Axillary Lymph Node Dissection Surgery

Introduction

Axillary lymph node dissection (ALND) is a surgical procedure commonly performed to treat certain types of cancer, particularly breast cancer. This procedure involves the removal of lymph nodes from the axilla, or armpit, to determine if cancer has spread beyond the primary tumor site. By analyzing the removed lymph nodes, clinicians can better understand the extent of the disease and make informed decisions about treatment options.

Anatomy of the Axillary Lymph Nodes

The axillary lymph nodes are a group of lymph nodes located in the armpit area. They play a crucial role in the immune system by filtering lymph fluid and trapping harmful substances such as bacteria, viruses, and cancer cells. There are three levels of axillary lymph nodes:

• Level I: These nodes are located in the lower part of the axilla, near the edge of the pectoralis minor muscle.
• Level II: These nodes are situated behind the pectoralis minor muscle.
• Level III: These nodes are located above the pectoralis minor muscle, near the clavicle.

The removal of these nodes can provide valuable information about the spread of cancer and help guide treatment decisions.

Indications for Axillary Lymph Node Dissection

ALND is typically indicated in the following situations:

• Breast Cancer: When a biopsy reveals cancer in the axillary lymph nodes, ALND is often performed to determine the extent of the spread and to remove affected nodes.
• Melanoma: In cases where melanoma has spread to the lymph nodes, ALND may be necessary to remove the affected nodes and prevent further spread.
• Other Cancers: Though less common, ALND may be performed for other cancers that have spread to the axillary lymph nodes.

The Surgical Procedure

ALND is performed under general anesthesia, and the duration of the surgery can vary depending on the extent of the dissection. The steps involved in the procedure are as follows:

• Incision: A surgical incision is made in the armpit to access the axillary lymph nodes.
• Removal of Lymph Nodes: The surgeon carefully removes the lymph nodes from levels I, II, and sometimes III. The number of nodes removed can vary.
• Closure: Once the lymph nodes are removed, the incision is closed with sutures or staples, and a drain may be placed to prevent fluid buildup.

Postoperative Care and Recovery

After ALND, patients are monitored in the recovery room before being transferred to a regular hospital room or discharged home. Postoperative care includes:

• Pain Management: Pain medication is prescribed to manage discomfort following the surgery.
• Drain Care: If a drain is placed, patients are instructed on how to care for it until it is removed.
• Physical Therapy: Exercises may be recommended to improve range of motion and prevent stiffness in the shoulder and arm.
• Follow-Up Appointments: Regular follow-up appointments are scheduled to monitor healing and discuss further treatment options.

Potential Complications

As with any surgical procedure, ALND carries a risk of complications. Some potential complications include:

• Lymphedema: Swelling of the arm due to the disruption of lymphatic drainage.
• Infection: Infection at the surgical site, which may require antibiotics or additional treatment.
• Nerve Injury: Damage to nerves in the axilla, potentially causing numbness, tingling, or weakness in the arm.
• Seroma: Accumulation of fluid at the surgical site, which may require drainage.
• Limited Range of Motion: Reduced mobility in the shoulder and arm, which physical therapy can help improve.

Advances in Axillary Lymph Node Management

In recent years, there have been significant advances in the management of axillary lymph nodes in cancer patients. Some of these include:

• Sentinel Lymph Node Biopsy (SLNB): A less invasive procedure that involves removing only the first few lymph nodes to which cancer cells are likely to spread. If these nodes are free of cancer, ALND may be avoided.
• Targeted Axillary Dissection: A technique that combines SLNB with the removal of only the affected lymph nodes, reducing the extent of surgery and associated complications.
• Neoadjuvant Therapy: Preoperative chemotherapy or radiation therapy to shrink tumors and reduce the need for extensive lymph node dissection.

Nursing Care of Patients with Axillary Lymph Node Dissection

Axillary Lymph Node Dissection (ALND) is a surgical procedure that involves the removal of lymph nodes from the axilla (underarm) to determine the spread of cancer. This procedure is often performed in patients with breast cancer or melanoma. Proper nursing care is essential to manage postoperative complications and promote recovery.

Postoperative Nursing Care

Pain Management

Effective pain management is crucial for patients recovering from ALND. Nurses should:

• Regularly assess pain levels using a standardized pain scale.
• Administer prescribed analgesics and monitor their effectiveness.
• Provide non-pharmacological pain relief methods such as ice packs, relaxation techniques, and repositioning.

Monitoring for Complications

Nurses must be vigilant in monitoring for potential complications, including:

• Infection: Observe the surgical site for signs of infection, such as redness, swelling, warmth, and discharge. Administer antibiotics as prescribed and educate the patient on proper wound care.
• Lymphedema: Monitor for swelling in the affected arm and educate the patient on preventive measures, such as avoiding heavy lifting and wearing compression garments.
• Seroma: Check for fluid accumulation at the surgical site. If a seroma develops, it may need to be drained by a healthcare professional.
• Nerve Injury: Assess for symptoms of nerve damage, including numbness, tingling, and weakness in the arm. Provide support and refer to a specialist if necessary.

Promoting Mobility

Encouraging early mobilization and physical therapy is vital to prevent stiffness and maintain the range of motion in the shoulder and arm. Nurses should:

• Teach and assist patients with gentle arm exercises.
• Encourage participation in physical therapy sessions.
• Educate patients on the importance of continuing exercises at home to promote recovery.

Patient Education

Patients should be well-informed about their condition and recovery process. Key education points include:

• Understanding the signs and symptoms of complications and when to seek medical attention.
• Proper wound care and hygiene to prevent infections.
• Techniques to reduce the risk of lymphedema, such as limb elevation and avoiding tight clothing.
• The importance of adhering to follow-up appointments and recommended treatments.

Emotional Support

Undergoing ALND can be emotionally challenging. Nurses should provide:

• Empathetic listening and emotional support.
• Resources for counseling or support groups if needed.
• Assurance and encouragement throughout the recovery process.

Advances in Axillary Lymph Node Management

Recent advances in the management of axillary lymph nodes have led to less invasive procedures and reduced complications. Nurses should be aware of these advancements to provide optimal care:

• Sentinel Lymph Node Biopsy (SLNB): This less invasive procedure involves removing only the first few lymph nodes to which cancer cells are likely to spread. If these nodes are cancer-free, ALND may be avoided.
• Targeted Axillary Dissection: Combines SLNB with the removal of only the affected lymph nodes, reducing the extent of surgery and associated complications.
• Neoadjuvant Therapy: Preoperative chemotherapy or radiation therapy to shrink tumors and reduce the need for extensive lymph node dissection.

REFERENCES

1. Menon G, Toomey AE, Lewis CR. Axillary Lymphadenectomy. [Updated 2025 Jan 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557873/
2. Switalla KM, Boughey JC, Dimitroff K, et al. Clipping the positive lymph node in patients with clinically node positive breast cancer treated with neoadjuvant chemotherapy: impact on axillary surgery in the ISPY-2 Clinical Trial. Ann Surg Oncol. 2024 Oct. 31 (11):7249-59.
3. Cancer Research UK. Lymph node ultrasound and biopsy — under the arm (axillary) https://www.cancerresearchuk.org/about-cancer/tests-and-scans/lymph-node-ultrasound-biopsy-under-arm-axilla. Updated 5/2/2024.
4. Kyriacou H, Khan YS. Anatomy, Shoulder and Upper Limb, Axillary Lymph Nodes (https://www.ncbi.nlm.nih.gov/books/NBK559188/). [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan
5. Toomey AE, Lewis CR. Axillary Lymphadenectomy (https://www.ncbi.nlm.nih.gov/books/NBK553184/). [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan

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