Axillary Lymph Node Dissection

What is Axillary Lymph Node Dissection?

Axillary Lymph Node Dissection (also referred to as axillary clearance surgery) is a procedure involving the removal of lymph nodes located under the arm.

Lymph nodes move and filter fluids between body tissues and the bloodstream. Because of this, cancer cells often spread to the lymph nodes. 

This procedure to remove one or a small cluster of lymph nodes is used to learn whether or not breast cancer has spread to the axilla (underarm) lymph nodes.

Why Consider the Axillary Lymph Node Dissection

Axillary Lymph Node Dissection helps to control the spread of cancer and hopefully reduce the chance of spread to other parts of the body.

This surgery reduces the chance that cancer could come back. It also helps your doctor plan further treatment for you.

Benefits of Axillary Lymph Node Dissection

The procedure allows critical treatment insights with the least possible surgery and trauma and leaves the other non-involved, functional lymph nodes intact. 

Minimising the number of underarm lymph nodes removed lessons uncomfortable postoperative side effects.

The more surgery a woman has in the breast/armpit area, the more potential for numbness, heightened sensitivity, and discomfort.

About the Axillary Lymph Node Dissection

Axillary Lymph Node Dissection is usually performed simultaneously as a mastectomy or breast-conserving surgery (BCS), but it can be done in a second operation.

Axillary Lymph Node Dissection may also be required if:

• A previous sentinel lymph node biopsy has shown three or more of the underarm lymph nodes have cancer cells
• Swollen underarm or collarbone lymph nodes can be felt before surgery or seen on imaging tests, and a fine needle aspiration or core needle biopsy shows cancer.
• Cancer has grown large enough to extend outside the lymph node(s), or
• The Sentinel Node Biopsy is positive for cancer cells after chemotherapy was given to shrink the tumour before surgery

Preparing for Axillary Lymph Node Dissection

Understand exactly what surgery is planned, along with the risks, benefits, and other options.

• Tell your doctors ALL the medicines and natural health products you take. Some of these can increase the risk of bleeding or interact with anaesthesia.
• If you take aspirin or some other blood thinner, ask your doctor if you should stop taking it before surgery. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
• Your doctor will tell you which medicines to take or stop before surgery. You may need to stop taking certain medicines a week or more before surgery. So talk to your doctor as soon as you can.
• If you have an advance care plan, let your doctor know. Bring a copy to the hospital. If you don't have one, you may want to prepare one. It lets your doctor and loved ones know your health care wishes. Doctors advise that everyone prepare these papers before any type of surgery or procedure.

Day of Procedure

Follow the instructions exactly about 

• when to stop eating and drinking. If you don't, your surgery may be cancelled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewellery and piercings. And take out contact lenses if you wear them.

During the Axillary Lymph Node Dissection

During this surgery, your doctor will remove lymph nodes that have cancer and those that cancer could easily spread to. 

The number of lymph nodes removed can range from 10 to 40 (though usually less than 20) from the area under the arm (axilla) and checked for cancer spread. 

After Axillary Lymph Node Dissection

After the surgery, you may go home the same day. Or you may need to spend the night at the hospital. 

Be sure you have someone to drive you home. Anaesthesia and pain medicine make it unsafe for you to drive.

You will be given more specific instructions about recovering from your surgery. They will cover things like diet, wound care, follow-up care, driving, and returning to your normal routine.

You will probably be able to return to work or your normal routine in 3 to 6 weeks.

This depends on your work and any other treatment you may need.

Axillary Lymph Node Dissection Follow Up

Follow-up care is a key part of your treatment and safety. Make and go to all appointments, and call your doctor if you have problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Side Effects Of Lymph Node Surgery

Lymph node surgery can lead to uncomfortable temporary side effects, these include normal post-operative effects such as pain, swelling, bleeding, blood clots, and Infection, as well as:

• Seroma - Where lymph backup in the armpit
• Lymphedema -  A possible long-term effect of lymph node surgery is swelling in the arm or chest called lymphedema. Because any excess fluid in the arms normally travels back into the bloodstream through the lymphatic system, removing the lymph nodes sometimes blocks drainage from the arm, causing this fluid to build up. 

The risk is thought to be around 20% to 30% in women who have an ALND. It may be more common if radiation is given after surgery or in women who are obese.

Sometimes the swelling lasts for only a few weeks and then goes away. But in some women, it lasts a long time. If your arm is swollen, tight, or painful after lymph node surgery, be sure to tell someone on your cancer care team right away.

• Limited arm and shoulder movement - You might also have limited movement in your arm and shoulder after surgery. Your doctor may advise exercises to help prevent permanent problems (a frozen shoulder).

Some women notice a rope-like structure that begins under the arm and can extend down toward the elbow. This is sometimes called axillary web syndrome or lymphatic cording. Symptoms may not appear for weeks or even months after surgery. It can cause pain and limit movement of the arm and shoulder. This often goes away without treatment, although some women may find physical therapy helpful.

• Numbness - Discomfort and numbness in the
• Mild armpit,
• Upper arm skin, and
• Inner arm is a common side effect because the nerve that controls sensation here travels through the lymph node area.