Publication:

Surgical management of axilla: controversy and care

Background Surgical staging of the axilla has traditionally provided the best prognostic information about breast cancer. However, the morbidity of a complete axillary clearance outweighs the therapeutic and prognostic benefits of the procedure. Authors observed the types of axillary lymph node dissection (ALND) performed in authors’ institute and the magnitude of morbidities of a complete ALND.

Methods This observational study was conducted at the Cancer Institute of Himalayan Institute of Medical Sciences for a period of one year. Sequelae of ALND was observed at 1, 3 and 6 months in all female patients undergoing axillary dissection as part of surgery for breast cancer.

Results Out of 150 patients 53 (35.33%) presented with locally advanced disease, and 84 (56%) had palpable axillary nodes. All patients with palpable nodes underwent level II-III dissection. 32 patients underwent sentinel node dissection using blue dye only. Tumour size correlated positively with grade of tumour (r =0.36, P <0.001) and number of positive lymph nodes (r = 0.34; P <0.001). There was significant difference in incidence of lymphedema at 6 months in patients who underwent level III dissection (27.38%) as opposed to those who did not (8.92 %) (p <0.05). The incidence of seroma was also more at 1 month in these patients (57.14%) vs (39.28%), (p <0.05). Post-operative pain/ wound infection/Restriction of motion were not statistically significant.

Conclusions Higher stages of presentation require higher levels of axillary dissection. Unwarranted dissection can be avoided by tailoring the surgery during initial clinical assessment.