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01.12.2014 | Research | Ausgabe 1/2014 Open Access

World Journal of Surgical Oncology 1/2014

Morbidity after conventional dissection of axillary lymph nodes in breast cancer patients

World Journal of Surgical Oncology > Ausgabe 1/2014
Emerson Wander Silva Soares, Hildebrando Massahiro Nagai, Luis César Bredt, Ademar Dantas da Cunha Jr, Reginaldo José Andrade, Géser Vinícius Silva Soares
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

EWSS conceived of the study, participated in its design and coordination, analysis and interpretation of data and helped to draft the manuscript. HMN participated in acquisition of data, have been involved in the design of the study and performed the statistical analysis. LCB participated in acquisition of data and have been involved in statistical analysis. ADCJr participated in its design and coordination and helped to draft the manuscript. RJA participated in its design and coordination and helped to revising the manuscript. GVSS participated in its design and coordination and helped to revising the manuscript. All authors read and approved the final manuscript.



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.
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