title: Comparative morbidity of axillary lymph node dissection and the sentinel lymph node technique: implications for patients with breast cancer.
abstract: OBJECTIVE
  To assess our long-term complications from complete axillary lymph node dissection (AXLND) in patients with breast cancer.
  
  
  BACKGROUND
  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.
authors.affiliation: Divisions of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA. AWS222@aol.com
authors.forename: Allan W
authors.initials: AW
authors.lastname: Silberman
authors.forename: Carie
authors.initials: C
authors.lastname: McVay
authors.forename: Jason S
authors.initials: JS
authors.lastname: Cohen
authors.forename: Jack F
authors.initials: JF
authors.lastname: Altura
authors.forename: Sandra
authors.initials: S
authors.lastname: Brackert
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Sarna
authors.forename: Daphne
authors.initials: D
authors.lastname: Palmer
authors.forename: Albert
authors.initials: A
authors.lastname: Ko
authors.forename: Leslie
authors.initials: L
authors.lastname: Memsic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008209:Lymphedema / Q000209:etiology; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*