Soares Emerson Wander Silva, Nagai Hildebrando Massahiro, Bredt Luis César, da Cunha Ademar Dantas, Andrade Reginaldo José, Soares Géser Vinícius Silva
Department of Gynecology, Western Paraná State University (Universidade Estadual do Oeste do Paraná, UNIOESTE), Cascavel, Paraná, Brazil.
World J Surg Oncol. 2014 Mar 27;12:67. doi: 10.1186/1477-7819-12-67.
Conventional axillary lymph node dissection (ALND) has recently become less radical. The treatment morbidity effects of reduced ALND aggressiveness are unknown. This article investigates the prevalence of the main complications of ALND: lymphedema, range-of-motion restriction, and arm paresthesia and pain.
This cross-sectional study included 200 women with invasive breast cancer who underwent breast-conserving surgery (82.5%, n = 165) or mastectomy (17.5%, n = 35) with ALND from 2007 to 2011. Arm perimetry was used to assess lymphedema, defined as a difference >2 cm in the upper arm circumference between the nonsurgical and surgical arms. Range-of-motion restriction was assessed by evaluating the degree of arm abduction. Paresthesia was measured in the inner and proximal arm regions. Arm pain was assessed by directly questioning the patients and defined as either present or absent.
The average (±SD) time between ALND and morbidity evaluation was 35 ± 18 months (range, 7-60 months). The average dissected lymph node number per patient was 14 ± 4 (range, 6-30 lymph nodes). Only 3.5% (n = 7) of the patients presented with lymphedema. Single-incision approaches to breast tumor and ALND (P = 0.04) and the presence of a postoperative seroma (P = 0.02) were associated with lymphedema in univariate analysis. Paresthesia was the most frequent side effect observed (53% of patients, n = 106). This complication was associated with increased age (P < 0.0001) and a larger dissected lymph node number (P = 0.01) in univariate and multivariate analysis. Additionally, 24% (n = 48) of patients had noticeable limited arm abduction. Among the patients, 27.5% (n = 55) experienced sporadic arm pain corresponding to the surgically treated armpit. In multivariate analysis, the pain risk was 1.9-fold higher in patients who underwent ALND corresponding to their dominant arm (95% CI, 1.0-3.7, P = 0.04).
Conventional ALND in breast cancer patients can result in unwanted complications. However, the current lymphedema prevalence is lower than that of the other analyzed side effects.
传统腋窝淋巴结清扫术（ALND）近来已不再那么激进。ALND激进程度降低对治疗相关发病率的影响尚不清楚。本文调查了ALND主要并发症的发生率：淋巴水肿、活动范围受限以及手臂感觉异常和疼痛。
这项横断面研究纳入了200例浸润性乳腺癌女性患者，她们在2007年至2011年期间接受了保乳手术（82.5%，n = 165）或乳房切除术（17.5%，n = 35）并进行了ALND。采用手臂周长测量评估淋巴水肿，定义为非手术侧与手术侧上臂周长相差>2 cm。通过评估手臂外展程度来评估活动范围受限情况。在内侧和近端手臂区域测量感觉异常。通过直接询问患者评估手臂疼痛，并定义为存在或不存在。
ALND与发病率评估之间的平均（±标准差）时间为35±18个月（范围7 - 60个月）。每位患者平均清扫的淋巴结数量为14±4个（范围6 - 30个淋巴结）。仅3.5%（n = 7）的患者出现淋巴水肿。在单因素分析中，乳房肿瘤和ALND的单切口入路（P = 0.04）以及术后血清肿的存在（P = 0.02）与淋巴水肿相关。感觉异常是观察到的最常见副作用（53%的患者，n = 106）。在单因素和多因素分析中，这种并发症与年龄增加（P < 0.0001）和清扫的淋巴结数量较多（P = 0.01）相关。此外，24%（n = 48）的患者有明显的手臂外展受限。在患者中，27.5%（n = 55）经历了与手术治疗腋窝相对应的偶发性手臂疼痛。在多因素分析中，接受与优势臂相对应的ALND的患者疼痛风险高1.9倍（95%CI，1.0 - 3.7，P = 0.04）。
乳腺癌患者的传统ALND可导致不良并发症。然而，目前淋巴水肿的发生率低于其他分析的副作用。
