P3-07-14: Sensory Disturbance of the Ipsilateral Upper Arm after Breast Cancer Surgery with Sentinel Node Biopsy Alone Compared with Axillary Dissection – A Prospective Study

Background Axillary surgery for breast cancer causes several postoperative complications including edema of the ipsilateral arm and sensory disturbance of the ipsilateral upper arm. Although sentinel node biopsy has been considered as a standard procedure for node-negative patients, some complications bother patients even after it. Although data regarding the quality of life of patients and/or subjective and objective assessment of arm morbidity after axillary surgery have been reported, to our knowledge, quite a few data have been reported on actual examination of sensory disturbance of the ipsilateral upper arm after sentinel node biopsy alone. We report comparative data regarding the objective and subjective degrees of postoperative sensory disturbance of the ipsilateral upper arm examined prospectively between sentinel node biopsy alone and axillary dissection. Patients and Methods A total of 118 patients, who received breast cancer surgery with sentinel node biopsy alone (51 patients)(SN group) or axillary dissection (67 patients)(AD group) at NHO Shikoku Cancer Center, were prospectively evaluated sensory disturbance regarding the following: (a) dysesthesia, (b) paresthesia, (c) degree of disturbed tactile sensation, (d) degree of disturbed pain sensation, (e) ratio of disturbed area of tactile sensation (defined as (A) length of disturbed area/(B) total length of upper arm), and (f) ratio of disturbed area of pain sensation (defined as A/B). Patients were either asked about the above or examined for them at one month, 6 months and 1 year, respectively, after surgery. At surgery it was recorded whether or not the intercostobrachial nerve(s) were totally preserved in patients who underwent axillary dissection. Unpaired t-test, Mann-Whitney U-test and Wilcoxon signed rank test were used to test statistical significance. Results: The mean ages at surgery were 54.7 and 53.7 years in the SN and AD groups, respectively (P = 0.66). The mean number of biopsied lymph nodes in the SN group was 2.4 (range: 1–5). In 22 patients of the AD group the intercostobrachial nerves were totally preserved. There was no difference in dysesthesia, paresthesia, and the level of disturbed pain sensation between the two groups throughout one year after surgery. However, the patients in the SN group showed milder disturbed tactile sensation at one and 6 months than those in the AD group (P = 0.04 and 0.03, respectively). Both the ratios of disturbed area of tactile and pain sensation were statistically significantly lower in the SN group than in the AD group throughout one year (P = 0.03 ∼ 0.12 for any comparison). On the other hand, the mean ratios in the AD group became lower from 0.23 to 0.17 for tactile sensation and from 0.20 to 0.13 in pain sensation (P = 0.02, and 0.05 for tactile and pain sensations, respectively). Conclusion: Sensory disturbance of the ipsilateral upper arm after sentinel node biopsy alone was much milder than after axillary dissection throughout the study period. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-14.