Javaid Rana Hassan, Bashir Eitezaz Ahmed, Waqas Ahmed, Kiani Asma Afzal, Raza Ahmed, Manzoor Shazia
Department of Surgery, Combined Military Hospital Rawalpindi, Pakistan.
J Ayub Med Coll Abbottabad. 2011 Oct-Dec;23(4):94-7.
To assess the long term complications of level II Axillary Lymph Node Dissection (AXLND) in patients with breast cancer and to see if they are high enough to warrant a Sentinel Lymph Node (SLN) biopsy in all patients presenting with carcinoma breast in our setup in Pakistan.
This study was conducted at Surgical Unit IV, Department of Surgery, Combined Military Hospital, Rawalpindi. Upper, lower arm circumferences and body mass index were ascertained in post Modified Radical Mastectomy (MRM) with level II AXLND, in female patients who had undergone surgeries from 1992 to 2008. Patient's perception of degree of lymph oedema, arm function and other symptoms like pain, tingling and numbness was noted. The number of lymph nodes removed, number of positive nodes and post operative radiotherapy were also recorded from the hospital records.
Thus upper arm circumference in 85.7% patients and lower arm circumference in 89.2% patients was within 2 Cm of the unaffected side. No, moderate and severe arm swelling was described by 83.35% of patients, 11.6% of patients and one patient respectively and 41.5% of patients describing some arm swelling had positive lymph nodes. Thus even if they had gone (SLN) biopsy, these patients would have had a subsequent AXLND. Over 94% of patients had either good or excellent arm function with most in the excellent range.
The patients at significant risk for positive nodal may be better served with an AXLND rather than the SLN technique.
评估乳腺癌患者行Ⅱ级腋窝淋巴结清扫术（AXLND）的长期并发症，并探讨在巴基斯坦我们所在机构中，这些并发症是否严重到足以让所有乳腺癌患者都接受前哨淋巴结（SLN）活检。
本研究在拉瓦尔品第联合军事医院外科四部进行。对1992年至2008年期间接受改良根治性乳房切除术（MRM）并行Ⅱ级AXLND的女性患者，测定其上臂、下臂周长及体重指数。记录患者对淋巴水肿程度、手臂功能以及疼痛、刺痛和麻木等其他症状的感受。同时从医院记录中获取切除的淋巴结数量、阳性淋巴结数量及术后放疗情况。
85.7%的患者上臂周长和89.2%的患者下臂周长与未受影响侧相差在2厘米以内。分别有83.35%、11.6%的患者及1例患者表示无、中度和重度手臂肿胀，且描述有手臂肿胀的患者中41.5%有阳性淋巴结。因此，即便这些患者接受了（SLN）活检，后续仍可能需行AXLND。超过94%的患者手臂功能良好或极佳，其中大多数处于极佳范围。
对于有显著淋巴结阳性风险的患者，行AXLND可能比SLN技术更合适。
