Axillary Lymph Node Dissection

• Axillary lymph node dissection is a surgical procedure to remove lymph nodes from the armpit, primarily for cancer staging and treatment.
• It helps determine if cancer cells have spread beyond the primary tumor, guiding further treatment decisions.
• The axillary lymph node dissection procedure involves general anesthesia, an incision in the armpit, and careful removal of affected lymph nodes.
• Recovery after axillary lymph node dissection often includes managing pain, drains, and limited arm mobility, with physical therapy playing a crucial role.
• Key risks of axillary lymph node dissection include lymphedema, numbness, infection, and seroma formation.

Defining Axillary Lymph Node Dissection

To understand what is Axillary Lymph Node Dissection, it is essential to recognize its role in cancer management. This surgical procedure involves the careful removal of a group of lymph nodes located in the axilla, or armpit. These lymph nodes are crucial components of the immune system and serve as a common pathway for cancer cells to spread from primary tumors, particularly those in the breast or upper extremities.

The primary purpose of what is axillary lymph node dissection is to accurately stage the cancer and determine if it has metastasized to the lymph nodes. This information is vital for guiding subsequent treatment decisions, such as chemotherapy, radiation therapy, or hormonal therapy. While historically a standard procedure, advancements like sentinel lymph node biopsy (SLNB) have made it a more targeted intervention, often reserved for cases where SLNB indicates nodal involvement or is not feasible.

The Axillary Lymph Node Dissection Procedure

The axillary lymph node dissection procedure is a significant surgical undertaking that requires careful preparation and execution. It is typically performed by a surgical oncologist and involves several distinct stages, from pre-operative assessments to the actual removal of the lymph nodes.

Preparing for Surgery

Before undergoing an axillary lymph node dissection, patients will typically have a series of pre-operative evaluations. These may include blood tests, imaging scans (such as mammograms, ultrasounds, or MRIs), and a thorough review of their medical history. Patients will also meet with their surgical team to discuss the procedure, potential outcomes, and any questions or concerns. It is important for patients to inform their doctor about any medications they are taking, especially blood thinners, as these may need to be adjusted or stopped prior to surgery.

Steps During the Procedure

The axillary lymph node dissection is performed under general anesthesia, meaning the patient will be asleep throughout the operation. The surgeon makes an incision in the armpit area, typically about 2-3 inches long. Through this incision, the surgeon carefully identifies and removes a specified number of lymph nodes, along with surrounding fatty tissue. The number of nodes removed can vary but often ranges from 10 to 40. Once the lymph nodes are removed, they are sent to a pathology lab for microscopic examination to check for the presence of cancer cells. A drain may be placed in the incision site to collect fluid, and the incision is then closed with sutures or surgical staples.

Recovery and Risks of Axillary Lymph Node Dissection

Understanding the recovery process and potential complications is crucial for patients undergoing this surgery. Both aspects significantly impact the patient’s post-operative experience and long-term well-being.

What to Expect During Recovery

Recovery after axillary lymph node dissection typically involves a hospital stay of one to two days, though this can vary. Patients will experience pain and discomfort in the armpit and arm, which can be managed with prescribed pain medication. A surgical drain, if placed, will need to be cared for at home and is usually removed within one to three weeks. It is common to experience numbness, tingling, or a sensation of tightness in the armpit and upper arm due to nerve involvement. Physical activity will be restricted initially, with specific arm exercises recommended to prevent stiffness and improve range of motion. Full recovery can take several weeks to months, and adherence to post-operative instructions is vital for optimal healing.

Potential Complications and Management

While generally safe, there are several risks of axillary lymph node dissection. One of the most significant and common complications is lymphedema, a chronic swelling of the arm, hand, or chest wall caused by damage to the lymphatic system. Studies indicate that lymphedema can affect between 10% to 30% of patients following ALND, though rates vary based on individual factors and adjunctive therapies. Management often involves physical therapy, compression garments, and lymphatic drainage massage. Other potential complications include:

• Seroma: A collection of fluid under the skin at the surgical site, which may require drainage.
• Infection: Though uncommon, signs include redness, warmth, increased pain, or fever.
• Nerve damage: Can lead to persistent numbness, tingling, or weakness in the arm or shoulder.
• Restricted arm and shoulder movement: Can be mitigated with early and consistent physical therapy.

Patients are encouraged to discuss any concerns about these risks with their healthcare team to ensure proper monitoring and timely intervention.