Name of the Procedure:

Axillary lymphadenectomy; superficial
Common Name(s): Axillary lymph node dissection, Axillary node removal

Summary

Axillary lymphadenectomy is a surgical procedure where lymph nodes located in the axilla (underarm area) are removed. This procedure focuses on superficial lymph nodes and is generally performed to diagnose or treat certain medical conditions.

Purpose

The procedure addresses medical conditions such as breast cancer, lymphoma, and infections that affect the lymph nodes. The goals are to remove lymph nodes that may contain cancer cells or other abnormalities, evaluate the extent of disease spread, and help in planning further treatment.

Indications

• Presence of cancer in the breast or nearby regions
• Swelling or enlargement of axillary lymph nodes
• Infections affecting the lymph nodes
• Diagnostic purposes to determine the spread of a malignancy

Patient criteria include:

• Confirmation of abnormal lymph nodes via imaging or clinical examination
• Indications of cancer spread based on biopsy results

Preparation

Patients are typically advised to:

• Fast (no food or drink) for a specified period before surgery
• Adjust or stop certain medications as directed by their healthcare provider
• Undergo pre-operative diagnostic tests, such as imaging studies or blood tests

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the axilla.
3. The surgeon carefully identifies and removes the superficial lymph nodes.
4. The incision is closed with sutures or staples, and a drain may be placed to remove excess fluids.

Tools and Equipment:

• Surgical scalpel
• Hemostats and dissection instruments
• Sutures and surgical staples

Anesthesia: General anesthesia is typically used to ensure the patient is asleep and pain-free.

Duration

The procedure typically takes about 1 to 3 hours, depending on the extent of the dissection required.

Setting

The procedure is performed in a hospital or a surgical center equipped for operative care.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurse
• Operating room technician

Risks and Complications

Common risks:

• Infection
• Bleeding
• Swelling and pain in the affected area

Rare risks:

• Nerve damage causing numbness or weakness
• Lymphedema (swelling due to lymph fluid buildup)
• Seroma formation (fluid accumulation in the surgical area)
• Complications related to anesthesia

Benefits

• Accurate staging of cancer and determination of its spread
• Potential removal of cancerous lymph nodes
• Information that can guide further treatment plans Benefits are often realized shortly after the procedure, with pathology results guiding subsequent therapy.

Recovery

• Patients may need to stay in the hospital for a day or overnight.
• Pain management with medications prescribed by the surgeon.
• Instructions for wound care and drain management, if a drain is placed.
• Avoid strenuous activities and heavy lifting for a few weeks.
• Follow-up appointments for suture removal, pathology results, and further treatment planning.

Alternatives

• Sentinel lymph node biopsy: Less invasive procedure focused on assessing fewer lymph nodes.
• Watchful waiting with regular follow-ups for those with minor lymph node involvement.
• Medical imaging for ongoing monitoring. Pros and cons:
• Sentinel lymph node biopsy is less invasive with a quicker recovery but may not be suitable for all situations.
• Watchful waiting can avoid immediate surgery but may delay definitive treatment.

Patient Experience

During the procedure, patients are under general anesthesia and do not feel pain. Post-procedure, there may be discomfort, swelling, and pain managed with medications. Patients should follow all post-operative instructions to ensure proper healing and avoid complications.