Surgical Technique can Prevent Arm Lymphoedema After Level III Clearance for Breast Cancer

Abstract

Clearance of the axillary tissue during operation is still the mainstay of treatment for node positive breast cancer. Level III axillary nodal clearance is supposed to increase the risk of lymph edema of arm, along with other factors. However, preservation of the fascia over the axillary vein during surgery reduces the risk of lymph edema greatly. In this study we measured the incidence of armlymphoedema that occured after Level III axillary clearance for breast cancer. During surgery, dissection over the anterior surface of axillary vein was limited to preserve the fascia covering axillaryvein. Other factors commonly implicated in the development of post-operative arm lymphoedema were also documented and their effect analysed. Forty three patients underwent operation for breast cancer including complete axillary clearance up to Level III. The incidence of lymphoedema was 25.5% (11 out of 43 patients). None of these patients had severe lymphoedema. On multivariate analysis, no other associated factors like BMI, chemotherapy and nodal metastases had any bearing on the development of lymph edema. We conclude that Level III axillary clearance of axilla is safe and not excessively morbid in terms of developing arm lymphoedema provided the fascia over axillary veinis preserved.