Morbidity of Breast Cancer Patients Following Complete Axillary Dissection or Sentinel Node Biopsy Only: A Comparative Evaluation

Haid, A.; Köberle-Wührer, Roswitha; Knauer, Michael; Burtscher, Judit; Fritzsche, H; Peschina, William; Jasarevic, Zerina; Ammann, Maria; Hergan, Klaus; Sturn, Heinz; Zimmermann, G.

doi:10.1023/a:1015234318582

Cited by 120 publications

(93 citation statements)

References 13 publications

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“…The present study confirms previous observations suggesting that SLNB is associated with less arm/shoulder morbidity (Giuliano et al, 2000;Schrenk et al, 2000;Burak et al, 2002;Haid et al, 2002;Temple et al, 2002) than ALND. Evaluation and comparison of QOL outcomes in a short time follow-up in breast cancer patients undergoing ALND or SLNB after breast-conserving surgery provides additional observations:…”

Section: Discussionsupporting

confidence: 92%

“…These results support the hypothesis, that current standard questionnaires do not cover all aspects of QOL (Janni et al, 2001). Several aspects of morbidity including pain, range of motion and sensory complaints of the affected arm have been reported to show significant difference in favour of SLNB (Giuliano et al, 2000;Schrenk et al, 2000;Burak et al, 2002;Haid et al, 2002;Temple et al, 2002). However, measuring instruments and scoring systems used in these studies differ widely.…”

Section: Discussionsupporting

confidence: 76%

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Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients

Peintinger¹,

et al. 2003

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The sentinel lymph node biopsy (SLNB) represents a minimal invasive surgical method for axillary staging in patients with primary breast cancer. In a prospective study, evaluation of quality of life (QOL) and arm morbidity was performed before surgery on a total of 56 breast cancer patients. The EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires were used for QOL assessment. Assessment of pain was additionally observed using the McGill Pain Questionnaire. Arm mobility was observed by goniometric measurement of arm movement. Data were collected before surgery (t1), 1 week after discharge (t2) and 9 -12 months after surgery (t3). The type of axillary surgery does not seem to affect global QOL at a short-time follow-up, but patients recover sooner after SLNB. Body image and sexual functioning remain stable in both types of axillary surgery. Arm/shoulder pain was reported in 36% of patients after SLNB in comparison to 68% receiving axillary lymph node dissection (ALND), and 'numbness' was reported only in 4% of patients in the SLNB group vs 19.3% after ALND. Abduction, flexion and horizontal adduction of the affected arm show significant impairment after ALND. Breast cancer patients should be counselled about the benefits of SLNB over ALND concerning QOL and postsurgery side effects in a short-term follow-up. Axillary lymph node dissection (ALND) in breast cancer patients still represents the routine surgical method for axillary staging. Although the axillary node status is the most important prognostic factor for recurrence and survival (Fisher et al, 1984;Carter et al, 1989) and information obtained by axillary dissection is useful for planning adjuvant treatment, it is associated with substantial morbidity (Kissin et al, 1986;Ivens et al, 1992;Keramopoulos et al, 1993;Hack et al, 1999;Kakuda et al, 1999) and psychological distress (Maunsell et al, 1993;Tobin et al, 1993;Shimozuma et al, 1999). Hack et al, showed arm/shoulder pain, weakness or numbness in 72% and impaired range of motion in 73% of breast cancer patients after ALND, whereas high levels of quality of life (QOL) were reported. Moderate to severe pain was reported between 20, 23 and 32% (Van Dam et al, 1993;Kuehn et al, 2000;Ververs et al, 2001) and was not significantly related to time since surgery. Other reports suggest that arm problems after ALND are associated with a negative effect on the overall QOL of breast cancer patients (Maunsell et al, 1993;Kuehn et al, 2000). As a result of the need to reduce axillary morbidity, many investigations have been performed on sentinel lymph node biopsy (SLNB), an alternative procedure. Using vital dye and/or radiocolloid, the sentinel node/s as the first lymph node to receive lymphatic drainage from the primary tumour can be identified by a minimal invasive surgical technique. Recently, published data showed no sensory morbidity after SLNB (Giuliano et al, 2000) at a median follow-up of 39 months. Schrenk et al (2000) reported less postoperative arm pain, numbness and arm motion restriction after SLNB at a foll...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 76%

Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients

Peintinger¹,

et al. 2003

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“…[9][10][11] An increasing number of studies reported EJSO 32 (2006) less treatment related morbidity for SLNB in comparison to ALND. [12][13][14][15][16][17][18][19][20] Generally disability in ADL of the SLNB group was less than that of the ALND group. 13,16,19 A shortcoming in most studies is the absence of pretreatment assessment and the absent of reliable and validated assessment instruments.…”

Section: Introductionmentioning

confidence: 89%

Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer

Rietman

Geertzen

Hoekstra

et al. 2006

European Journal of Surgical Oncology (EJSO)

131

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Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer Rietman, J.S.; Geertzen, J.H.B.; Hoekstra, H.J.; Baas, P.; Dolsma, W.V.; de Vries, J; Groothoff, J.W.; Eisma, W.H.; Dijkstra, P.U. AbstractBackground: In a prospective study, long term upper-limb morbidity, perceived disabilities in activities of daily life (ADL) and quality of life (QOL) were assessed before and 2 years after sentinel lymph node biopsy (SLNB) or axillary lymph node dissections (ALND) for breast cancer. Methods: Two hundred and four patients with stage I/II breast cancer, mean age 55.6 years (SD: 11.6) entered the study and 181 patients (89%) could be evaluated after 2 years. Fifty-seven patients underwent SLNB (31%) and 124 patients underwent an ALND (69%). Assessments included pain, shoulder range of motion, muscle strength, arm volume, perceived shoulder disability in ADL and QOL. Results: Significant (P!0.05) changes between before and 2 years after surgery were found in almost all assessments of shoulder function, ADL and several QOL subscales. Patients in the ALND group showed significant more changes in range of motion (ROM), grip strength, arm volume, ADL and QOL physical-and role functioning, pain and sleeplessness and arm symptoms compared to the SLNB group. Multivariate linear regression analysis showed that ALND could predict decrease of ROM, grip strength, ADL and physical functioning (QOL) and increase of arm volume, pain and arm symptoms score (QOL). Radiation on the axilla predicts an additional decrease in shoulder ROM and increase of arm volume. Conclusion: Two years after surgery for breast cancer, patients show significantly less treatment related upper limb morbidity, perceived disability in ADL and worsening of QOL after SLNB compared with ALND. q

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“…However, it is associated with significant morbidity, including postoperative arm lymphedema and neuropathy of the involved extremity, and seroma formation in the axilla (Noguchi et al, 1997). Particularly, arm lymphedema develops in 7%-77% of patients who undergo axillary lymph node dissection (Blanchard et al, 2003;Leidenius et al, 2005;Haid et al, 2002;Mansel et al, 2006;Ronka et al, 2005;Schijven et al, 2003;Schrenk et al, 2000;Swenson et al, 2002). At present, sentinel lymph node biopsy is accepted as the standard method of surgical staging for axillary lymph nodes in breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Axillary reverse mapping for breast cancer

Noguchi

2009

Breast Cancer Res Treat

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Morbidity of Breast Cancer Patients Following Complete Axillary Dissection or Sentinel Node Biopsy Only: A Comparative Evaluation

Cited by 120 publications

References 13 publications

Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients

Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients

Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer

Axillary reverse mapping for breast cancer

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