Annals of Surgical Oncology

, Volume 11, Issue 11, pp 1018–1024 | Cite as

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

  • J. S. Rietman
  • P. U. Dijkstra
  • J. H. B. Geertzen
  • P. Baas
  • J. de Vries
  • W. V. Dolsma
  • J. W. Groothoff
  • W. H. Eisma
  • H. J. Hoekstra
Original Articles


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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Copyright information

© The Society of Surgical Oncology, Inc. 2004

Authors and Affiliations

  • J. S. Rietman
    • 1
    • 2
    • 3
    • 7
  • P. U. Dijkstra
    • 2
    • 3
  • J. H. B. Geertzen
    • 2
    • 3
  • P. Baas
    • 4
  • J. de Vries
    • 5
  • W. V. Dolsma
    • 6
  • J. W. Groothoff
    • 3
  • W. H. Eisma
    • 2
  • H. J. Hoekstra
    • 5
  1. 1.Department of Rehabilitation MedicineMartini HospitalGroningenThe Netherlands
  2. 2.Department of Rehabilitation MedicineGroningen University HospitalGroningenThe Netherlands
  3. 3.Northern Centre for Health Care ResearchUniversity GroningenGroningenThe Netherlands
  4. 4.Department of SurgeryMartini HospitalGroningenThe Netherlands
  5. 5.Department of Surgical OncologyGroningen University HospitalGroningenThe Netherlands
  6. 6.Department of Radiation OncologyGroningen University HospitalGroningenThe Netherlands
  7. 7.Department of Rehabilitation MedicineMartini Hospital GroningenGroningenThe Netherlands

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