Axillary Dissection and Sentinel Node Biopsy - the Latest Studies

For many women, breast cancer surgery will often include either removal of the lymph nodes under the armpit (axillary dissection) or the newer, less invasive procedure of removing only the "main" lymph node (sentinel node biopsy, also known as SNB). For me, personally, as a breast cancer patient, the lymph node surgery and subsequent complications was much more disheartening than the breast surgery (mastectomy) itself. I believe this was, in part, due to the fact that no one gave me much information about the possible effects of the node surgery prior to the event. Many physicians also think that while you are happy to be alive and surviving after your breast surgery, you should ignore any pain or discomfort (or at least minimalize it) from the secondary surgeries.

The first study comes from University Hospital of the Medical School University in Greece. It was published in the European Journal of Surgical Oncology.

http://www.sciencedirect.com/science?_ob...

This study wants to see what effect,if any, external compression of the shoulder(outside pressure bandaging)will have after axillary dissection. Usually after ALND (axillary lymph node dissection), a closed-suction drainage catheter is inserted. Now, I've had this and it is a)unattractive, b)not painful, c)annoying to empty and measure, d)a challenge to hide under clothing, e)not really a big deal in the grand scheme of breast cancer.

This group of physicians is hoping fo find a way to reduce the volume of drainage and the length of post-operative drainage. (Nice idea, but not necessarily on my top ten list of breast cancer treatment innovations.) The good news is that their study revealed that post ALND compression is not necessary. No patient wants to have to undergo breast surgery, node dissection, drain catheters and then be told that her arm must be immobilized also!

The method included 100 women who had ALND. Their arm/shoulder was left unencumbered and free to move as they choose. This group was compared with 60 historial patients who had their ipsilateral (shoulder part) arm immobilized for 4 days. They recorded the amount of drainage for each patient and the length of time until drain removal. Any complications post-surgery were also noted. They conclude that the only difference was that the patients who had their arm immobilized remained in the hospital longer. Drainage and time till drain removal remained similar for both groups. The factors which did affect drain production were body mass index(BMI)and removal of 10+ lymph nodes.

As a patient advocate who is a firm believer in "evidence-based medicine", I should point out what I feel are a few areas which weaken the study's conclusions. (Remember, this is my personal opinion as a lay person).

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