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Treatment-Related Upper Limb Morbidity 1 Year after Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection for Stage I or II Breast Cancer

From the Department of Rehabilitation Medicine, Martini Hospital, Groningen, The Netherlands (JSR); Department of Rehabilitation Medicine, Groningen University Hospital, Groningen, The Netherlands (JSR, PUD, JHBG, WHE); Northern Centre for Health Care Research, University Groningen, Groningen, The Netherlands (JSR, PUD, JHBG, JWG); Department of Surgery, Martini Hospital, Groningen, The Netherlands (PB); Department of Surgical Oncology, Groningen University Hospital, Groningen, The Netherlands (JdV, HJH); and Department of Radiation Oncology, Groningen University Hospital, Groningen, The Netherlands (WVD).

Correspondence: Address correspondence and reprint requests to: Johan S. Rietman, MD, Department of Rehabilitation Medicine, Martini Hospital Groningen, PO Box 30033, NL-9700 RM Groningen, The Netherlands; Fax: 3-150-524-5183; E-mail: j.s.rietman{at}planet.nl

Background: In a prospective study, upper limb morbidity and perceived disability/activities of daily life (ADLs) were assessed before and 1 year after sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND).

Methods: A total of 204 patients with stage I/II breast cancer (mean age, 55.6 years; SD, 11.6 years) entered the study, and 189 patients (93%) could be evaluated after 1 year. Fifty-eight patients (31%) underwent only SLNB, and 131 (69%) underwent ALND. Assessments performed before surgery (t₀) and 1 year after surgery (t₁), included pain, shoulder range of motion, muscle strength, upper arm/forearm circumference, and perceived shoulder disability/ADL.

Results: Considerable treatment-related upper limb morbidity was observed. Significant (P < .05) changes between t₀ and t₁ were found in all assessments except strength of elbow flexors. Patients in the ALND group showed significantly more changes in the range of motion in forward flexion, abduction, and abduction/external rotation; grip strength and strength of shoulder abductors; circumference of upper arm and forearm; and perceived shoulder disability in ADLs compared with the SLNB group. Multivariate linear regression analysis showed that ALND could predict a decrease of range of motion in forward flexion, abduction, strength of shoulder abductors, grip strength, and shoulder-related ADLs and an increase in the circumference of the upper arm. Radiation of the axilla (19 patients) predicts an additional decrease in shoulder range of motion.

Conclusions: One year after treatment of breast cancer, there is significantly less upper limb morbidity after SLNB compared with ALND. ALND is a predictor for upper limb morbidity.

Key Words: Breast cancer • Staging • Sentinel lymph node • Axillary dissection • Radiation • Morbidity

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