title: Early and late morbidity associated with axillary levels I-III dissection in breast cancer.
abstract: OBJECTIVE
  Axillary dissection may cause substantial morbidity in breast cancer patients. The purpose of this study was to investigate the value of a registration method of morbidity of the arm and shoulder, which is frequently used by surgeons and which includes the measurement of range of movement, strength, and pain.
  
  
  METHODS
  We surveyed 148 patients who had received an axillary dissection as part of breast cancer surgery. Of these patients, 77 had undergone axillary dissection 6-12 months ago and 71 patients more than 5 years ago. In all patients, an objective measurement of shoulder movement and a subjective measurement of pain and arm strength was performed.
  
  
  RESULTS
  A difference of more than 20 degrees in abduction, ventral elevation, or dorsal elevation occurred in 12% of the patients. Pain or loss of strength were measured in half of the patients. Shoulder movement, pain, and arm strength were not significantly different between the patients who underwent mastectomy or breast conserving surgery. Also, no significant difference could be found in shoulder movement, pain, and arm strength between the patients who underwent axillary dissection 6-12 months ago and those who underwent it more than 5 years ago.
  
  
  CONCLUSIONS
  Pain, loss of arm strength, and limitation of shoulder movement are frequent complaints after axillary dissection for breast cancer and appear to be independent of the length of follow-up and the type of surgery (i.e., breast-conservation or mastectomy).
authors.affiliation: Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: Miranda F
authors.initials: MF
authors.lastname: Ernst
authors.forename: Adri C
authors.initials: AC
authors.lastname: Voogd
authors.forename: Willemijn
authors.initials: W
authors.lastname: Balder
authors.forename: Jean H G
authors.initials: JH
authors.lastname: Klinkenbijl
authors.forename: Jan A
authors.initials: JA
authors.lastname: Roukema
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000502:physiology; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009017:Morbidity; D009068:Movement; D010149:Postoperative Pain / Q000209:etiology*; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000502:physiology; D013718:Tensile Strength