[Complications following axillary dissection for breast carcinoma]

Area of Science:

• Oncology
• Surgical Pathology
• Pain Management

Background:

• Axillary dissection is crucial for breast cancer staging and regional control.
• This procedure can lead to significant morbidity, including post-operative pain.
• Damage to intercostobrachial nerves is increasingly recognized as a cause of arm pain after surgery.

Purpose of the Study:

• To evaluate the morbidity associated with routine axillary dissection.
• To assess the incidence and severity of post-axillary dissection pain.
• To determine the impact of intercostobrachial nerve transection on patient outcomes.

Main Methods:

• Interview and clinical examination of 71 women (75 axillae) who underwent axillary dissection for breast cancer.
• Data collection on sensory deficits, pain (using NRS score), seroma, lymphedema, and shoulder function.
• Correlation of symptoms with intercostobrachial nerve status.

Main Results:

• Sensory deficit in the axilla/arm was present in almost all patients.
• 35% of patients experienced arm pain, consistent with intercostobrachial nerve innervation.
• Moderate to severe pain (NRS ≥ 5) occurred in one-third of those with pain.
• Seroma and lymphedema were observed in 21 patients; reduced shoulder abduction in 6.
• Most complaints were non-invalidating (48 patients), but 10 reported moderate invalidity.

Conclusions:

• Routine transection of intercostobrachial nerves during axillary dissection leads to sensory changes and potential pain.
• Preserving one or two intercostobrachial nerves should be considered to minimize operative morbidity.
• Histological examination of axillary nodes remains vital for staging and adjuvant therapy decisions.