Axillary dissection
Axillary dissection, also known as axillary lymph node dissection or axillary lymphadenectomy, is a surgical procedure aimed at removing and examining lymph nodes located in the underarm area (axilla). This procedure is typically performed for patients with operable breast cancer or melanoma to assess whether cancer has spread beyond the primary tumor site. By examining the removed lymph nodes, healthcare providers can determine the presence of malignant cells, which informs further treatment options.
The surgery is conducted under general anesthesia and usually lasts up to two hours. An incision is made in the armpit to access and remove a cluster of lymph nodes, which may also involve some surrounding fatty tissue. Postoperative care includes pain management, infection prevention, and rehabilitation exercises to maintain arm movement. While the procedure can be effective, it carries risks such as numbness, swelling (lymphedema), and potential infections.
In recent years, sentinel lymph node biopsy has emerged as an alternative to axillary dissection, as it involves removing fewer nodes and may reduce complications. However, axillary dissection remains relevant, particularly in cases where sentinel node biopsy yields inaccurate results or in patients with multiple affected lymph nodes. Understanding these options is crucial for individuals facing decisions about cancer treatment.
On this Page
Axillary dissection
ALSO KNOWN AS: Axillary lymph node dissection, axillary lymphadenectomy
DEFINITION: Axillary dissection is a surgical procedure carried out to remove and examine underarm lymph nodes through an incision in the armpit region (axilla).
Cancers treated: Carcinoma of the breast, melanoma
Why performed: For persons with operable breast cancer or melanoma, axillary dissection is used to determine whether cancer has spread beyond the primary tumor. Because these primary tumor cells usually infiltrate axillary lymph nodes before invading distant organs, physicians recommend that nodes be removed and examined histologically for the absence or presence of malignant cells. The results guide the treatment course.
Patient preparation: A few days before surgery, the patient undergoes a blood test, chest X-ray, and electrocardiogram to assess general health. To avoid excessive bleeding, any blood-thinning medications are usually suspended at this time. Patients are cautioned not to eat or drink in the eight hours before surgery and, on admission to the hospital, are asked to sign an informed consent form.
Steps of the procedure: The operation, performed under general anesthesia, lasts up to two hours. The surgeon makes an incision under the arm and removes a section of fat that contains a cluster of lymph nodes. The incision is sutured, and a drain is generally inserted to remove excess fluid.
After the procedure: Most patients remain in the hospital overnight, longer if complications develop. Nurses monitor the patient until the anesthetic wears off and vital signs stabilize. The drain may be left in place until the first follow-up visit. Postoperative measures include medication to relieve pain, preventive care to avoid infection at the incision site, the use of compression bandages to reduce fluid retention, and stretching exercises to rehabilitate arm movement. No heavy lifting is allowed during the recovery period of up to six weeks.
Risks: The most common complications of axillary dissection are numbness under the arm, swelling of the arm (lymphedema) with feelings of tightness and reduced range of motion, and infection at the incision site.
Results: Before proceeding with an axillary dissection, the surgeon may decide to biopsy the sentinel lymph node (the very first node that drains fluid from the tumor). If no cancer cells are found, no other nodes or only a few adjacent key nodes are removed. If tumor cells are detected, however, a more extensive axillary dissection is performed to excise six to ten nodes. The greater the number of cancerous nodes, the less favorable the survival prognosis.
In the mid-2020s, sentinel lymph node biopsy had begun to replace axillary dissection. In sentinel lymph node biopsy, doctors inject either a blue dye or weak radioactive solution to locate sentinel nodes, of which one or two are then removed and tested for cancer. Sentinel lymph node biopsy has not completely replaced axillary dissections. However, specifically in cases where sentinel lymph node biopsy is producing inaccurate results, the patient presents with many positive lymph nodes, or the patient has already received certain types of chemotherapy.
Bibliography
“Axillary Lymph Node Dissection.” Breastcancer.org, 29 June 2022, www.breastcancer.org/treatment/surgery/lymph-node-removal/axillary-dissection. Accessed 18 June 2024.
Beck, Anna C., and Monica Morrow. "Axillary Lymph Node Dissection: Dead or Still Alive?" The Breast: Official Journal of the European Society of Mastology, vol. 69, 2023, pp. 469-475, doi.org/10.1016/j.breast.2023.01.009. Accessed 18 June 2024.
Dixon, J. Michael. Breast Surgery: A Companion to Specialist Surgical Practice. 5th ed. Philadelphia: Elsevier, 2014.
Giuliano, A. E., et al. "Axillary Dissection vs. No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis: A Randomized Clinical Trial." Journal of the American Medical Association, vol. 305.6, 2011, 569–75.
“Sentinel Lymph Node Biopsy.” National Cancer Institute, 25 June 2019, www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet. Accessed 18 June 2024.
Silberman, Howard, and Allan W. Silberman. Principles and Practice of Surgical Oncology: A Multidisciplinary Approach to Difficult Problems. Philadelphia: Lippincott, 2010.
Singhal, Hemant, and Lawrence Heister. “Axillary Dissection: Overview, Periprocedural Care, Technique.” Medscape Reference, 11 Mar. 2019, emedicine.medscape.com/article/1894763-overview. Accessed 18 June 2024.
Toomey, Ariel. “Axillary Lymphadenectomy - StatPearls.” NCBI, 24 July 2023, www.ncbi.nlm.nih.gov/books/NBK557873. Accessed 18 June 2024.