Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Ann Surg Oncol. 2010 Sep;17(9):2384-94. doi: 10.1245/s10434-010-0981-8. Epub 2010 Mar 11.
Long-term shoulder and arm function following sentinel lymph node biopsy (SLNB) may surpass that following complete axillary lymph node dissection (CLND) or axillary lymph node dissection (ALND). We objectively examined the morbidity and compared outcomes after SLNB, SLNB + CLND, and ALND in stage I/II breast cancer patients.
Breast cancer patients who had SLNB (n = 51), SLNB + CLND (n = 55), and ALND (n = 65) were physically examined 1 day before surgery (T0), and after 6 (T1), 26 (T2), 52 (T3), and 104 (T4) weeks. Differences in 8 parameters between the affected and unaffected arms were calculated. General linear models were computed to examine time, group, and interaction effects.
All outcomes changed significantly, mostly nonlinearly, over time (T0-T4). Between T1 and T4, limitations decreased in abduction (all groups); anteflexion, abduction-exorotation, abduction strength (SLNB + CLND, ALND); flexion strength (SLNB + CLND); and arm volume (SLNB, SLNB + CLND). At T4, limitations in anteflexion (SLNB, ALND), abduction (SLNB + CLND, ALND), exorotation (ALND), abduction-exorotation (all groups), and volume (SLNB + CLND, ALND) increased significantly compared with T0. The SLNB group showed an advantage in anteflexion, abduction, abduction-exorotation, and volume. Groups changed significantly but differently over time in anteflexion, abduction, abduction/exorotation, abduction strength, flexion strength, and volume. Effect sizes varied from 0.19 to 0.00.
Initial declines in range of motion and strength were followed by recovery, although not always to presurgery levels. Range of motion and volume outcomes were better for SLNB than ALND, but not strength. SLNB surpassed SLNB + CLND in 2 of the range of motion variables. The clinical relevance of these results is negligible.
前哨淋巴结活检（SLNB）后的肩部和手臂功能长期预后可能优于完全腋窝淋巴结清扫术（CLND）或腋窝淋巴结清扫术（ALND）。我们客观地检查了发病率，并比较了 I/II 期乳腺癌患者 SLNB、SLNB+CLND 和 ALND 后的结果。
接受 SLNB（n=51）、SLNB+CLND（n=55）和 ALND（n=65）的乳腺癌患者在手术前 1 天（T0）、术后 6 周（T1）、26 周（T2）、52 周（T3）和 104 周（T4）进行体格检查。计算受影响和未受影响手臂之间 8 个参数的差异。使用通用线性模型来检查时间、组和交互作用的影响。
所有结果均随时间显著变化（T0-T4），主要呈非线性变化。在 T1 到 T4 之间，外展（所有组）；前屈、外展-外旋、外展力量（SLNB+CLND、ALND）；屈曲力量（SLNB+CLND）；和手臂体积（SLNB、SLNB+CLND）减少。在 T4 时，与 T0 相比，前屈（SLNB、ALND）、外展（SLNB+CLND、ALND）、外旋（ALND）、外展-外旋（所有组）和体积（SLNB+CLND、ALND）的受限明显增加。与 SLNB+CLND 和 ALND 相比，SLNB 组在前屈、外展、外展-外旋和体积方面具有优势。各组在 T0 时的前屈、外展、外展-外旋、外展力量、屈曲力量和体积变化明显，但方式不同。效应大小从 0.19 到 0.00 不等。
运动范围和力量最初下降，随后恢复，但并非总是恢复到术前水平。与 ALND 相比，SLNB 在运动范围和体积方面优于 ALND，但在力量方面并非如此。在 2 个运动变量中，SLNB 优于 SLNB+CLND。这些结果的临床意义可以忽略不计。
