COMPLICATIONS OF AXILLARY LYMPH-NODE DISSECTION FOR CARCINOMA OF THE BREAST - A REPORT BASED ON A PATIENT SURVEY

BACKGROUND. Axillary lymph node dissection is commonly performed as pa rt of the primary management of breast carcinoma. Its value in patient management, however, has recently been questioned. Few studies exist that document long term complications. METHODS. Four hundred thirty-tw o patients with Stage I or II breast carcinoma who were free of recurr ence 2-5 years after surgery were identified. A cross-sectional survey was conducted to determine the prevalence of long term symptoms and c omplications as perceived by the patient, and patient and treatment fa ctors that may have predicted complications were determined. Three hun dred thirty of the 432 (76%) completed a mailed, self-administered que stionnaire. In addition, the medical records of the 330 patients were reviewed. Patient and treatment factors were analyzed with logistic re gression. RESULTS. Numbness was reported by 35% of patients at the tim e of the survey. Pain was noted in 30%, arm swelling in 15%, and limit ation of arm movement in 8%. Eight percent reported episodes of infect ion or inflammation at some point since the diagnosis of breast carcin oma. The majority of symptoms were mild and interfered minimally with daily activities. Younger age (P = 0.001) was associated with more fre quent reporting of pain. Numbness was more common in younger patients (P = 0.004) as well as in those with a history of smoking (P = 0.012). There was a positive association of limitation of arm motion with adj uvant tamoxifen therapy (P = 0.016). Arm swelling was associated with both younger age (P = 0.004) and greater body surface area (P = 0.008) . Radiation therapy was associated with a higher frequency of infectio n or inflammation in the arm andlor breast (P = 0.001). CONCLUSIONS. M ild symptoms, especially pain and numbness, are common 2-5 years after axillary lymph node dissection. The frequency of inflammation or infe ction in patients treated with radiation to the breast or chest wall a fter an axillary lymph node dissection may be greater than previously appreciated. Severe complications or symptoms that have a major impact on daily activities are uncommon. These findings should help health c are providers and their patients with breast carcinoma weigh the pros and cons of axillary lymph node dissection. Cancer 1998;83:1362-8. (C) 1998 American Cancer Society.