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Impact of Axillary Reverse Mapping on Non-lymphedema Functional Axillary Complications After Axillary Lymph Node
Kristen Williams1, Katherine Lecroy1, Mu Jin1
1Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
Introduction:
Axillary reverse mapping (ARM) is a procedure during axillary lymph node dissection (ALND) to preserve lymphatic channels draining the arm. Non-lymphedema outcomes were further investigated after ARM.
Patients And Methods:
A retrospective review of breast cancer patients from an academic institution from 2017 to 2021 who underwent ALND was performed. A total of 275 patients met inclusion criteria, and 201 underwent ARM with injection of isosulfan blue dye into the ipsilateral upper arm with identification and preservation of the lymphatics when possible. Clinicopathologic information was collected. Surgical complications were identified based on clinical documentation. Short-term outcomes evaluated included seroma, hematoma, and infection. Long-term functional outcomes studied included cording, decreased range of motion, referral to physical therapy within six months, neck, chest, or shoulder pain, and paresthesia.
Results:
No significant differences were noted between groups with regard to seroma, hematoma, or infection (P = 1.000, P = .467, P = 1.000, respectively). Long-term functional complications were also similar; cording was noted in 52.7% of patients treated with ALND alone, compared to 49.2% of ARM patients (P = .668). On multivariate analysis, the relative risk of any functional complication appeared similar between ARM-treated patients and ALND-only patients (relative risks 0.78, confidence interval [CI], 0.34, 1.67, P = 0.500). Patients who received adjuvant radiotherapy had 5.73 relative risk of developing these functional complications (CI, 2.52,13, P < .001) compared to those not receiving radiotherapy. One patient treated with ARM reported hives, and no anaphylaxis was observed.
Conclusion:
Similar short-term complication rates as well as rates of non-lymphedema functional complications were noted between ALND patients treated with and without ARM.
