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Axillary dissection in primary breast cancer: variations of the surgical technique and influence on morbidity.

Identifieur interne : 002128 ( PubMed/Corpus ); précédent : 002127; suivant : 002129

Axillary dissection in primary breast cancer: variations of the surgical technique and influence on morbidity.

Auteurs : Sebastian Wojcinski ; Sirin Nuengsri ; Peter Hillemanns ; Werner Schmidt ; Mustafa Deryal ; Kubilay Ertan ; Friedrich Degenhardt

Source :

Cancer management and research [ 1179-1322 ] ; 2012.

RBID : pubmed:22570566

Abstract

Lymphedema of the arm is the most common and impairing complication after breast cancer surgery with axillary lymph node dissection (ALND). Our prospective study evaluated the effect of two different surgical techniques for ALND on postoperative morbidity. Patients were scheduled to undergo ALND. Patients in group 1 (n = 17) underwent the most common and standard technique of ALND, which uses sharp dissection of the tissue and subsequent electro-coagulation of bleedings. Patients in group 2 (n = 17) underwent a modified standard technique of ALND with clamping and ligatures of all resection margins. Postoperative wound secretion was quantified and patients were followed up for 6 months to assess long-term morbidity. The variations in surgical technique had no significant influence on the outcome variables. However, patients in group 2 showed a tendency to less wound secretion (713 versus 802 mL; P = nonsignificant), a decreased rate of immediate postoperative seromas (11.8 versus 23.5%; P = nonsignificant) and less lymphedema after 3 months (29.4 versus 41.2%; P = nonsignificant). Moreover, the number of resected lymph nodes correlated with the total amount of drained fluid (P = 0.006), the duration of the drain (P = 0.015), and the risk for the development of lymphedema after 3 months (P = 0.016). The described variations in surgical technique had no influence on the outcomes of the patients. The number of resected axillary lymph nodes remains the most important risk factor for treatment-related morbidity. Therefore, a well-balanced choice of the extent of the axillary dissection should be the surgeon's main concern.

DOI: 10.2147/CMAR.S30207
PubMed: 22570566

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<author><name sortKey="Wojcinski, Sebastian" sort="Wojcinski, Sebastian" uniqKey="Wojcinski S" first="Sebastian" last="Wojcinski">Sebastian Wojcinski</name>
<affiliation><nlm:affiliation>Franziskus Hospital, Department of Obstetrics/Gynecology, Bielefeld, Germany.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Nuengsri, Sirin" sort="Nuengsri, Sirin" uniqKey="Nuengsri S" first="Sirin" last="Nuengsri">Sirin Nuengsri</name>
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<author><name sortKey="Hillemanns, Peter" sort="Hillemanns, Peter" uniqKey="Hillemanns P" first="Peter" last="Hillemanns">Peter Hillemanns</name>
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<author><name sortKey="Schmidt, Werner" sort="Schmidt, Werner" uniqKey="Schmidt W" first="Werner" last="Schmidt">Werner Schmidt</name>
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<author><name sortKey="Deryal, Mustafa" sort="Deryal, Mustafa" uniqKey="Deryal M" first="Mustafa" last="Deryal">Mustafa Deryal</name>
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<author><name sortKey="Ertan, Kubilay" sort="Ertan, Kubilay" uniqKey="Ertan K" first="Kubilay" last="Ertan">Kubilay Ertan</name>
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<author><name sortKey="Degenhardt, Friedrich" sort="Degenhardt, Friedrich" uniqKey="Degenhardt F" first="Friedrich" last="Degenhardt">Friedrich Degenhardt</name>
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<front><div type="abstract" xml:lang="en">Lymphedema of the arm is the most common and impairing complication after breast cancer surgery with axillary lymph node dissection (ALND). Our prospective study evaluated the effect of two different surgical techniques for ALND on postoperative morbidity. Patients were scheduled to undergo ALND. Patients in group 1 (n = 17) underwent the most common and standard technique of ALND, which uses sharp dissection of the tissue and subsequent electro-coagulation of bleedings. Patients in group 2 (n = 17) underwent a modified standard technique of ALND with clamping and ligatures of all resection margins. Postoperative wound secretion was quantified and patients were followed up for 6 months to assess long-term morbidity. The variations in surgical technique had no significant influence on the outcome variables. However, patients in group 2 showed a tendency to less wound secretion (713 versus 802 mL; P = nonsignificant), a decreased rate of immediate postoperative seromas (11.8 versus 23.5%; P = nonsignificant) and less lymphedema after 3 months (29.4 versus 41.2%; P = nonsignificant). Moreover, the number of resected lymph nodes correlated with the total amount of drained fluid (P = 0.006), the duration of the drain (P = 0.015), and the risk for the development of lymphedema after 3 months (P = 0.016). The described variations in surgical technique had no influence on the outcomes of the patients. The number of resected axillary lymph nodes remains the most important risk factor for treatment-related morbidity. Therefore, a well-balanced choice of the extent of the axillary dissection should be the surgeon's main concern.</div>
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<Abstract><AbstractText>Lymphedema of the arm is the most common and impairing complication after breast cancer surgery with axillary lymph node dissection (ALND). Our prospective study evaluated the effect of two different surgical techniques for ALND on postoperative morbidity. Patients were scheduled to undergo ALND. Patients in group 1 (n = 17) underwent the most common and standard technique of ALND, which uses sharp dissection of the tissue and subsequent electro-coagulation of bleedings. Patients in group 2 (n = 17) underwent a modified standard technique of ALND with clamping and ligatures of all resection margins. Postoperative wound secretion was quantified and patients were followed up for 6 months to assess long-term morbidity. The variations in surgical technique had no significant influence on the outcome variables. However, patients in group 2 showed a tendency to less wound secretion (713 versus 802 mL; P = nonsignificant), a decreased rate of immediate postoperative seromas (11.8 versus 23.5%; P = nonsignificant) and less lymphedema after 3 months (29.4 versus 41.2%; P = nonsignificant). Moreover, the number of resected lymph nodes correlated with the total amount of drained fluid (P = 0.006), the duration of the drain (P = 0.015), and the risk for the development of lymphedema after 3 months (P = 0.016). The described variations in surgical technique had no influence on the outcomes of the patients. The number of resected axillary lymph nodes remains the most important risk factor for treatment-related morbidity. Therefore, a well-balanced choice of the extent of the axillary dissection should be the surgeon's main concern.</AbstractText>
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<CommentsCorrectionsList><CommentsCorrections RefType="Cites"><RefSource>J Natl Cancer Inst. 2001 Jan 17;93(2):96-111</RefSource>
<PMID Version="1">11208879</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Radiother Oncol. 1995 Apr;35(1):11-5</RefSource>
<PMID Version="1">7569011</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Eur J Surg. 1999 Jan;165(1):9-13</RefSource>
<PMID Version="1">10069628</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>J Clin Oncol. 2007 Aug 20;25(24):3657-63</RefSource>
<PMID Version="1">17485711</PMID>
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<CommentsCorrections RefType="Cites"><RefSource>Acta Oncol. 2000;39(3):389-92</RefSource>
<PMID Version="1">10987236</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Mem Acad Chir (Paris). 1954 Mar 24-Apr 7;80(12-14):394-6</RefSource>
<PMID Version="1">13176072</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Breast Cancer Res Treat. 2011 Oct;129(3):675-89</RefSource>
<PMID Version="1">21743996</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Cancer. 2005 Feb 1;103(3):451-61</RefSource>
<PMID Version="1">15611971</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>J Clin Oncol. 2006 Nov 1;24(31):5091-7</RefSource>
<PMID Version="1">17033037</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Eur J Surg Oncol. 2006 Sep;32(7):729-32</RefSource>
<PMID Version="1">16777367</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Semin Radiat Oncol. 2003 Jul;13(3):214-25</RefSource>
<PMID Version="1">12903011</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>ANZ J Surg. 2006 Dec;76(12):1088-95</RefSource>
<PMID Version="1">17199696</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Eur J Surg Oncol. 2003 May;29(4):341-50</RefSource>
<PMID Version="1">12711287</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Ann Surg Oncol. 2009 Jul;16(7):1959-72</RefSource>
<PMID Version="1">19365624</PMID>
</CommentsCorrections>
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Axillary dissection in primary breast cancer: variations of the surgical technique and influence on morbidity.

Axillary dissection in primary breast cancer: variations of the surgical technique and influence on morbidity.

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