The clinical relevance of an armpit dissection with sparing of the nodes of the upper extrimity.

Background:

Axillary lymph node dissection has potential negative side effects associated with the procedure including upper extremity lymphedema.1-9 Axillary reverse mapping (ARM) is a recently described technique which enables discrimination of lymphatic drainage of the breast from the arm. If upper extremity lymphedema is caused by cutting axillary lymphatic’s, then being able to see and identify them would allow them to be preserved.10 The aim of this study is to determine the clinical relevance of ARM expressed by the occurrence of postoperative complications. To minimize the risk overlooking ARM node metastases, we will only include patients with an indication for a complementary axillary lymph node dissection based on a tumor-positive sentinel lymph node. Patients with an indication for an axillary lymph node dissection based on a clinical positive axilla can be included in the feasibility study to confirm the feasibility of the procedure and to perform a further subgroup analysis.



Methods and design:

280 Patients diagnosed with axillary metastasis of invasive breast cancer and an indication for a complementary axillary lymph node dissection based on a positive sentinel lymph node will be randomised to receive an axillary lymph node dissection with sparing of the ARM nodes and a standard axillary lymph node dissection. The postoperative outcome will be measured after 6,12 and 24 months. The primary outcome is the presence of breast cancer related lymphedema.
The secondary outcome measurements include other postoperative complications (pain, paresthesia, numbness and loss of shoulder mobility), quality of live and axillary recurrence ratio.

The hypothesis is that patients undergoing an axillary lymph node dissecion with preserving of the lymph nodes and vessels of the upper extrimity (ALND-ARM) have less postoperative complications compared to patients undergoing a standard axillary lymph node dissection (ALND-standard).

Follow-up will be performed at 6, 12 and 24 months after the primary intervention

A standard ALND compared with a limited and more tailor-made axillary lymph node dissecion, based on the ARM technique.