Complications of level I and II axillary dissection in the treatment of carcinoma of the breast

Objective To assess the complications of level I and II axillary lymph node dissectio n in the treatment of stage I and II breast cancer, with breast-conservatio n surgery and mastectomy. Summary Background Data The role of axillary dissection for staging, and as an effective means of c ontrolling regional nodal disease, has long been recognized. As small and l ow-grade lesions have been detected more frequently, and as its therapeutic impact has been questioned, axillary dissection has increasingly been perc eived as associated with significant complications. Methods Two hundred patients, 112 of whom had breast-conservation surgery with axil lary dissection and 88 of whom had total mastectomy with axillary dissectio n, were evaluated 1 year or more after surgery for arm swelling as well as nonedema complications. All patients had arm circumference measurements at the same four sites on both the operated and nonoperated sides. Results No patient had an axillary recurrence. The mean difference in circumference on the nonoperated versus operated side was 0.425 cm +/- 1.39 at the midbi ceps (p < 0.001), 0.315 cm +/- 1.27 at the antecubital fossa (p < 0.001), 0 .355 cm +/- 1.53 at the midforearm (p < 0.005), and 0.055 cm +/- 0.75 at th e wrist (n.s.). Seven patients (3.5%) had mild swelling of the hand. Heavy and obese body habitus were the only significant predictors of edema on mul tivariate analysis. One hundred fifty-three (76.5%) patients had numbness o r paresthesias of the medial arm and/or axilla after surgery; in 125 (82%) of these, the problem had lessened or had resolved on follow-up assessment. Conclusions The characterization of a level I and II axillary dissection as a procedure with significant complications does not appear justified based on this exp erience.