Lymphedema after sentinel lymphadenectomy for breast carcinoma

• Published in: Cancer Vol. 92; no. 4; pp. 748 - 752
• Main Authors: Sener, Stephen F., Winchester, David J., Martz, Carole H., Feldman, Joseph L., Cavanaugh, Jean A., Winchester, David P., Weigel, Beth, Bonnefoi, Kathleen, Kirby, Katina, Morehead, Claudia
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 15.08.2001
• Subjects: axillary dissection; breast carcinoma; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Clinical Protocols; Humans; Lymph Node Excision - adverse effects; lymphedema; Lymphedema - etiology; Neoplasm Staging; Risk Factors; sentinel lymphadenectomy
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(20010815)92:4<748::AID-CNCR1378>3.0.CO;2-V

BACKGROUND Initial studies of sentinel lymphadenectomy for patients with breast carcinoma confirmed that the status of the sentinel lymph nodes was an accurate predictor of the presence of metastatic disease in the axillary lymph nodes. Sentinel lymphadenectomy, as an axillary staging procedure, has risks of morbidity that have yet to be defined. METHODS Patients were enrolled in a two‐phase protocol that included concurrent data collection of patient characteristics and treatment variables. During the first (validation) phase, 72 patients underwent sentinel lymph node excision followed by a level I–II axillary dissection. After the technique had been established, the second phase commenced, during which only patients with positive sentinel lymph nodes underwent an axillary dissection. RESULTS During the second phase, lymphedema was identified in 9 of 303 patients (3.0%) who underwent sentinel lymphadenectomy alone and in 20 of 117 patients (17.1%) who underwent sentinel lymphadenectomy combined with axillary dissection (P < 0.0001). Of 303 patients who underwent sentinel lymphadenectomy alone, 8 of 155 patients (5.1%) with tumors located in the upper outer quadrant and 1 of 148 patients (0.7%) with tumors in other locations developed lymphedema (P = 0.012). CONCLUSIONS The risk of developing lymphedema after undergoing sentinel lymphadenectomy was measurable but significantly lower than after undergoing axillary dissection. Tumor location in the upper outer quadrant and postoperative trauma and/or infection were identifiable risk factors for lymphedema. Cancer 2001;92:748–52. © 2001 American Cancer Society. After surgical staging of the axilla for breast carcinoma, the risk of lymphedema was 3.0% after patients underwent sentinel lymphadenectomy alone and 17.1% after patients underwent sentinel lymphadenectomy combined with level I–II axillary dissection.