Strategies for morbidity control of axillary dissection for breast cancer
(Strategieen voar de controle van rnorbiditeit van okselklierdissectie bij borstkanker)
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Breast cancer accounts for one third of all cancers in females in the Netherlands I and the incidence has been increasing world-wide in the past decades 2.. For the majority of patients, surgery forms the primary treatment of choice 3. Dissection of the axillary lymph nodes has been part of the surgical treatment since the introduction of radical mastectomy at the end of the nineteenth century 4 and has remained an important element in the management of breast cancer up until the present day 5. iniiiaily, lymph node dissection was considered to be essential for the cure of breast cancer, but over the last decades it has been primarily regarded as a staging procedure, with the secondary purpose of maintaining local control in the axilla 6,7, In the absence of reliable, non-invasive techniques, axillary lymph node dissection remains the most important method for determining axillary node status, A number of studies have reported the adverse effects of axillary lymph node dissection, which include seroma formation 8, edema of the arm and breast ,),10, shoulder dysfunction 11,12 and loss of sensation in the distribution area of the intercostobrachial nerves 11,13, The length of hospital stay after axillary lymphadenectomy for breast cancer is usually determined by the need for wound and drain management of the patient 14-16, Recently. clinicians have begun to explore the possibilities of earlier discharge of the patient, and the conclusion has been made that this offers safe and cost-effective management 17-20 and may be of psychological benefit for the patient 21,22, Changes related to the indications and sequelae of axillary lymph node dissection and to the postoperative care need have major implications, as they affect the wellbeing of many women.
The studies described in Chapter 5 and 6 were financially supported by the Ministry
of Welfare, Health and Sports, the Netherlands. The study described in Chapter 7
was supported by the Dutch Foundation for Preventive Medicine (Preventiefonds).
Financial support for this thesis was given by Glaxo \\Vellcome, Astra Tech, Van
Straten, Zeneca Farma and VVAA.
- breast cancer
- axillary dissection
- breast cancer patients