Mastectomy without Lymphedema?
Thu, April 12, 2007 at 03:45AM Lymphedema of the arm is a complication of breast cancer surgery and radiation. It’s swelling of the affected arm and hand, due to decreased drainage of lymphatic fluid (tissue fluids) form the arm, because the axillary lymph nodes have been removed or destroyed by the procedure. It occurs in 15% to 20% percent of breast cancer survivors, and can cause pain, loss of mobility and skin infections.
Many techniques are used to try to achieve good removal of possibly cancerous lymph glands while sparing the healthy ones. One development is biopsy of so-called ‘sentinel nodes’ during surgery; the first node that the fluid passes through in a group of nodes is called the sentinel lymph node. Thus, the sentinel lymph node is the protective node that acts as the first filter of harmful materials. Based on the findings, surgeons can remove fewer lymph nodes, leaving more nodes intact to remove lymph from the arm.
A new approach was described at the recent Society of Surgical Oncology Symposium. Known as axillary reverse mapping (ARM), it involves injecting a blue dye into the lower arm just before surgery, which allows the drainage of lymph from the arm to be mapped visually during the dissection of the axilla, so that the nodes draining the arm can be spared. Of 40 patients who had breast cancer surgery, 18 required axillary lymph node removal. Of these, 14 had a sentinel lymph node biopsy. None of the patients who had ARM developed lymphedema in the next 8 months. This has led the surgeons at Little Rock , where the procedure was created, to make it standard practice at their hospital. If the excellent results are confirmed with the observation period extended well beyond 8 months, it represents a big step forward in preventing lymphedema while still offering the best chance for survival.
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