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Comparative Morbidity of Axillary Lymph Node Dissection and the Sentinel Lymph Node Technique

Identifieur interne : 001226 ( Pmc/Curation ); précédent : 001225; suivant : 001227

Comparative Morbidity of Axillary Lymph Node Dissection and the Sentinel Lymph Node Technique

Auteurs : Allan W. Silberman ; Carie Mcvay ; Jason S. Cohen ; Jack F. Altura ; Sandra Brackert ; Gregory P. Sarna ; Daphne Palmer ; Albert Ko ; Leslie Memsic

Source :

Annals of Surgery [ 0003-4932 ] ; 2004.

RBID : PMC:1356366

Abstract

Objective:

To assess our long-term complications from complete axillary lymph node dissection (AXLND) in patients with breast cancer.

Summary Background Data:

Complete AXLND as part of the surgical therapy for breast cancer has come under increased scrutiny due the use of the sentinel lymph node (SLN) biopsy technique to assess the status of the axillary nodes. As the enthusiasm for the SLN technique has increased, our impression has been that the perceived complication rate from AXLND has increased dramatically while the negative aspects of the SLN technique have been underemphasized.

Methods:

Female patients seen in routine follow-up over a 1-year period were eligible for our retrospective study of the long-term complications from AXLND if they were a minimum of 1 year out from all primary therapy; ie, surgery, radiation, and/or chemotherapy. All patients had previously undergone either a modified radical mastectomy (MRM) or a segmental mastectomy with axillary dissection and postoperative radiation (SegAx/XRT). All patients had a Level I–III dissection. Objective measurements, including upper and lower arm circumferences and body mass index (BMI), were obtained, and a subjective evaluation from the patients was conducted.

Results:

Ninety-four patients were eligible for our study; 44 had undergone MRM, and 50 had undergone SegAx/XRT. The average number of nodes removed was 25.6 (standard deviation, 8). Thirty-three percent of the patients had positive nodal disease, 95% of the patients had an upper arm circumference within 2 cm of the unaffected side, and 93.3% had a lower arm circumference within 2 cm of the unaffected side. Subjectively, 90.4% of the patients had either no or minimal arm swelling, and 96.8% of the patients had “good” or “excellent” overall arm function. The most common long-term symptom was numbness involving the upper, inner aspect of the affected arm (25.5%).

Conclusions:

Our data indicate that a complete AXLND can be performed with minimal long-term morbidity. The lower the morbidity of AXLND, the less acceptable are the unique complications of the SLN technique.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356366

DOI: 10.1097/01.sla.0000129358.80798.62
PubMed: 15213610
PubMed Central: 1356366

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PMC:1356366

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<author><name sortKey="Silberman, Allan W" sort="Silberman, Allan W" uniqKey="Silberman A" first="Allan W." last="Silberman">Allan W. Silberman</name>
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<author><name sortKey="Mcvay, Carie" sort="Mcvay, Carie" uniqKey="Mcvay C" first="Carie" last="Mcvay">Carie Mcvay</name>
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<author><name sortKey="Cohen, Jason S" sort="Cohen, Jason S" uniqKey="Cohen J" first="Jason S." last="Cohen">Jason S. Cohen</name>
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<author><name sortKey="Palmer, Daphne" sort="Palmer, Daphne" uniqKey="Palmer D" first="Daphne" last="Palmer">Daphne Palmer</name>
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<series><title level="j">Annals of Surgery</title>
<idno type="ISSN">0003-4932</idno>
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<imprint><date when="2004">2004</date>
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<front><div type="abstract" xml:lang="en"><sec><title>Objective:</title>
<p>To assess our long-term complications from complete axillary lymph node dissection (AXLND) in patients with breast cancer.</p>
</sec>
<sec><title>Summary Background Data:</title>
<p>Complete AXLND as part of the surgical therapy for breast cancer has come under increased scrutiny due the use of the sentinel lymph node (SLN) biopsy technique to assess the status of the axillary nodes. As the enthusiasm for the SLN technique has increased, our impression has been that the perceived complication rate from AXLND has increased dramatically while the negative aspects of the SLN technique have been underemphasized.</p>
</sec>
<sec><title>Methods:</title>
<p>Female patients seen in routine follow-up over a 1-year period were eligible for our retrospective study of the long-term complications from AXLND if they were a minimum of 1 year out from all primary therapy; ie, surgery, radiation, and/or chemotherapy. All patients had previously undergone either a modified radical mastectomy (MRM) or a segmental mastectomy with axillary dissection and postoperative radiation (SegAx/XRT). All patients had a Level I–III dissection. Objective measurements, including upper and lower arm circumferences and body mass index (BMI), were obtained, and a subjective evaluation from the patients was conducted.</p>
</sec>
<sec><title>Results:</title>
<p>Ninety-four patients were eligible for our study; 44 had undergone MRM, and 50 had undergone SegAx/XRT. The average number of nodes removed was 25.6 (standard deviation, 8). Thirty-three percent of the patients had positive nodal disease, 95% of the patients had an upper arm circumference within 2 cm of the unaffected side, and 93.3% had a lower arm circumference within 2 cm of the unaffected side. Subjectively, 90.4% of the patients had either no or minimal arm swelling, and 96.8% of the patients had “good” or “excellent” overall arm function. The most common long-term symptom was numbness involving the upper, inner aspect of the affected arm (25.5%).</p>
</sec>
<sec><title>Conclusions:</title>
<p>Our data indicate that a complete AXLND can be performed with minimal long-term morbidity. The lower the morbidity of AXLND, the less acceptable are the unique complications of the SLN technique.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="other"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
  <front><journal-meta><journal-id journal-id-type="nlm-ta">Ann Surg</journal-id>
<journal-id journal-id-type="publisher-id">Annals of Surgery</journal-id>
<journal-title>Annals of Surgery</journal-title>
<issn pub-type="ppub">0003-4932</issn>
<issn pub-type="epub">1528-1140</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">15213610</article-id>
<article-id pub-id-type="pmc">1356366</article-id>
<article-id pub-id-type="publisher-id">0000658-200407000-00001</article-id>
<article-id pub-id-type="doi">10.1097/01.sla.0000129358.80798.62</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Feature</subject>
</subj-group>
</article-categories>
<title-group><article-title>Comparative Morbidity of Axillary Lymph Node Dissection and the Sentinel Lymph Node Technique</article-title>
<subtitle>Implications for Patients With Breast Cancer</subtitle>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Silberman</surname>
<given-names>Allan W.</given-names>
</name>
<degrees>MD, PhD</degrees>
<xref ref-type="aff" rid="N0x93b3948.0x9392da8">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>McVay</surname>
<given-names>Carie</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="N0x93b3948.0x9392da8">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cohen</surname>
<given-names>Jason S.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="N0x93b3948.0x9392da8">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Altura</surname>
<given-names>Jack F.</given-names>
</name>
<xref ref-type="aff" rid="N0x93b3948.0x9392da8">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Brackert</surname>
<given-names>Sandra</given-names>
</name>
<degrees>RN</degrees>
<xref ref-type="aff" rid="N0x93b3948.0x9392da8">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sarna</surname>
<given-names>Gregory P.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="N0x93b3948.0x9392da8">†</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Palmer</surname>
<given-names>Daphne</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="N0x93b3948.0x9392da8">‡</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ko</surname>
<given-names>Albert</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="N0x93b3948.0x9392da8">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Memsic</surname>
<given-names>Leslie</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="N0x93b3948.0x9392da8">*</xref>
</contrib>
</contrib-group>
<aff id="N0x93b3948.0x9392da8">From the Divisions of *Surgical Oncology, †Medical Oncology, and ‡Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.<break></break>
</aff>
<pub-date pub-type="ppub"><month>7</month>
<year>2004</year>
</pub-date>
<volume>240</volume>
<issue>1</issue>
<fpage>1</fpage>
<lpage>6</lpage>
<copyright-statement>© 2004 Lippincott Williams & Wilkins, Inc.</copyright-statement>
<abstract><sec><title>Objective:</title>
<p>To assess our long-term complications from complete axillary lymph node dissection (AXLND) in patients with breast cancer.</p>
</sec>
<sec><title>Summary Background Data:</title>
<p>Complete AXLND as part of the surgical therapy for breast cancer has come under increased scrutiny due the use of the sentinel lymph node (SLN) biopsy technique to assess the status of the axillary nodes. As the enthusiasm for the SLN technique has increased, our impression has been that the perceived complication rate from AXLND has increased dramatically while the negative aspects of the SLN technique have been underemphasized.</p>
</sec>
<sec><title>Methods:</title>
<p>Female patients seen in routine follow-up over a 1-year period were eligible for our retrospective study of the long-term complications from AXLND if they were a minimum of 1 year out from all primary therapy; ie, surgery, radiation, and/or chemotherapy. All patients had previously undergone either a modified radical mastectomy (MRM) or a segmental mastectomy with axillary dissection and postoperative radiation (SegAx/XRT). All patients had a Level I–III dissection. Objective measurements, including upper and lower arm circumferences and body mass index (BMI), were obtained, and a subjective evaluation from the patients was conducted.</p>
</sec>
<sec><title>Results:</title>
<p>Ninety-four patients were eligible for our study; 44 had undergone MRM, and 50 had undergone SegAx/XRT. The average number of nodes removed was 25.6 (standard deviation, 8). Thirty-three percent of the patients had positive nodal disease, 95% of the patients had an upper arm circumference within 2 cm of the unaffected side, and 93.3% had a lower arm circumference within 2 cm of the unaffected side. Subjectively, 90.4% of the patients had either no or minimal arm swelling, and 96.8% of the patients had “good” or “excellent” overall arm function. The most common long-term symptom was numbness involving the upper, inner aspect of the affected arm (25.5%).</p>
</sec>
<sec><title>Conclusions:</title>
<p>Our data indicate that a complete AXLND can be performed with minimal long-term morbidity. The lower the morbidity of AXLND, the less acceptable are the unique complications of the SLN technique.</p>
</sec>
</abstract>
<abstract abstract-type="toc"><p>Our data evaluating the long-term complications of a complete axillary lymph node dissection indicate that this operation can be performed with minimal long-term morbidity. The recent literature appears to overestimate the complications of axillary node dissection and underestimate the complications of the sentinel lymph node technique in the understandable enthusiasm surrounding a new methodology. The implications of the sentinel lymph node technique are discussed.</p>
</abstract>
</article-meta>
</front>
</pmc>
</record>

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Comparative Morbidity of Axillary Lymph Node Dissection and the Sentinel Lymph Node Technique

Comparative Morbidity of Axillary Lymph Node Dissection and the Sentinel Lymph Node Technique

Source :

Abstract

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