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

Sebastian Wojcinski^1,*, Sirin Nuengsri^2,*, Peter Hillemanns³, Werner Schmidt⁴, Mustafa Deryal⁵, Kubilay Ertan⁶, Friedrich Degenhardt^1
1Franziskus 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 manuscript

Abstract: 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