title: Morbidity after conventional dissection of axillary lymph nodes in breast cancer patients.
abstract: BACKGROUND
  Conventional axillary lymph node dissection (ALND) has recently become less radical. The treatment morbidity effects of reduced ALND aggressiveness are unknown. This article investigates the prevalence of the main complications of ALND: lymphedema, range-of-motion restriction, and arm paresthesia and pain.
  
  
  METHODS
  This cross-sectional study included 200 women with invasive breast cancer who underwent breast-conserving surgery (82.5%, n = 165) or mastectomy (17.5%, n = 35) with ALND from 2007 to 2011. Arm perimetry was used to assess lymphedema, defined as a difference >2 cm in the upper arm circumference between the nonsurgical and surgical arms. Range-of-motion restriction was assessed by evaluating the degree of arm abduction. Paresthesia was measured in the inner and proximal arm regions. Arm pain was assessed by directly questioning the patients and defined as either present or absent.
  
  
  RESULTS
  The average (±SD) time between ALND and morbidity evaluation was 35 ± 18 months (range, 7-60 months). The average dissected lymph node number per patient was 14 ± 4 (range, 6-30 lymph nodes). Only 3.5% (n = 7) of the patients presented with lymphedema. Single-incision approaches to breast tumor and ALND (P = 0.04) and the presence of a postoperative seroma (P = 0.02) were associated with lymphedema in univariate analysis. Paresthesia was the most frequent side effect observed (53% of patients, n = 106). This complication was associated with increased age (P < 0.0001) and a larger dissected lymph node number (P = 0.01) in univariate and multivariate analysis. Additionally, 24% (n = 48) of patients had noticeable limited arm abduction. Among the patients, 27.5% (n = 55) experienced sporadic arm pain corresponding to the surgically treated armpit. In multivariate analysis, the pain risk was 1.9-fold higher in patients who underwent ALND corresponding to their dominant arm (95% CI, 1.0-3.7, P = 0.04).
  
  
  CONCLUSIONS
  Conventional ALND in breast cancer patients can result in unwanted complications. However, the current lymphedema prevalence is lower than that of the other analyzed side effects.
authors.affiliation: Department of Gynecology, Western Paraná State University (Universidade Estadual do Oeste do Paraná, UNIOESTE), Cascavel, Paraná, Brazil. ewss@ig.com.br.
authors.forename: Emerson Wander Silva
authors.initials: EW
authors.lastname: Soares
authors.forename: Hildebrando Massahiro
authors.initials: HM
authors.lastname: Nagai
authors.forename: Luis César
authors.initials: LC
authors.lastname: Bredt
authors.forename: Ademar Dantas
authors.initials: AD
authors.lastname: da Cunha
authors.forename: Reginaldo José
authors.initials: RJ
authors.lastname: Andrade
authors.forename: Géser Vinícius Silva
authors.initials: GV
authors.lastname: Soares
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology; D008408:Mastectomy / Q000009:adverse effects*; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D009017:Morbidity; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology*; D010292:Paresthesia / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011379:Prognosis; D016059:Range of Motion, Articular