Name of the Procedure:

Axillary Lymphadenectomy; Complete (Axillary Lymph Node Dissection, ALND)

Summary

Axillary lymphadenectomy, also known as a complete axillary lymph node dissection (ALND), is a surgical procedure to remove lymph nodes from the axilla, which is the area under the arm. This is often done to check for the spread of breast cancer or other cancers.

Purpose

The procedure is primarily performed to assess or prevent the spread of cancer to lymph nodes in the axillary region. By removing these lymph nodes, doctors can better understand the extent of cancer spread and make informed decisions regarding further treatment.

Indications

This procedure is typically recommended for patients who have been diagnosed with breast cancer or other cancers that may spread to the axillary lymph nodes. It is particularly indicated when a sentinel lymph node biopsy shows cancerous cells, or if imaging tests suggest enlarged lymph nodes.

Preparation

Patients may be asked to fast for a certain period before surgery. Medications, including blood thinners, might need to be adjusted or stopped. Preoperative assessments often include blood tests, imaging studies, and possibly an electrocardiogram (EKG) to ensure the patient is fit for surgery.

Procedure Description

1. Anesthesia: The patient will receive general anesthesia, ensuring they are asleep and pain-free during the procedure.
2. Incision: A surgeon makes an incision under the arm.
3. Lymph Node Removal: The surgeon identifies and excises multiple (often 10-40) lymph nodes from the axilla.
4. Closure: The incision is closed with sutures, and a drain might be placed to prevent fluid accumulation.
5. Completion: The patient is moved to a recovery area to wake from anesthesia and be monitored.

Duration

The procedure typically takes 1-3 hours.

Setting

Axillary lymphadenectomy is usually performed in a hospital operating room or a specialized surgical center.

Personnel

The surgical team includes a surgeon, an anesthesiologist, surgical nurses, and support staff.

Risks and Complications

Possible risks and complications include infection, bleeding, lymphedema (swelling due to lymph fluid), numbness, shoulder pain or stiffness, and seroma (fluid accumulation). Rare complications can include severe allergic reactions to anesthesia and damage to surrounding tissues.

Benefits

The procedure provides critical information about the extent of cancer spread, which is essential for staging the disease and planning further treatment, such as chemotherapy, radiation, or targeted therapy. It can also help prevent future cancer metastasis.

Recovery

Post-procedure care involves managing pain with prescribed medications, caring for the surgical site, and possibly draining fluid from a placed drain. Patients are usually advised to avoid heavy lifting and strenuous activities for several weeks. Follow-up appointments are necessary to monitor recovery and address any complications.

Alternatives

Alternative treatments include a sentinel lymph node biopsy, which is less extensive and typically involves removing fewer lymph nodes. Non-surgical options, such as radiation or systemic therapies (chemotherapy, hormonal therapy), might also be considered depending on the individual case. The choice of alternative treatments depends on factors like cancer stage, patient health, and potential treatment efficacy.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Postoperatively, there may be pain and discomfort in the underarm area, which can be managed with pain medications. Swelling or restricted shoulder movement is common, and physical therapy might be recommended to aid recovery.

Pain management, proper wound care, and regular follow-up visits are essential to ensure a smooth recovery and address any complications promptly.