Axillary Lymph Node Dissection Through a Separate Incision Does Not Increase Rates of Breast Cancer-Related Lymphedema.

Abstract

Breast cancer patients treated with axillary lymph node dissection (ALND) have an approximate 20-30% lifetime risk of developing lymphedema, with multiple factors implicated in the pathogenesis. In patients undergoing mastectomy, ALND can be performed through the mastectomy incision or through a separate axillary incision. It is unknown whether the latter causes more lymphatic disruption resulting in higher lymphedema rates. We aimed to assess whether ALND through the mastectomy incision versus a separate incision impacts rates of breast cancer-related lymphedema (BCRL). A retrospective chart review was performed of patients who underwent mastectomy and ALND from 2017 to 2020. Patients were grouped by ALND via mastectomy or a separate incision. The primary outcome of interest was development of BCRL as defined by ICD-10 codes. A total of 1,036 patients were included; 483 via a separate axillary incision and 553 underwent ALND via the mastectomy incision. Median time to lymphedema development was 15 months. The BCRL rates between patients who had ALND via a separate incision were not significantly different from those who had ALND via the mastectomy incision (29 vs. 30%, p = 0.77). Multivariable logistical regression showed patients with ALND performed through a separate incision did not have significantly greater odds of developing lymphedema compared with those with ALND performed through the mastectomy incision (odds ratio 0.89; 95% confidence interval 0.65-1.21; p = 0.45). Patients who received ALND via a separate axillary incision as compared to the mastectomy incision do not have significantly greater rates of BCRL. Oncologic safety should be prioritized when considering lymph node retrieval technique.