Silberman Allan W, McVay Carie, Cohen Jason S, Altura Jack F, Brackert Sandra, Sarna Gregory P, Palmer Daphne, Ko Albert, Memsic Leslie
Divisions of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Ann Surg. 2004 Jul;240(1):1-6. doi: 10.1097/01.sla.0000129358.80798.62.
To assess our long-term complications from complete axillary lymph node dissection (AXLND) in patients with breast cancer.
Complete AXLND as part of the surgical therapy for breast cancer has come under increased scrutiny due the use of the sentinel lymph node (SLN) biopsy technique to assess the status of the axillary nodes. As the enthusiasm for the SLN technique has increased, our impression has been that the perceived complication rate from AXLND has increased dramatically while the negative aspects of the SLN technique have been underemphasized.
Female patients seen in routine follow-up over a 1-year period were eligible for our retrospective study of the long-term complications from AXLND if they were a minimum of 1 year out from all primary therapy; ie, surgery, radiation, and/or chemotherapy. All patients had previously undergone either a modified radical mastectomy (MRM) or a segmental mastectomy with axillary dissection and postoperative radiation (SegAx/XRT). All patients had a Level I-III dissection. Objective measurements, including upper and lower arm circumferences and body mass index (BMI), were obtained, and a subjective evaluation from the patients was conducted.
Ninety-four patients were eligible for our study; 44 had undergone MRM, and 50 had undergone SegAx/XRT. The average number of nodes removed was 25.6 (standard deviation, 8). Thirty-three percent of the patients had positive nodal disease, 95% of the patients had an upper arm circumference within 2 cm of the unaffected side, and 93.3% had a lower arm circumference within 2 cm of the unaffected side. Subjectively, 90.4% of the patients had either no or minimal arm swelling, and 96.8% of the patients had "good" or "excellent" overall arm function. The most common long-term symptom was numbness involving the upper, inner aspect of the affected arm (25.5%).
Our data indicate that a complete AXLND can be performed with minimal long-term morbidity. The lower the morbidity of AXLND, the less acceptable are the unique complications of the SLN technique.
评估乳腺癌患者行腋窝淋巴结清扫术（AXLND）后的长期并发症。
由于前哨淋巴结（SLN）活检技术用于评估腋窝淋巴结状态，作为乳腺癌手术治疗一部分的完整AXLND受到了越来越多的审视。随着对SLN技术的热情增加，我们的印象是，AXLND的并发症发生率被认为显著增加，而SLN技术的负面因素却未得到充分重视。
在为期1年的常规随访中见到的女性患者，如果她们距离所有主要治疗（即手术、放疗和/或化疗）至少1年，则有资格纳入我们关于AXLND长期并发症的回顾性研究。所有患者先前均接受过改良根治性乳房切除术（MRM）或保乳手术加腋窝清扫及术后放疗（SegAx/XRT）。所有患者均进行了Ⅰ-Ⅲ级清扫。获取了包括上臂和下臂周长以及体重指数（BMI）在内的客观测量数据，并对患者进行了主观评估。
94例患者符合我们的研究条件；44例接受了MRM，50例接受了SegAx/XRT。切除淋巴结的平均数量为25.6个（标准差为8）。33%的患者有阳性淋巴结疾病，95%的患者患侧上臂周长与未受影响侧相差在2 cm以内，93.3%的患者患侧下臂周长与未受影响侧相差在2 cm以内。主观上，90.4%的患者手臂无肿胀或仅有轻微肿胀，96.8%的患者手臂整体功能为“良好”或“优秀”。最常见的长期症状是患侧手臂上部内侧麻木（25.5%）。
我们的数据表明，完整的AXLND可在长期发病率极低的情况下进行。AXLND的发病率越低，SLN技术的独特并发症就越难以接受。
