title: Complications of level I and II axillary dissection in the treatment of carcinoma of the breast.
abstract: OBJECTIVE
  To assess the complications of level I and II axillary lymph node dissection in the treatment of stage I and II breast cancer, with breast-conservation surgery and mastectomy.
  
  
  BACKGROUND
  The role of axillary dissection for staging, and as an effective means of controlling regional nodal disease, has long been recognized. As small and low-grade lesions have been detected more frequently, and as its therapeutic impact has been questioned, axillary dissection has increasingly been perceived as associated with significant complications.
  
  
  METHODS
  Two hundred patients, 112 of whom had breast-conservation surgery with axillary dissection and 88 of whom had total mastectomy with axillary dissection, were evaluated 1 year or more after surgery for arm swelling as well as nonedema complications. All patients had arm circumference measurements at the same four sites on both the operated and nonoperated sides.
  
  
  RESULTS
  No patient had an axillary recurrence. The mean difference in circumference on the nonoperated versus operated side was 0.425 cm +/- 1.39 at the midbiceps (p < 0.001), 0.315 cm +/- 1.27 at the antecubital fossa (p < 0.001), 0.355 cm +/- 1.53 at the midforearm (p < 0.005), and 0.055 cm +/- 0.75 at the wrist (n.s.). Seven patients (3.5%) had mild swelling of the hand. Heavy and obese body habitus were the only significant predictors of edema on multivariate analysis. One hundred fifty-three (76.5%) patients had numbness or paresthesias of the medial arm and/or axilla after surgery; in 125 (82%) of these, the problem had lessened or had resolved on follow-up assessment.
  
  
  CONCLUSIONS
  The characterization of a level I and II axillary dissection as a procedure with significant complications does not appear justified based on this experience.
authors.affiliation: Department of Surgery, Kaplan Comprehensive Cancer Center, New York University Medical Center, New York City 10016, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Roses
authors.forename: A D
authors.initials: AD
authors.lastname: Brooks
authors.forename: M N
authors.initials: MN
authors.lastname: Harris
authors.forename: R L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: J
authors.initials: J
authors.lastname: Mitnick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology