Axillary dissection in primary breast cancer: variations of the surgical technique and influence on morbidity

Abstract

Sebastian Wojcinski1,*, Sirin Nuengsri2,*, Peter Hillemanns3, Werner Schmidt4, Mustafa Deryal5, Kubilay Ertan6, Friedrich Degenhardt11Franziskus Hospital, Department of Obstetrics/Gynecology, Bielefeld, Germany; 2Karlsruhe Hospital, Department of Internal Medicine, Karlsruhe, Germany; 3Hannover Medical School, Department of Obstetrics/Gynecology, Hannover, Germany; 4University Hospital of Saarland, Department of Obstetrics/Gynecology, Homburg/Saar, Germany; 5Caritas Hospital Saarbrücken St Theresia, Department of Obstetrics/Gynecology, Saarbrücken, Germany; 6Leverkusen Hospital, Department of Obstetrics/Gynecology, Leverkusen, Germany*The first two authors contributed equally to this manuscriptAbstract: Lymphedema of the arm is the most common and impairing complication after breast cancer surgery with axillary lymph node dissection (ALND). Our prospective study evaluated the effect of two different surgical techniques for ALND on postoperative morbidity. Patients were scheduled to undergo ALND. Patients in group 1 (n = 17) underwent the most common and standard technique of ALND, which uses sharp dissection of the tissue and subsequent electrocoagulation of bleedings. Patients in group 2 (n = 17) underwent a modified standard technique of ALND with clamping and ligatures of all resection margins. Postoperative wound secretion was quantified and patients were followed up for 6 months to assess long-term morbidity. The variations in surgical technique had no significant influence on the outcome variables. However, patients in group 2 showed a tendency to less wound secretion (713 versus 802 mL; P = nonsignificant), a decreased rate of immediate postoperative seromas (11.8 versus 23.5%; P = nonsignificant) and less lymphedema after 3 months (29.4 versus 41.2%; P = nonsignificant). Moreover, the number of resected lymph nodes correlated with the total amount of drained fluid (P = 0.006), the duration of the drain (P = 0.015), and the risk for the development of lymphedema after 3 months (P = 0.016). The described variations in surgical technique had no influence on the outcomes of the patients. The number of resected axillary lymph nodes remains the most important risk factor for treatment-related morbidity. Therefore, a well-balanced choice of the extent of the axillary dissection should be the surgeon's main concern.Keywords: breast cancer, axillary dissection, lymphedema, morbidity