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Complications of Axillary Lymph Node Dissection in Treatment of Early Breast Cancer: A Comparison of MRM and BCS

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Abstract

ALND is part of primary management of breast cancer. In spite of complications it causes, its use in prognostication and planning adjuvant treatment in carcinoma breast is unquestioned. Prospective study was conducted on 100 patients of EBC [clinical stage I&II]. 50 underwent MRM, 50 WLE&AC. Patients were asked to rate on likert scale various symptoms on follow up. Multivariate regression analysis was carried out between pain, numbness, limitation of shoulder or arm motion, arm swelling, infection and age, BSA, clinical status of axilla, no. of LNs removed, no. of positive LNs, co-morbidities, chemotherapy, radiotherapy, hormone therapy, type of surgery. 60% patients reported one or more symptoms. Numbness, pain were reported by 39% each, arm swelling by 25%, limitation of arm movement by 16%, infection by 11%. Symptoms were mild in majority. On regression analyses numbness was associated with EBRT, co-morbidity, type of operation (p value- <0.01, <0.01, <0.05), pain had no significant association, swelling with EBRT, no. of LNs positive for metastases, co-morbidity, type of operation (p value- <0.01, <0.05, <0.05, <0.01), limitation of arm motion with no. of positive LNs (p value < 0.01), infection with no. of positive LNs, co-morbidity (p value <0.05, <0.05). There was no statistically significant difference in reporting of symptoms by patients in two groups. ALND caused morbidity in majority of patients but few reported severe symptoms and interference with daily activities.

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References

  1. Goel AK, Seenu V, Shukla NK, Raina V (1995) Breast Cancer presentation at a regional cancer centre. Natl Med J India 8:6–9

    PubMed  CAS  Google Scholar 

  2. Moore MP, Kinne DW (1997) Axillary lymphadenopathy: a diagnostic and therapeutic procedure. J Surg Oncol 66:2–6

    Article  PubMed  CAS  Google Scholar 

  3. Nagel PHAF, Bruggink EDH, Wobbes Th, Strobbe LJA (2003) Arm morbidity after complete axillary lymph node dissection for breast cancer. Acta Chir Belg 103:212–216

    PubMed  CAS  Google Scholar 

  4. Say CC, Donegan W (1979) A biostatical evaluation of complications from Mastectomy. Surg Gynaecological abstract 138:370–376

    Google Scholar 

  5. Aitken DR, Hinton JP (1983) Complications associated with mastectomy Surg Clin North Am 63:1331–1352

    CAS  Google Scholar 

  6. Budd DC, Cochran RC, Sturtz DL et al (1978) Surgical morbidity after mastectomy operations. Am J Surg 135:218–220

    Article  PubMed  CAS  Google Scholar 

  7. Kissin MW, Thompsone M, Price AB (1982) The inadequacy of axillary sampling in breast cancer. Lancet 29:1210–1211

    Article  Google Scholar 

  8. Siegel BM, Mayzel MD, Love SM (1990) Level I and II axillary dissection in the treatment of early-stage breast cancer. Arch Surg 125:1144–1147

    PubMed  CAS  Google Scholar 

  9. Rosen PP, Lesser ML, Kinne DW, Beattie E (1983) Discontinuous or “skip” metastases in breast carcinoma. Analysis of 1228 axillary dissections. Ann Surg 197:276–283

    Article  PubMed  CAS  Google Scholar 

  10. Veronesi U, Giovanni P, Galimberti V et al (1997) Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph nodes. Lancet 349:1864–1867

    Article  PubMed  CAS  Google Scholar 

  11. Petrek JA, Peters MM, Nori S et al (1990) Axillary lymphadenectomy. A prospective randomized trial of thirteen factors influencing drainage, including early and delayed arm mobilization. Arch Surg 125:378–382

    PubMed  CAS  Google Scholar 

  12. Dauson I, Stain L, Heslinga JM et al (1989) Effect of shoulder immobilization on wound seroma and shoulder dysfunction following modified radical mastectomy. A randomized prospective clinical trial. Br J Surg 76:311–312

    Article  Google Scholar 

  13. Jansen RFM, Van Geel AN, de Groot HGW (1990) Immediate versus delayed shoulder exercises after axillary lymph node dissection. Am J Surg 160:481–484

    Article  PubMed  CAS  Google Scholar 

  14. Janni W, Rjosk D, Dimpfl TH, Haertl K, Storbl B, Hepp F et al (2001) Quality of life influenced by the primary surgical treatment for stage I-III breast cancer- long term follow up of a matched pair analysis. Ann Surg Oncol 8:542–548

    PubMed  CAS  Google Scholar 

  15. Cohen L, Hack TF, de Moor C, Katz J, Goss PE (2000) The effects of type of surgery and time on the psychological adjustment in women after breast cancer treatment. Ann Surg Oncol 7:427–434

    Article  PubMed  CAS  Google Scholar 

  16. Dubashi B, Vidhubala E, Cyriac S, Sagar TG (2010) Quality of life among young women with breast cancer: study from a tertiary cancer institute in south India. Indian J of Cancer 47:142–147, cited 2011 May 22

    Article  CAS  Google Scholar 

  17. Zarali O, Karman N, Ozaslan C, Huseyinova S, Altinok M (2009) Long term complications associated with mastectomy and axillary dissection. Acta Oncol Turcica 42:17–23

    Google Scholar 

  18. Zanapalioglu Y, Atahen K, Gur S, Cokmez A, Tarcan E (2009) Effect of breast conserving surgery in quality of life in breast cancer patients. J Br Health 5(3):152–156

    Google Scholar 

  19. Fisher B (2005) A vignette from breast cancer history: one hundred years after the Greenough report. J Am Bell Surg 2001(4):484–486

    Article  Google Scholar 

  20. Fisher B, Redmond C, Wormark N (1989) Eight year results of randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in treatment of breast cancer. N Eng J Med 320(13):822–828

    Article  CAS  Google Scholar 

  21. Sarrazin D, Le M, Rochard F (1989) Ten years results of randomized trial comparing a conservative treatment and mastectomy in early breast cancer. Radiother and Oncol 14:177–184

    Article  CAS  Google Scholar 

  22. Veronesi U, Benfi A, Del Vecchio M et al (1998) Comparison of Halsted mastectomy with quadrantectomy, axillary dissection and radiotherapy in early breast cancer long term results. Eur J Cancer Clin Oncol 22:1085–1089

    Article  Google Scholar 

  23. Fisher B, Redmond C, Fisher ER et al (1985) Ten year results of a randomized clinical trial comparing radical mastectomy and trial mastectomy with or without radiation. NEJM 312:674–681

    Article  PubMed  CAS  Google Scholar 

  24. Dewar JA, Sarrazin D et al (1987) Management of the axilla in conservatively treated breast cancer: 592 patients treated at Institute Gestave Roussy. Int J Radiot Oncol Biol Phys 13:475–481

    Article  CAS  Google Scholar 

  25. Fisher B, Wormark N, Bauer M et al (1981) The accuracy of clinical nodal staging and of limited axillarydissection as a determinant of histological nodal status in carcinoma of the breast. Surg Gyn Obst 152:765–772

    PubMed  CAS  Google Scholar 

  26. Fowble B, Solen L, Shultz D, Goodman R (1989) Frequency, sites of relapse and outcome of regional node failures following conservative surgery and radiation for early breast cancer. Int J Radiat Oncol Biol Phys 17:703–710

    Article  PubMed  CAS  Google Scholar 

  27. Gerard JP, Montbarbon JF et al (1985) Conservative treatment of early carcinoma of the breast: significance of axillary dissection and Iridium implant. Radiat Oncol 3:17–22

    Article  CAS  Google Scholar 

  28. Leung S, Otmazguine Y et al (1986) Local regional recurrences following radical external beam irradiation and interstitial implantation for operable breast cancer – a 23 year experience. Radiat Oncol 5:1–10

    Article  CAS  Google Scholar 

  29. Veronesi U, Paganelli G, Viale G et al (1999) Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 91:368–373

    Article  PubMed  CAS  Google Scholar 

  30. Nandakumar A, Anantha N, Venugopal TC et al (1995) Survival in breast cancer: a population based study in Bangalore, India. Int J Cancer 60:593–596

    Article  PubMed  CAS  Google Scholar 

  31. Raina V, Bhutani M, Bedi R et al (2005) Clinical features and prognostic factors of early breast cancer at a major cancer centre in North India. Ind J Cancer 42:40–45

    Article  Google Scholar 

  32. Pegorao RJ, Nirmal D, Bryer JV et al (1985) Clinical patterns of presentation of breast cancer of different racial group in South Africa. S Afr Med J 68:808–810

    Google Scholar 

  33. Bland KI, Vezerides MP et al (1999) Breast: principles of surgery, 533–601

  34. Kemperman H, Boyer J, Mar A et al (1995) Prognostic factors for survival after breast conserving therapy for stage I & II breast cancer. The role of local recurrence Aus J Cancer 31A:690–698

    CAS  Google Scholar 

  35. Mansfield CH, Kormarvicay LT et al (1995) Cancer 75:2328–2336

    Article  PubMed  CAS  Google Scholar 

  36. Jacobson JA, Danform DN et al (1995) Ten year results of a comparison of conservation with mastectomy in the treatment of stage I & II breast cancer. The New Eng J Med 332:907–911

    Article  CAS  Google Scholar 

  37. Bland KI, Menck HR, Scott-Conner C et al (1998) The National Cancer Data base 10-year survey of breast carcinoma treatment at hospitals in the United States. Cancer 83:1262–1273

    Article  PubMed  CAS  Google Scholar 

  38. NHS Breast screening programme and British Association of Surgical Oncology Audit of Screen detected breast cancers. 1997–1998. NHS Breast screening Programme, 1999

  39. Deo SS, Mohanti BK et al (2001) Attitudes and treatment of breast conservation therapy for stage I & II breast cancer using per operative Iridium-192 implant boost to tumor bed. Australas Radiol 45:35–58

    Article  PubMed  CAS  Google Scholar 

  40. Biesterfield S, Schroder W et al (1979) Simultaneous histochemical and biochemical hormone receptor assessment in breast cancer provides complementary prognostic information. Aus Cancer Res 17:4723–4729

    Google Scholar 

  41. Li Cl, Doling JR, Maloni KE (2003) Incidence of invasive breast cancer by hormone receptor status from 1992 to 1998. J Clin Oncol 21:28–34

    Article  PubMed  CAS  Google Scholar 

  42. Raina V, Taneja V et al (2000) Estreogen receptor status in breast cancer. Indian Practitioner 53:405–407

    Google Scholar 

  43. Redkar AA, Kabre SS, Mittra I (1992) Estrogen and progesterone receptor measurement in breast cancer with enzyme immunoassay and Correlation with other prognostic factors. Indian J Med Res 96:1–8

    PubMed  CAS  Google Scholar 

  44. Slamon D, Clark G, Woug S et al (1987) Human breast cancer: correlation of relapse and survival with amplification of the Her-2-neu oncogen. Science 235:177–182

    Article  PubMed  CAS  Google Scholar 

  45. Parmigiani G, Berry AD, Winer PE, Tebaldi C, Iglehart DJ, Prosnitz RL (1999) Is axillary lymph node dissection indicated for early-stage breast cancer? A Decision Analysis J Clin Oncol 17:1465–1473

    CAS  Google Scholar 

  46. Maunsell E, Brisson J, Deschenes L (1993) Arm problems and psychological distress after surgery for breast cancer. Can J Surg 36:315–320

    PubMed  CAS  Google Scholar 

  47. Lin PP, Allison DC, Wainstock J et al (1993) Impact of axillary lymph node dissection on the therapy of breast cancer patients. J Clin Oncol 11:1536–1544

    PubMed  CAS  Google Scholar 

  48. Ivens D, Hoe AL, Podd JJ et al (1992) Assessment of morbidity from complete axillary dissection. Br J Cancer 66:136–138

    Article  PubMed  CAS  Google Scholar 

  49. Warmuth MA, Brown G et al (1998) Complications of axillary lymph node dissection for carcinoma of the breast. A report based on patient survey. Cancer 83:1362–1368

    Article  PubMed  CAS  Google Scholar 

  50. Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Hölzel D (2003) Axilla surgery severely affects quality of life: results of a 5-year prospective study in breast cancer patients. Breast Cancer Research and Treatment 79:47–57

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Fortis Hospital, Mohali, Punjab, 160062, India

    Preetinder Brar

  2. Department of General Surgery, Fortis Hospital, Mohali, Punjab, 160062, India

    Iqbal Singh

  3. Department of Surgical Oncology, Ludhiana Medicity, Ludhiana, India

    Satish Jain

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  1. Preetinder Brar
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  2. Satish Jain
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  3. Iqbal Singh
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Correspondence to Preetinder Brar.

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Brar, P., Jain, S. & Singh, I. Complications of Axillary Lymph Node Dissection in Treatment of Early Breast Cancer: A Comparison of MRM and BCS. Indian J Surg Oncol 2, 126–132 (2011). https://doi.org/10.1007/s13193-011-0078-2

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