Objective assessment of axillary morbidity in breast cancer treatment

Historically, axillary lymph node dissection (ALND) was a critical aspect o f the operative management of breast cancer. Recently the role of ALND has been questioned, with postoperative morbidity possibly overshadowing patien t benefit. Our objective was to quantitatively assess the long-term morbidi ty of ALND in patients with breast cancer. We conducted a cross-sectional s tudy of patients being followed by the Breast Surgery Clinic at a universit y-affiliated urban hospital. Ninety-five patients with unilateral breast ca ncer who had undergone ALND were evaluated at routine follow-up visits in t he latter half of 1998. A questionnaire was used to quantify the degree of subjective findings, including arm swelling, chest wall pain, decreased mob ility, and weakness. Upper extremity strength, active range of motion, and circumference were measured. Overall, 70 per cent of patients had at least one complaint, with 18 per cent having moderate to severe symptoms. Twenty- one per cent had notable decrements in strength or range of motion, 9.3 per cent of patients required chronic compression garments for lymphedema, and 6.4 per cent changed their vocational status because of surgical morbidity . We conclude that adverse effects from ALND occur commonly. Objective find ings are less common, perhaps causing clinicians to underappreciate postope rative morbidity. A significant subset of patients had enduring disability.