Long-term morbidity following axillary dissection in breast cancer patients - clinical assessment, significance for life quality and the impact of demographic, oncologic and therapeutic factors

Objective. This study describes in detail the surgery-related symptoms foll owing axillary lymph node dissection in breast cancer patients and consider s both their significance for long term quality of life and the impact of p ossible influencing factors. Material and methods: Three hundred and ninety six patients were studied re trospectively using a self-report questionnaire and a clinical examination. The symptoms, numbness, pain, edema, arm strength and mobility were evalua ted. The subjective assessment of the degree of symptom intensity was compa red with objective measurements. The extent of surgery (number of resected nodes, level of dissection) as well as the influence of demographic, oncolo gic and adjuvant measures (age, time interval, number of involved nodes, ch emotherapy) were evaluated. Results. Shoulder-arm morbidity and fear of cancer recurrence were the most important long-term sources of distress following breast cancer surgery in our study population. Demographic, oncologic and therapeutic measures incl uding the extent of surgery had no influence on long-term morbidity. The in tensity of all evaluated symptoms was reported to be more severe in patient s' subjective statements than in the results of clinical assessment. Conclusion. Shoulder-arm morbidity following axillary dissection is a frust rating polysymptomatic disease that seems to be relatively unaffected by th erapeutic measures. The surgical trauma necessary for adequate tumor stagin g (removal of 10 lymph nodes) seems decisive for the postsurgery syndrome f ollowing axillary dissection. For node-positive patients complete axillary clearing may improve tumor control without worsening long-term-morbidity. N ew techniques, such as the sentinel-node-biopsy, that selects patients with negative axillary status while preserving the integrity of axillary struct ures, may improve the overall morbidity.