Objective. This study describes in detail the surgery-related symptoms following axillary lymph node dissection in breast cancer patients and considers both their significance for long term quality of life and the impact of possible influencing factors.
Material and methods: Three hundred and ninety six patients were studied retrospectively using a self-report questionnaire and a clinical examination. The symptoms, numbness, pain, edema, arm strength and mobility were evaluated. The subjective assessment of the degree of symptom intensity was compared with objective measurements. The extent of surgery (number of resected nodes, level of dissection) as well as the influence of demographic, oncologic and adjuvant measures (age, time interval, number of involved nodes, chemotherapy) were evaluated.
Results. Shoulder-arm morbidity and fear of cancer recurrence were the most important long-term sources of distress following breast cancer surgery in our study population. Demographic, oncologic and therapeutic measures including the extent of surgery had no influence on long-term morbidity. The intensity of all evaluated symptoms was reported to be more severe in patients' subjective statements than in the results of clinical assessment.
Conclusion. Shoulder-arm morbidity following axillary dissection is a frustrating polysymptomatic disease that seems to be relatively unaffected by therapeutic measures. The surgical trauma necessary for adequate tumor staging (removal of 10 lymph nodes) seems decisive for the postsurgery syndrome following axillary dissection. For node-positive patients complete axillary clearing may improve tumor control without worsening long-term-morbidity. New techniques, such as the sentinel-node-biopsy, that selects patients with negative axillary status while preserving the integrity of axillary structures, may improve the overall morbidity.
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Moffat FL, Jr., Senofsky GM, Davis K, Clark KC, Robinson DS, Ketcham AS: Axillary node dissection for early breast cancer: some is good, but all is better. J Surg Oncol 51(1): 8-13, 1992
Moore MP, Kinne DW: Is axillary lymph node dissection necessary in the routine management of breast cancer? Yes. Important Adv Oncol 245-250, 1996
Orr RK: The impact of prophylactic axillary node dissection on breast cancer survival — a Bayesian meta-analysis. Ann Surg Oncol 6(1): 17-18, 1999
Fisher B, Redmond C, Fisher ER, Bauer M, Wolmark N, Wickerham DL, Deutsch M, Montague E, Margolese R, Foster R: Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 312(11): 674-681, 1985
Silverstein MJ, Gierson ED, Waisman JR, Senofsky GM, Colburn WJ, Gamagami P: Axillary lymph node dissection for T1a breast carcinoma. Is it indicated? Cancer 73(3): 664-667, 1994
Chontos AJ, Maher DP, Ratzer ER, Fenoglio ME: Axillary lymph node dissection: is it required in T1a breast cancer? J Am Coll Surg 184(5): 493-498, 1997
Xianglin D, Freeman JL, Goodwin S: The declining use of axillary dissection in patients with early stage breast cancer. Breast Cancer Res Treat 53(2): 137-144, 1999
Keramopoulos A, Tsionou C, Minaretzis D, Michalas S, Aravantinos D: Arm morbidity following treatment of breast cancer with total axillary dissection: a multivariated approach. Oncology 50(6): 445-449, 1993
Maunsell E, Brisson J, Deschenes L: Arm problems and psychological distress after surgery for breast cancer. Can J Surg 36: 315-320, 1993
Hack TF, Cohen L, Katz J, Robson L, Goss P: Physical and psychological morbidity after axillary lymph node dissection for breast cancer. J Clin Oncol 17: 143-149, 1999
Mathiesen O, Carl J, Bonderup O, Panduro J: Axillary sampling and the risk of erroneous staging of breast cancer. An analysis of 960 consecutive patients. Acta Oncol 29(6): 721-725, 1990
Suzanne F, Emering C, Wattiez A, Bournazeau JA, Bruhat MA, Jaquetin B: Axillary lymphadenectomy by lipoaspiration and endoscopic picking. A propos of 72 cases. Chirurgie 122: 138-142, 1997
Kamprath S, Bechler J, Kuhne-Heid R, Krause N, Schneider A: Endoscopic axillary lymphadenectomy without prior liposuction. Development of a technique and initial experience. Surg Endosc 13(12): 1226-1229, 1999
Giuliano AE, Kirgan DM, Guenther JM, Morton DL: Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 220(3): 391-398, 1994
Krag DN, Weaver DL, Alex JC, Fairbank JT: Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 2(6): 335-339, 1993
Krag D, Weaver DL, Ashikaga T, Moffat F, Klimberg S, Shriver C, Felman S, Kusminsky R, Gadd M, Kuhn J, Harlow S, Beitsch P: The sentinel node in breast cancer. A multicenter validation study. New Eng J Med 339(14): 941-946, 1998
Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M, Costa A, de Cicco C, Geraghty JG, Luini A, Sacchini V, Veronesi P: Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 349(9069): 1864-1867, 1997
Noguchi M, Tsugawa K, Bando E, Kawahara F, Miwa K, Yokoyama K, Nakajima K, Tonami N: Sentinel-lymphadenectomy in breast cancer: identification of sentinel-lymph node and detection of metastases. Breast Cancer Res Treat 53(2): 97-104, 1999
Roses DF, Brooks AD, Harris MN, Shapiro RL, Mitnick J: Complications of Level I and II axillary dissection in the treatment of carcinoma of the breast. Ann Surg 230(2): 194-201, 1999
Brismar B, Ljungdahl I: Postoperative lymphoedema after treatment of breast cancer: Acta Chir Scand 149: 687-689, 1983
Larson D, Weinstein M, Goldberg I, Silver B, Recht A, Cady B, Silen W, Harris JR: Edema of the arm as a function of the extent of axillary surgery in patients with stage I–II carcinoma of the breast treated with primary radiotherapy. Int J Radiol Oncol Biol Phys 12: 1575-1582, 1986
Liljegren G, Holmberg L: Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage I. Results from a randomised trial. Eur J Cancer 33(2): 193-199, 1997
Tasmuth T, von Smitten K, Kalso E: Pain and other symptoms during the first year after radical and conservative surgery for breast cancer. Br J Cancer 74: 2024-2031, 1996
Ivens D, Hoe AL, Podd TJ, Hamilton CR, Taylor I, Royle GT: Assessment of morbidity from complete axillary dissection. Br J Cancer 66: 136-138, 1992
Kuhnke E: Determination of volume by measuring the circumferences. Folia Angiol 24: 228-232, 1976
Dorval M, Maunsell E, Deschenes L, Brisson J, Masse B: Long-term quality of life after breast cancer: comparison of 8-year survivors with population controls. J Clin Oncol 16(2): 487-494, 1998
Tobin MB, Psych MRC, Lacey HJ, Psych FRC, Meyer L, Mortimer PS: The psychological morbidity of breast cancer-related swelling. Cancer 72: 3248-3252, 1993
White RE, Vezeridis MP, Konstadoulakis M, Cole BF, Wanebo HJ, Bland KI: Therapeutic options and results for the management of minimally invasive carcinoma of the breast: influence of axillary dissection for treatment of T1a and T1b lesions. J Am Coll Surg 183(6): 575-582, 1996
Sosa JA, Diener-West M, Gusev Y, Choti MA, Lange JR, Dooley D, Zeiger M: Association between extent of axillary lymph node dissection and survival in patients with stage I breast cancer. Ann Surg Oncol 5(2): 140-149
Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, Kjaer M, Gadeberg CC, Mouridsen HT, Jensen MB, Zedeler K: Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Tria. N Engl J Med 337(14): 949-955, 1997
Ragaz J, Jackson SM, Le N, Plenderleith IH, Spinelli JJ, Basco VE, Wilson KS, Knowling MA, Coppin CM, Paradis M, Coldman AJ, Olivotto IA: Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 337(14): 956-962, 1997
Tate JJT, Lewis V, Archer T, Guyer PG, Royle GT, Taylor I: Ultrasound detection of axillary lymph node metastases in breast cancer. Eur J Surg Oncol 15: 271-276, 1998
De Freitas R, Costa V, Schneider RV, Nicolau MA, Mrussi E: Accuracy of ultrasound and clinical examination in the diagnosis of axillary lymph node metastases in breast cancer. Eur J Surg Oncol 17: 240-244, 1991
Avril N, Dose J, Jänicke F, Ziegler S, Römer W, Weber W, Herz M, Nathrath W, Graeff H, Schwaiger M: Assessment of axillary lymph node involvement in breast cancer patients with positron emission tomography using radiolabeled 2-/flurine-18-fluoro-2-deoxy-D-glucose. J Natl Cancer Inst 88: 1204-1209, 1996
Fowble B, Solin LJ, Schutz DJ: Frequency, sites of relapse and outcome of regional node failure following conservative surgery and radiation for early breast cancer. Int J Radiat Oncol Biol Phys 17: 703-710, 1989
Recht A, Pierce SM, Abner A: Regional nodal failure after conservative surgery and radiotherapy for early stage breast cancer. J Clin Oncol 9: 988-996, 1991
Christensen SB, Lundgren E: Sequelae of axillary dissection versus axillary sampling with or without irradiation for breast cancer. Acta Chir Scand 155: 515-520, 1989
Constant CR, Murley AHG: A clinical method of function assessment of the shoulder. Clin Ortop 214: 160-164, 1985
Aitken RJ, Gaze MN, Rodger A, Chetty U, Forrest APM: Arm morbidity within a trial of mastectomy and either nodal sample with selective radiotherapy or axillary clearance. Br J Surg 76(6): 568-571
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Kuehn, T., Klauss, W., Darsow, M. et al. Long-Term Morbidity Following Axillary Dissection in Breast Cancer Patients – Clinical Assessment, Significance for Life Quality and the Impact of Demographic, Oncologic and Therapeutic Factors. Breast Cancer Res Treat 64, 275–286 (2000). https://doi.org/10.1023/A:1026564723698
- axillary dissection
- breast cancer
- quality of life