Axillary Web Syndrome after Sentinel Node Biopsy

Aydoğan, Fatih; Belli, Aslı Akın; Bağhaki, Semih; Karabulut, Kağan; Tahan, Gülgün; Uras, Cihan

doi:10.1159/000145384

Cited by 23 publications

(15 citation statements)

References 7 publications

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“…We summated the subcategories into “paresthesia” and a “decreased ROM of the ipsilateral shoulder” for the purposes of comparison across the trials and our study. To date, while only the technical outcomes are available from NSABP B-32 [33-34] and no more than a 3-year follow-up of morbidity [35-36], our report provides clinically important information not only with regard to the outcomes but also the rates of complications at 10 years.…”

Section: Discussionmentioning

confidence: 99%

Complication Rates in Patients With Negative Axillary Nodes 10 Years After Local Breast Radiotherapy After Either Sentinel Lymph Node Dissection or Axillary Clearance

Wernicke¹,

Shamis

Sidhu

et al. 2013

American Journal of Clinical Oncology

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Background We assess complication rates in node negative breast cancer patients treated with breast radiotherapy (RT) only after sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND). Materials and Methods Between 1995 and 2001, 226 women with AJCC stage I-II breast cancer were treated with lumpectomy, either SLND or SLND+ALND, and had available toxicities in follow-up: 111/136 (82%) and 115/129 (89%) in SLND and ALND groups, respectively. RT targeted the breast to median dose of 48.2Gy (range, 46.0-50.4Gy) without axillary RT. Chi-square tests compared complication rates of two groups for axillary web syndrome (AWS), seroma, wound infection, decreased range of motion (ROM) of the ipsilateral shoulder, paresthesia, and lymphedema. Results Median follow-up was 9.9 years (range, 8.3 -15.3 years). Median number of nodes assessed was 2 (range, 1-5) in SLND and 18 (range, 7-36) in ALND (p<0.0001). Acute complications occurred during the first 2 years and were AWS, seroma, and wound infection. Incidences of seroma 5/111 (4.5%) in SLND and 16/115 (13.9%) in ALND (p<0.02, respectively) and wound infection 3/111 (2.7%) in SLND and 10/115 (8.7%) in ALND (p<0.05, respectively) differed significantly. AWS was not statistically different between the groups. At 10-years, the only chronic complications were decreased ROM of the shoulder 46/111 (41.4%) in SLND and 92/115 (80.0%) in ALND (p<0.0001), paresthesia 12/111 (10.8%) in SLND and 39/115 (33.9%) in ALND (p<0.0001), and lymphedema assessed by patients 10/111 (10.0%) in SLND and 39/115 (33.9%) in ALND (p<0.0001). Chronic lymphedema, assessed by clinicians, occurred in 6/111 (5.4%) in SLND and 21/115 (18.3%) in ALND cohorts, respectively (p<0.0001). Conclusion Our mature findings support that in patients with negative axillary nodal status SLND and breast RT provide excellent long-term cure rates while avoiding morbidities associated with ALND or addition of axillary RT field.

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Section: Discussionmentioning

confidence: 99%

Complication Rates in Patients With Negative Axillary Nodes 10 Years After Local Breast Radiotherapy After Either Sentinel Lymph Node Dissection or Axillary Clearance

Wernicke¹,

Shamis

Sidhu

et al. 2013

American Journal of Clinical Oncology

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“…Menezes et al [12] observed that 85.7% of patients with limited range of motion have AWS, and Moskovitz et al [13] verified that 74% of the patients who showed AWS had joint restriction. These divergent results in the literature could be because of the different methodological designs because most articles about AWS are case reports [6,7,10,[14][15][16][17] or retrospectives studies [12,13,18] where the identification of AWS may have induced the symptoms. In this study, all women were subjected at palpation and examination of the affected arm independent of the symptoms reported.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for axillary web syndrome after breast cancer surgery

Bergmann

Mendes

Dias

et al. 2011

Breast Cancer Res Treat

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The objective of the study is to estimate the incidence and risk factors of axillary web syndrome (AWS) in early postoperative period (45 days). From the prospective cohort of women undergoing breast cancer surgery, we collected the variables related to patient characteristics, treatment, tumor, and postoperative complications. We performed bivariate and logistic regression. A total of 193 patients are included with a mean age of 58.26 years, majority of which are women who are overweight or obese (72.3%). The incidence of AWS was 28.1%. The presence of pain in the ipsilateral upper-limb associated with AWS was reported in 5.4% of the patients, and the shoulder joint restriction was observed in 11.4%. When controlling for confounding between AWS and the factors that showed statistical significance in bivariate analysis, the variables that explain the occurrence of the AWS were the type of axillary surgery, where women who underwent sentinel lymph node biopsy showed 68% less risk compared with those that underwent axillary lymphadenectomy (AL) (RR = 0.32; 95% CI, 0.13-0.79; P value = 0.014) and numbness in the arm after an injury of the intercostobrachial nerve, which is 3.19 times the risk of the AWS (RR = 3.19; 95% CI, 1.40-7.29, P value = 0.006). From the above findings, we concluded that the incidence of AWS was 28.1%, and it was associated with AL and numbness in the arm after injury of the intercostobrachial nerve.

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“…Because this syndrome can develop after a patient's last surgical follow-up visit [22], it is important that family physicians, as well as oncologists and surgeons, be able to clinically diagnose the syndrome so that they can reassure their patients that the condition is usually self-limiting [29] and make referrals to a physical therapist if the patient's range-of-motion is especially compromised or if she is experiencing pain during everyday activities.…”

Section: Resultsmentioning

confidence: 99%

Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication

Harris¹

2018

Breast Care

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The purpose of this review is to define axillary web syndrome (AWS) and describe its diagnosis and management. The following databases were searched through July 2017: PubMed, EMBASE (OvidSP), Cumulative Index for Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Cochrane Database of Systematic Reviews. Search terms included ‘axillary web syndrome', ‘axillary cording', and ‘lymphatic cording'. 49 articles were identified; 8 did not relate to breast cancer, and 3 were not in English. Of the remaining articles, the majority were case reports, case series, or descriptive reviews. 2 systematic reviews were located as well as 1 randomized trial, 6 prospective cohort studies, and 2 retrospective cohort studies. Although a common sequela after axillary surgery for breast cancer staging, AWS has been poorly described in the medical literature as to the underlying pathophysiology, diagnosis, and management. Interventions range from patient education and simple reassurance that the syndrome will resolve spontaneously to active physical or manual therapies to maintain upper extremity range-of-motion, especially adequate motion for undergoing radiation therapy. Oncologists, breast surgeons, family physicians, and oncology nurse practitioners that work with patients with breast cancer should educate them about this prevalent complication and inform them preoperatively about what to anticipate.

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Axillary Web Syndrome after Sentinel Node Biopsy

Cited by 23 publications

References 7 publications

Complication Rates in Patients With Negative Axillary Nodes 10 Years After Local Breast Radiotherapy After Either Sentinel Lymph Node Dissection or Axillary Clearance

Complication Rates in Patients With Negative Axillary Nodes 10 Years After Local Breast Radiotherapy After Either Sentinel Lymph Node Dissection or Axillary Clearance

Incidence and risk factors for axillary web syndrome after breast cancer surgery

Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication

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