title: Long-term morbidity of axillary lymph node dissection: implications for patients with carcinoma breast.
abstract: BACKGROUND
  To assess the long term complications of level II Axillary Lymph Node Dissection (AXLND) in patients with breast cancer and to see if they are high enough to warrant a Sentinel Lymph Node (SLN) biopsy in all patients presenting with carcinoma breast in our setup in Pakistan.
  
  
  METHODS
  This study was conducted at Surgical Unit IV, Department of Surgery, Combined Military Hospital, Rawalpindi. Upper, lower arm circumferences and body mass index were ascertained in post Modified Radical Mastectomy (MRM) with level II AXLND, in female patients who had undergone surgeries from 1992 to 2008. Patient's perception of degree of lymph oedema, arm function and other symptoms like pain, tingling and numbness was noted. The number of lymph nodes removed, number of positive nodes and post operative radiotherapy were also recorded from the hospital records.
  
  
  RESULTS
  Thus upper arm circumference in 85.7% patients and lower arm circumference in 89.2% patients was within 2 Cm of the unaffected side. No, moderate and severe arm swelling was described by 83.35% of patients, 11.6% of patients and one patient respectively and 41.5% of patients describing some arm swelling had positive lymph nodes. Thus even if they had gone (SLN) biopsy, these patients would have had a subsequent AXLND. Over 94% of patients had either good or excellent arm function with most in the excellent range.
  
  
  CONCLUSIONS
  The patients at significant risk for positive nodal may be better served with an AXLND rather than the SLN technique.
authors.affiliation: Department of Surgery, Combined Military Hospital Rawalpindi, Pakistan. me_hassan@hotmail.com
authors.forename: Rana Hassan
authors.initials: RH
authors.lastname: Javaid
authors.forename: Eitezaz Ahmed
authors.initials: EA
authors.lastname: Bashir
authors.forename: Ahmed
authors.initials: A
authors.lastname: Waqas
authors.forename: Asma Afzal
authors.initials: AA
authors.lastname: Kiani
authors.forename: Ahmed
authors.initials: A
authors.lastname: Raza
authors.forename: Shazia
authors.initials: S
authors.lastname: Manzoor
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D010154:Pakistan; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects