Complications, Functional Recovery, and Quality of Life in Breast Cancer Patients Undergoing Axillary Surgery

Survivorship considerations have gained increasing importance in patients with early breast cancer. Every surgical procedure poses a risk of complications and a potential negative impact on patient-reported outcomes (PROs), thereby driving growing interest in de-escalation strategies in breast cancer surgery. In this context, we aimed to assess complication rates, the potential role of physiatric rehabilitation in managing these complications, and the impact of axillary surgery on PROs.

This retrospective single-center cohort study included breast cancer patients who underwent surgery between January 2022 and March 2023 at the Breast Unit of Policlinico Umberto I, Rome. Among 164 patients operated on during the study period, 71 who underwent axillary surgery and received postoperative physiatric evaluation according to the institutional care pathway (PDTA) were included. The Disability of the Arm, Shoulder and Hand (DASH) questionnaire was administered to evaluate PROs.

Among the included patients (n = 71), SLNB was performed in 71.83% and ALND in 21.13%. A total of 34/71 patients (47.89%) developed complications requiring rehabilitative treatment and were classified as cases, while the remaining patients constituted the control group. Overall, shoulder painful mobility limitation (56.34%) (SPML), motor deficit (54.93%) (MD), and sensory deficit (46.48%) (SD) were the most frequent complications, whereas lymphedema (LE) and scapular winging (SW) occurred in 4.23% each. More extensive axillary procedures were associated with a higher number of lymph nodes removed (p < 0.0001). Cases had significantly more lymph nodes removed than controls (p = 0.0003). Patients requiring rehabilitation were younger on average than controls. Recovery time differed significantly between cases and controls (p < 0.0001), with most patients recovering within 3 months from the first physiatric visit. DASH scores were significantly worse in patients requiring rehabilitative treatment than in controls (p < 0.0001). The mean DASH score was 14%. Higher DASH values were associated with postoperative complications requiring rehabilitation and delayed or absent recovery, particularly SPML, DM, DS, and SW.

Functional impairment of the upper limb remained frequent and may affect patients' daily activities. These findings support the importance of integrating surgical management with early physiatric evaluation and rehabilitation to optimize functional recovery. Systematic assessment using patient-reported outcome measures (PROMs), such as the DASH questionnaire, may help identify disability early and support patient follow-up.