Axillary Dissection

What is Axillary Dissection?

An axillary lymph node dissection (ALND) is surgery to take out armpit lymph nodes (underarm or axilla). Axillary lymph nodes are the lymph nodes in the armpit. An ALND is also known as an axillary dissection, an axillary lymphadenectomy, or an axillary node dissection.

During an axillary dissection, the axilla is cut open. This is usually done to find, look at, or remove lymph nodes. The armpit or underarm area of the body is called the “axilla.” The axillary dissection procedure is often used to treat women with breast cancer in the area under their arms.

The lymph nodes in the axilla that are affected by breast cancer are called sentinel lymph nodes or guardian lymph nodes. Lymph nodes are important to the lymphatic system because their main job is to filter out particles and molecules that the body doesn’t recognise.

What are lymphatic nodes?

Part of the lymphatic system is the lymph nodes. The lymphatic system helps the body fight off infections. It is made up of lymph vessels, lymph fluid, lymph nodes, bone marrow, and lymphatic organs (thymus, adenoid, tonsil and spleen).

Lymph vessels are like blood vessels in that they are very thin tubes. They gather lymph fluid and move it away from the tissues and into the lymph nodes. Lymph nodes are small organs made up of lymphatic tissue that look like beans. Cancer cells can travel from where cancer started to the lymph nodes through the lymph fluid.

There are three levels of lymph nodes in the axilla:

• level I (low axilla) is in the lower part of the armpit.
• level II (mid axilla) is in the middle part of the armpit.
• level III (high axilla) is in the upper part of the armpit near the breastbone (sternum)

Most of the time, breast cancer is the type of cancer that spreads to the lymph nodes in the armpit. Skin cancers, like melanoma or non-melanoma, can also spread to the axillary lymph nodes. Some kinds of cancer start in the lymph nodes in the armpit.

Reasons for doing an axillary lymph node dissection

A lymph node dissection of the axilla is performed to:

• Examine the lymph nodes of the armpit for cancer to determine how many lymph nodes have cancer and how far it has travelled.
• cancerous lymph nodes are surgically removed
• When there is a strong likelihood that cancer may spread to lymph nodes, they are removed.
• lessen the likelihood that cancer may return (recur)
• removing cancer from lymph nodes after radiation therapy or chemotherapy
• enables clinicians to plan subsequent treatment.

The steps involved in lymph nodes dissection from the armpit

An ALND is performed while the patient is unconscious. It is possible to perform this procedure at the same time as the original cancer operation, such as during surgery to treat breast cancer.

Through this incision, the surgeon gains access to the level I and level II lymph nodes and removes 10-40 of them. Removing level III lymph nodes does not improve survival and is associated with an increased risk of side effects, hence it is rarely done.

In contrast, if cancer has advanced to the lymph nodes and caused a lump in the armpit, or if larger nodes are observed on imaging tests, then level III lymph nodes may be removed (such as an ultrasound, a CT scan or an MRI).

A specialist who focuses on the origins and mechanisms of disease examines the lymph nodes and any other surgically removed tissue in a laboratory (a pathologist).

Lymph nodes are removed, and then the incision is closed with stitches or staples. A bag is connected to the tube’s end to catch any discharge. This lessens the likelihood of fluid accumulation and speeds recovery. We leave the drain in place for a few weeks, or until we notice very little discharge.

What does the result mean?

Each lymph node that is taken out is checked to see if it has cancer.

• A lymph node that tests negative has no cancer cells.
• A lymph node with a positive test has cancer cells.

The pathologist’s report tells what kind of cancer the person has, how many lymph nodes were taken out, and how many lymph nodes have cancer cells. The report may also say if cancer has spread past the lymph node’s outer layer (the capsule).

The number of positive lymph nodes is used by doctors to help stage the sickness. They decide how to treat cancer based on the stage and other information about the type and grade of the disease.

Your doctor will decide if you need more tests, treatment, or follow-up care based on the results.

How long it takes for surgery

It takes about an hour to do surgery. Different places have different ways of getting checked in and getting ready for surgery. Different women will need different amounts of time in the recovery room to wake up and feel like they are ready to go home.

Unwanted effects involved in this surgery

Adverse reactions to ALNDs can occur at any point during or after the procedure, even days or weeks afterwards. In some cases, symptoms manifest months or even years after an ALND has been performed. Some of the negative consequences may be long-lasting or even permanent, while others resolve on their own or with treatment.

Please notify your healthcare provider if you experience any of the following symptoms that you suspect may be caused by an ALND:

• a buildup of fluid beneath the skin (seroma) in the armpit around the incision; a bloated and tight-feeling arm; stiffness or problems moving the arm or shoulder; indications of infection, such as pain, redness, pus, discharge, or fever
• altered states of perception, such as pain or numbness (may happen if nerves are damaged)
• ongoing discomfort (may be caused by damage to the nerves in the armpit)
• discomfort, tightness in the arm, and difficulty moving the shoulder are all symptoms of axillary web syndrome (AWS), also known as lymphatic cording. This occurs when cords of scar tissue growth in the lymph capillaries from the armpit to the elbow.
• Antibiotics may be prescribed to treat or prevent an infection, and fluid may be drained if necessary.

When it comes to axillary surgery, Dr Mansi is your one-stop destination

Dr Mansi Chowhan is an accomplished surgical oncologist who has been active in the medical industry for over a dozen years. She was presented with a gold award for her exceptional performance while pursuing her postgraduate education. She is a highly qualified surgeon who specialises in breast oncoplastic surgery, head and neck surgery, and reconstructive operations from internationally proclaimed institutions.