Axillary web syndrome after axillary dissection

Background: Some patients undergoing axillary lymph node dissection (ALND) experience postoperative pain and limited range of motion associated with a palpable web of tissue extending from the axilla into the ipsilateral arm. The purpose of this study is to characterize the previously undescribed ax illary web syndrome (AWS). Methods: To identify patients-with AWS, a retrospective review was performe d of all invasive breast cancer patients heated by a single surgeon (REM) b etween 1980 and 1996. Records were also reviewed of ii more recent patients who developed AWS after undergoing sentinel node lymph node dissection (SL ND) without ALND. Results: Among 750 sequentially treated patients, 44 (6%) developed AWS bet ween 1 and 8 weeks after their axillary procedure. The palpable subcutaneou s cords extended from the axillary crease down the ipsilateral arm, across the antecubital space, and in severe cases down to the base of the thumb. T he web was associated with pain and limited shoulder abduction (less than o r equal to 90 degrees in 74% of patients). AWS resolved in all cases within 2 to 3 months. AWS also occurred after SLND. Tissue sampling of webs in 4 patients showed occlusion in lymphatic and venous channels. Conclusions: AWS is a self-limiting cause of morbidity in the early postope rative period. More Limited axillary surgery, with less lymphovenous disrup tion, might reduce the severity and incidence of this syndrome, although SL ND does not eliminate its occurrence. (C) 2001 Excerpta Medica, Inc. All ri ghts reserved.