymphovenous injury</json:string><json:string>other symptoms</json:string><json:string>axillary lymph nodes</json:string><json:string>clin oncol</json:string><json:string>medical record</json:string><json:string>seroma infection</json:string></teeft></keywords><author><json:item><name>Alexander H Moskovitz M.D.</name><affiliations><json:string>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</json:string></affiliations></json:item><json:item><name>Benjamin O Anderson M.D.</name><affiliations><json:string>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</json:string></affiliations></json:item><json:item><name>Raymond S Yeung M.D.</name><affiliations><json:string>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</json:string></affiliations></json:item><json:item><name>David R Byrd M.D.</name><affiliations><json:string>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</json:string></affiliations></json:item><json:item><name>Thomas J Lawton M.D.</name><affiliations><json:string>Department of Pathology, Bio-Clinical Breast Care Program, University of Washington School of Medicine, Seattle, WA, USA</json:string></affiliations></json:item><json:item><name>Roger E Moe M.D.</name><affiliations><json:string>E-mail: rmoe@u.washington.edu</json:string><json:string>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Axillary pain</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Axillary web syndrome</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Mondor’s disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Axillary lymph node dissection</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Postoperative morbidity</value></json:item></subject><articleId><json:string>6293</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Background: Some patients undergoing axillary lymph node dissection (ALND) experience postoperative pain and limited range of motion associated with a palpable web of tissue extending from the axilla into the ipsilateral arm. The purpose of this study is to characterize the previously undescribed axillary web syndrome (AWS).Methods: To identify patients with AWS, a retrospective review was performed of all invasive breast cancer patients treated by a single surgeon (REM) between 1980 and 1996. Records were also reviewed of 4 more recent patients who developed AWS after undergoing sentinel node lymph node dissection (SLND) without ALND.Results: Among 750 sequentially treated patients, 44 (6%) developed AWS between 1 and 8 weeks after their axillary procedure. The palpable subcutaneous cords extended from the axillary crease down the ipsilateral arm, across the antecubital space, and in severe cases down to the base of the thumb. The web was associated with pain and limited shoulder abduction (≤90° in 74% of patients). AWS resolved in all cases within 2 to 3 months. AWS also occurred after SLND. Tissue sampling of webs in 4 patients showed occlusion in lymphatic and venous channels.Conclusions: AWS is a self-limiting cause of morbidity in the early postoperative period. More limited axillary surgery, with less lymphovenous disruption, might reduce the severity and incidence of this syndrome, although SLND does not eliminate its occurrence.</abstract><qualityIndicators><score>5.875</score><pdfVersion>1.2</pdfVersion><pdfPageSize>578 x 776 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1461</abstractCharCount><pdfWordCount>3223</pdfWordCount><pdfCharCount>19477</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>221</abstractWordCount></qualityIndicators><title>Axillary web syndrome after axillary dissection</title><pii><json:string>S0002-9610(01)00602-X</json:string></pii><genre><json:string>research-article</json:string></genre><host><title>The American Journal of Surgery</title><language><json:string>unknown</json:string></language><publicationDate>2001</publicationDate><issn><json:string>0002-9610</json:string></issn><pii><json:string>S0002-9610(00)X0049-9</json:string></pii><volume>181</volume><issue>5</issue><pages><first>434</first><last>439</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>surgery</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>surgery</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string><json:string>toxicologie</json:string></inist></categories><publicationDate>2001</publicationDate><copyrightDate>2001</copyrightDate><doi><json:string>10.1016/S0002-9610(01)00602-X</json:string></doi><id>6FA01B0A760AE0FC9AF7EDF0F3A827364B962041</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/6FA01B0A760AE0FC9AF7EDF0F3A827364B962041/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/6FA01B0A760AE0FC9AF7EDF0F3A827364B962041/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/6FA01B0A760AE0FC9AF7EDF0F3A827364B962041/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Axillary web syndrome after axillary dissection</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©2001 Elsevier Science Inc.</p></availability><date>2001</date></publicationStmt><notesStmt><note type="content">Fig. 1: Diagram of Axillary Web Syndrome. Demonstrates taut cords of tissue extending from mid axilla down the ipsilateral arm, across the antecubital space, and to base of the thumb.</note><note type="content">Fig. 2: Postoperative syndrome timing. Graphic representation of the number of clinic visits with documented AWS compared to the time after ALND.</note><note type="content">Fig. 3: Thrombosed lymphatic. Hematoxylin and eosin stain, 20× magnification by light microscopy.</note><note type="content">Fig. 4: Normal arm lymphangiogram. A, arm view. B, axilla view. (Reproduced with permission, see references 23 and 24)</note><note type="content">Table 1: Axillary web syndrome patient demographics and cancer staging (n = 44)</note><note type="content">Table 2: Lymph node status in axillary web syndrome (AWS) patients∗</note><note type="content">Table 3: Timing of axillary web syndrome (AWS), breast procedure versus ALND∗</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Axillary web syndrome after axillary dissection</title><author xml:id="author-0000"><persName><forename type="first">Alexander H</forename><surname>Moskovitz</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Benjamin O</forename><surname>Anderson</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Raymond S</forename><surname>Yeung</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</affiliation></author><author xml:id="author-0003"><persName><forename type="first">David R</forename><surname>Byrd</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Thomas J</forename><surname>Lawton</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Pathology, Bio-Clinical Breast Care Program, University of Washington School of Medicine, Seattle, WA, USA</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Roger E</forename><surname>Moe</surname></persName><roleName type="degree">M.D.</roleName><email>rmoe@u.washington.edu</email><note type="correspondence"><p>Corresponding author. Tel.: +1-206-543-3053; fax: +1-206-543-8136</p></note><affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</affiliation></author><idno type="istex">6FA01B0A760AE0FC9AF7EDF0F3A827364B962041</idno><idno type="DOI">10.1016/S0002-9610(01)00602-X</idno><idno type="PII">S0002-9610(01)00602-X</idno><idno type="ArticleID">6293</idno></analytic><monogr><title level="j">The American Journal of Surgery</title><title level="j" type="abbrev">AJS</title><idno type="pISSN">0002-9610</idno><idno type="PII">S0002-9610(00)X0049-9</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2001"></date><biblScope unit="volume">181</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="434">434</biblScope><biblScope unit="page" to="439">439</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2001</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Background: Some patients undergoing axillary lymph node dissection (ALND) experience postoperative pain and limited range of motion associated with a palpable web of tissue extending from the axilla into the ipsilateral arm. The purpose of this study is to characterize the previously undescribed axillary web syndrome (AWS).Methods: To identify patients with AWS, a retrospective review was performed of all invasive breast cancer patients treated by a single surgeon (REM) between 1980 and 1996. Records were also reviewed of 4 more recent patients who developed AWS after undergoing sentinel node lymph node dissection (SLND) without ALND.Results: Among 750 sequentially treated patients, 44 (6%) developed AWS between 1 and 8 weeks after their axillary procedure. The palpable subcutaneous cords extended from the axillary crease down the ipsilateral arm, across the antecubital space, and in severe cases down to the base of the thumb. The web was associated with pain and limited shoulder abduction (≤90° in 74% of patients). AWS resolved in all cases within 2 to 3 months. AWS also occurred after SLND. Tissue sampling of webs in 4 patients showed occlusion in lymphatic and venous channels.Conclusions: AWS is a self-limiting cause of morbidity in the early postoperative period. More limited axillary surgery, with less lymphovenous disruption, might reduce the severity and incidence of this syndrome, although SLND does not eliminate its occurrence.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Axillary pain</term></item><item><term>Axillary web syndrome</term></item><item><term>Mondor’s disease</term></item><item><term>Axillary lymph node dissection</term></item><item><term>Postoperative morbidity</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2001-02-14">Modified</change><change when="2001">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/6FA01B0A760AE0FC9AF7EDF0F3A827364B962041/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: ce:floats; body; tail"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="GR1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="GR2"></istex:entity><istex:entity SYSTEM="gr3" NDATA="IMAGE" name="GR3"></istex:entity><istex:entity SYSTEM="gr4" NDATA="IMAGE" name="GR4"></istex:entity></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla" xml:lang="en"><item-info><jid>AJS</jid><aid>6293</aid><ce:pii>S0002-9610(01)00602-X</ce:pii><ce:doi>10.1016/S0002-9610(01)00602-X</ce:doi><ce:copyright type="full-transfer" year="2001">Elsevier Science Inc.</ce:copyright></item-info><head><ce:title>Axillary web syndrome after axillary dissection</ce:title><ce:author-group><ce:author><ce:given-name>Alexander H</ce:given-name><ce:surname>Moskovitz</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="AFF1"><ce:sup loc="post">a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Benjamin O</ce:given-name><ce:surname>Anderson</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="AFF1"><ce:sup loc="post">a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Raymond S</ce:given-name><ce:surname>Yeung</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="AFF1"><ce:sup loc="post">a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>David R</ce:given-name><ce:surname>Byrd</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="AFF1"><ce:sup loc="post">a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Thomas J</ce:given-name><ce:surname>Lawton</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="AFF2"><ce:sup loc="post">b</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Roger E</ce:given-name><ce:surname>Moe</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="AFF1"><ce:sup loc="post">a</ce:sup></ce:cross-ref><ce:cross-ref refid="CORR1">*</ce:cross-ref><ce:e-address type="email">rmoe@u.washington.edu</ce:e-address></ce:author><ce:affiliation id="AFF1"><ce:label>a</ce:label><ce:textfn>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>b</ce:label><ce:textfn>Department of Pathology, Bio-Clinical Breast Care Program, University of Washington School of Medicine, Seattle, WA, USA</ce:textfn></ce:affiliation><ce:correspondence id="CORR1"><ce:label>*</ce:label><ce:text>Corresponding author. Tel.: +1-206-543-3053; fax: +1-206-543-8136</ce:text></ce:correspondence></ce:author-group><ce:date-received day="22" month="12" year="2000"></ce:date-received><ce:date-revised day="14" month="2" year="2001"></ce:date-revised><ce:abstract class="author"><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para view="all" id="simple-para.0045">Background: Some patients undergoing axillary lymph node dissection (ALND) experience postoperative pain and limited range of motion associated with a palpable web of tissue extending from the axilla into the ipsilateral arm. The purpose of this study is to characterize the previously undescribed axillary web syndrome (AWS).</ce:simple-para><ce:simple-para view="all" id="simple-para.0050">Methods: To identify patients with AWS, a retrospective review was performed of all invasive breast cancer patients treated by a single surgeon (REM) between 1980 and 1996. Records were also reviewed of 4 more recent patients who developed AWS after undergoing sentinel node lymph node dissection (SLND) without ALND.</ce:simple-para><ce:simple-para view="all" id="simple-para.0055">Results: Among 750 sequentially treated patients, 44 (6%) developed AWS between 1 and 8 weeks after their axillary procedure. The palpable subcutaneous cords extended from the axillary crease down the ipsilateral arm, across the antecubital space, and in severe cases down to the base of the thumb. The web was associated with pain and limited shoulder abduction (≤90° in 74% of patients). AWS resolved in all cases within 2 to 3 months. AWS also occurred after SLND. Tissue sampling of webs in 4 patients showed occlusion in lymphatic and venous channels.</ce:simple-para><ce:simple-para view="all" id="simple-para.0060">Conclusions: AWS is a self-limiting cause of morbidity in the early postoperative period. More limited axillary surgery, with less lymphovenous disruption, might reduce the severity and incidence of this syndrome, although SLND does not eliminate its occurrence.</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords class="keyword"><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text>Axillary pain</ce:text></ce:keyword><ce:keyword><ce:text>Axillary web syndrome</ce:text></ce:keyword><ce:keyword><ce:text>Mondor’s disease</ce:text></ce:keyword><ce:keyword><ce:text>Axillary lymph node dissection</ce:text></ce:keyword><ce:keyword><ce:text>Postoperative morbidity</ce:text></ce:keyword></ce:keywords></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Axillary web syndrome after axillary dissection</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Axillary web syndrome after axillary dissection</title></titleInfo><name type="personal"><namePart type="given">Alexander H</namePart><namePart type="family">Moskovitz</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Benjamin O</namePart><namePart type="family">Anderson</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Raymond S</namePart><namePart type="family">Yeung</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">David R</namePart><namePart type="family">Byrd</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Thomas J</namePart><namePart type="family">Lawton</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Pathology, Bio-Clinical Breast Care Program, University of Washington School of Medicine, Seattle, WA, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Roger E</namePart><namePart type="family">Moe</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>E-mail: rmoe@u.washington.edu</affiliation><affiliation>Department of Surgery, Surgical Oncology Section, Bio-Clinical Breast Care Program, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98195, USA</affiliation><description>Corresponding author. Tel.: +1-206-543-3053; fax: +1-206-543-8136</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">2001</dateIssued><dateModified encoding="w3cdtf">2001-02-14</dateModified><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Background: Some patients undergoing axillary lymph node dissection (ALND) experience postoperative pain and limited range of motion associated with a palpable web of tissue extending from the axilla into the ipsilateral arm. The purpose of this study is to characterize the previously undescribed axillary web syndrome (AWS).Methods: To identify patients with AWS, a retrospective review was performed of all invasive breast cancer patients treated by a single surgeon (REM) between 1980 and 1996. Records were also reviewed of 4 more recent patients who developed AWS after undergoing sentinel node lymph node dissection (SLND) without ALND.Results: Among 750 sequentially treated patients, 44 (6%) developed AWS between 1 and 8 weeks after their axillary procedure. The palpable subcutaneous cords extended from the axillary crease down the ipsilateral arm, across the antecubital space, and in severe cases down to the base of the thumb. The web was associated with pain and limited shoulder abduction (≤90° in 74% of patients). AWS resolved in all cases within 2 to 3 months. AWS also occurred after SLND. Tissue sampling of webs in 4 patients showed occlusion in lymphatic and venous channels.Conclusions: AWS is a self-limiting cause of morbidity in the early postoperative period. More limited axillary surgery, with less lymphovenous disruption, might reduce the severity and incidence of this syndrome, although SLND does not eliminate its occurrence.</abstract><note type="content">Fig. 1: Diagram of Axillary Web Syndrome. Demonstrates taut cords of tissue extending from mid axilla down the ipsilateral arm, across the antecubital space, and to base of the thumb.</note><note type="content">Fig. 2: Postoperative syndrome timing. Graphic representation of the number of clinic visits with documented AWS compared to the time after ALND.</note><note type="content">Fig. 3: Thrombosed lymphatic. Hematoxylin and eosin stain, 20× magnification by light microscopy.</note><note type="content">Fig. 4: Normal arm lymphangiogram. A, arm view. B, axilla view. (Reproduced with permission, see references 23 and 24)</note><note type="content">Table 1: Axillary web syndrome patient demographics and cancer staging (n = 44)</note><note type="content">Table 2: Lymph node status in axillary web syndrome (AWS) patients∗</note><note type="content">Table 3: Timing of axillary web syndrome (AWS), breast procedure versus ALND∗</note><subject lang="en"><genre>Keywords</genre><topic>Axillary pain</topic><topic>Axillary web syndrome</topic><topic>Mondor’s disease</topic><topic>Axillary lymph node dissection</topic><topic>Postoperative morbidity</topic></subject><relatedItem type="host"><titleInfo><title>The American Journal of Surgery</title></titleInfo><titleInfo type="abbreviated"><title>AJS</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">200105</dateIssued></originInfo><identifier type="ISSN">0002-9610</identifier><identifier type="PII">S0002-9610(00)X0049-9</identifier><part><date>200105</date><detail type="volume"><number>181</number><caption>vol.</caption></detail><detail type="issue"><number>5</number><caption>no.</caption></detail><extent unit="issue pages"><start>A1</start><end>A12</end></extent><extent unit="issue pages"><start>389</start><end>480</end></extent><extent unit="pages"><start>434</start><end>439</end></extent></part></relatedItem><identifier type="istex">6FA01B0A760AE0FC9AF7EDF0F3A827364B962041</identifier><identifier type="DOI">10.1016/S0002-9610(01)00602-X</identifier><identifier type="PII">S0002-9610(01)00602-X</identifier><identifier type="ArticleID">6293</identifier><accessCondition type="use and reproduction" contentType="copyright">©2001 Elsevier Science Inc.</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Elsevier Science Inc., ©2001</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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