Axillary Lymph Node Dissection

An axillary lymph node dissection, also known as axillary lymphadenectomy, is a surgical procedure that involves the removal of lymph nodes from the axilla (armpit) to diagnose or treat cancer, most commonly breast cancer.

Indications

• Breast cancer: Axillary lymph node dissection is often performed in conjunction with mastectomy or lumpectomy to remove cancerous cells that may have spread from the breast to the axillary lymph nodes.
• Melanoma: The procedure may also be used to treat melanoma, a type of skin cancer, that has spread to the axillary lymph nodes.
• Other cancers: Axillary lymph node dissection may be performed for other types of cancer, such as lymphoma or sarcoma, that have metastasized to the axilla.

Procedure

The procedure typically involves the following steps:

1. Administration of general anesthesia: The patient is given general anesthesia to ensure they are comfortable and pain-free during the procedure.
2. Incision: A surgical incision is made in the axilla, usually about 2-3 inches long.
3. Dissection: The surgeon carefully dissects the lymph nodes from the surrounding tissue, taking care to preserve nerves and blood vessels.
4. Removal of lymph nodes: The lymph nodes are removed and sent to a pathologist for examination under a microscope to check for cancer cells.
5. Closure: The incision is closed with sutures or staples, and the area is dressed with bandages.

Risks and Complications

As with any surgical procedure, axillary lymph node dissection carries certain risks and complications, including:

• Bleeding or hematoma: Excessive bleeding or accumulation of blood at the surgical site.
• Infection: Bacterial infection of the surgical site or surrounding tissue.
• Nerve damage: Injury to nerves in the axilla, which can cause numbness, tingling, or weakness in the arm or hand.
• Lymphedema: Swelling of the arm or hand due to disruption of lymphatic drainage.
• Scarring: Formation of keloid or hypertrophic scars at the surgical site.

Recovery and Follow-up

After the procedure, patients typically require:

• Pain management: Medication to manage pain and discomfort at the surgical site.
• Wound care: Dressing changes and wound care to promote healing and prevent infection.
• Physical therapy: Exercises to maintain range of motion and strength in the affected arm.
• Follow-up appointments: Regular follow-up appointments with the surgeon or oncologist to monitor for complications and assess the effectiveness of treatment.

Alternatives and Recent Developments

In recent years, there has been a shift towards less invasive procedures, such as:

• Sentinel lymph node biopsy: A procedure that involves removing only the first lymph node to which cancer cells are likely to spread.
• Axillary lymph node sampling: A procedure that involves removing a smaller number of lymph nodes for examination.

These alternatives aim to reduce the risk of complications and improve patient outcomes, while still providing accurate diagnosis and effective treatment.