Complete versus selective axillary lymph node dissection in treatment of early breast carcinoma

Axillary lymph node dissection for staging the axilla in breast carcinoma patients is associated with considerable morbidity, such as edema of the arm, pain, sensory disturbances, impairment of arm mobility, and shoulder stiffness. Selective lymph node biopsy electively removes the palpable lymph node, which gets the drainage from the tumor and should therefore be associated with nearly zero morbidity. Postoperative morbidity (increase in arm circumference, subjective lymphedema, pain, numbness, effect on arm strength and mobility, and stiffness) of the operated arm was prospectively compared in 20 breast carcinoma patients after axillary lymph node dissection (ALND) and 20 patients following Selective lymph node (SLN) biopsy. Patient characteristics were comparable between the two groups. Postoperative follow-up was 15.4 months (range, 4-24 months) in the SLN group and 17.0 months (range, 4-24 months) in the ALND group. Following axillary dissection, patients showed a significant increase in upper and forearm circumference of the operated arm compared with the SLN patients, as well as a significantly higher rate of subjective lymphedema, pain, numbness, and motion restriction. Neither difference between groups regarding arm stiffness or arm strength, nor did the type of surgery affect daily living.