Is dissection of the internerve tissue during axillary lymphadenectomy for breast cancer necessary?

Mostafa, A.; Mokbel, Kefah; Engledow, Alec; Leris, A.C.A.; Choy, Christina; Wells, Clive; Carpenter, R

doi:10.1053/ejso.1999.0760

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…Even though the long thoracic nerve is identified and preserved during axillary dissection [33-36], a higher risk of damage than with sentinel nodes biopsy can be expected to occur. We note that using a logistic regression model that includes age, body mass index, and ALND (Table 2), the expected risk of SA would range from 0.4% in the lowest risk group (older overweight patients treated with SNB), to 63% in the highest risk group (younger leaner patients treated with ALND).…”

Section: Discussionmentioning

confidence: 99%

Scapula alata in early breast cancer patients enrolled in a randomized clinical trial of post-surgery short-course image-guided radiotherapy

et al. 2012

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BackgroundScapula alata (SA) is a known complication of breast surgery associated with palsy of the serratus anterior, but it is seldom mentioned. We evaluated the risk factors associated with SA and the relationship of SA with ipsilateral shoulder/arm morbidity in a series of patients enrolled in a trial of post-surgery radiotherapy (RT).MethodsThe trial randomized women with completely resected stage I-II breast cancer to short-course image-guided RT, versus conventional RT. SA, arm volume and shoulder-arm mobility were measured prior to RT and at one to three months post-RT. Shoulder/arm morbidities were computed as a post-RT percentage change relative to pre-RT measurements.ResultsOf 119 evaluable patients, 13 (= 10.9%) had pre-RT SA. Age younger than 50 years old, a body mass index less than 25 kg/m2, and axillary lymph node dissection were significant risk factors, with odds ratios of 4.8 (P = 0.009), 6.1 (P = 0.016), and 6.1 (P = 0.005), respectively. Randomization group was not significant. At one to three months’ post-RT, mean arm volume increased by 4.1% (P = 0.036) and abduction decreased by 8.6% (P = 0.046) among SA patients, but not among non-SA patients. SA resolved in eight, persisted in five, and appeared in one patient.ConclusionThe relationship of SA with lower body mass index suggests that SA might have been underestimated in overweight patients. Despite apparent resolution of SA in most patients, pre-RT SA portended an increased risk of shoulder/arm morbidity. We argue that SA warrants further investigation. Incidentally, the observation of SA occurring after RT in one patient represents the second case of post-RT SA reported in the literature.

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Section: Discussionmentioning

confidence: 99%

Scapula alata in early breast cancer patients enrolled in a randomized clinical trial of post-surgery short-course image-guided radiotherapy

et al. 2012

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“…Injury to the intercostal brachial or thoracodorsal nerve may occur with axillary lymph node dissection and is a major cause of axillary paresthesia, muscular dysfunction (eg, dysfunction of the serratus anterior or latissimus dorsi), and pain 14, 68. Nerve injuries may resolve over several months without therapeutic intervention; however, muscle recruitment pattern, flow‐on effect to surrounding musculature, and use of the arm may be permanently altered without intervention 69…”

Section: Identifying Known Risk Factors For the Development Or Exacermentioning

confidence: 99%

“…31,[63][64][65][66][67] Injury to the intercostal brachial or thoracodorsal nerve may occur with axillary lymph node dissection and is a major cause of axillary paresthesia, muscular dysfunction (eg, dysfunction of the serratus anterior or latissimus dorsi), and pain. 14,68 Nerve injuries may resolve over several months without therapeutic intervention; however, muscle recruitment pattern, flow-on effect to surrounding musculature, and use of the arm may be permanently altered without intervention. 69 Research on radiation-induced upper-body morbidity has uncovered a wide range of issues, including skin fragility, 16,17 fibrosis, and inflammatory changes to the soft tissue in the irradiated area, 17,70 as well as brachial plexopathies and other neuropathic impairments that may lead to sensory and motor changes.…”

Section: Lymphedemamentioning

confidence: 99%

Upper‐body morbidity after breast cancer

Hayes

Johansson

Stout

et al. 2012

Cancer

305

141

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The purpose of this paper is to review the incidence of upper‐body morbidity (arm and breast symptoms, impairments, and lymphedema), methods for diagnosis, and prevention and treatment strategies. It was also the purpose to highlight the evidence base for integration of prospective surveillance for upper‐body morbidity within standard clinical care of women with breast cancer. Between 10% and 64% of women report upper‐body symptoms between 6 months and 3 years after breast cancer, and approximately 20% develop lymphedema. Symptoms remain common into longer‐term survivorship, and although lymphedema may be transient for some, those who present with mild lymphedema are at increased risk of developing moderate to severe lymphedema. The etiology of morbidity seems to be multifactorial, with the most consistent risk factors being those associated with extent of treatment. However, known risk factors cannot reliably distinguish between those who will and will not develop upper‐body morbidity. Upper‐body morbidity may be treatable with physical therapy. There is also evidence in support of integrating regular surveillance for upper‐body morbidity into the routine care provided to women with breast cancer, with early diagnosis potentially contributing to more effective management and prevention of progression of these conditions. Cancer 2012;118(8 suppl). © 2012 American Cancer Society.

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“…Breast surgeons excise this sheet near the floor of the axilla. It has been shown to be rich in lymphatic tissue …”

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confidence: 99%

Functional axillary anatomy: time for a new look at the clavipectoral fascia?

King¹,

Shortis²

2012

ANZ Journal of Surgery

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Is dissection of the internerve tissue during axillary lymphadenectomy for breast cancer necessary?

Cited by 4 publications

References 5 publications

Scapula alata in early breast cancer patients enrolled in a randomized clinical trial of post-surgery short-course image-guided radiotherapy

Scapula alata in early breast cancer patients enrolled in a randomized clinical trial of post-surgery short-course image-guided radiotherapy

Upper‐body morbidity after breast cancer

Functional axillary anatomy: time for a new look at the clavipectoral fascia?

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