Collateralization of the upper extremity lymphatic system after axillary lymph node dissection

Lymphatic drainage from the arm may be altered after axillary lymph node dissection (ALND). Understanding these alterations is important as they may change standard surgical and radiation treatment in recurrent breast cancer or upper extremity skin cancers, including melanoma. Utilizing a single-ins...

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Published in:Journal of surgical oncology 2024-09
Main Authors: Fanning, James E, Chung, David K V, Reynolds, Hayley M, Jayathungage Don, Tharanga D, Suami, Hiroo, Donohoe, Kevin J, Singhal, Dhruv
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container_title Journal of surgical oncology
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creator Fanning, James E
Chung, David K V
Reynolds, Hayley M
Jayathungage Don, Tharanga D
Suami, Hiroo
Donohoe, Kevin J
Singhal, Dhruv
description Lymphatic drainage from the arm may be altered after axillary lymph node dissection (ALND). Understanding these alterations is important as they may change standard surgical and radiation treatment in recurrent breast cancer or upper extremity skin cancers, including melanoma. Utilizing a single-institution planar and single photon emission computed tomography/computed tomography lymphoscintigraphy database, we identified patients with a diagnosis of upper extremity cutaneous melanoma from 2008 to 2023 who previously underwent ALND for cancer treatment and did not develop upper extremity cancer-related lymphedema. ALND patients were matched to control patients presenting with cutaneous melanomas at the same anatomic sites. Sentinel lymph nodes (SLNs) were compared between both groups. Of 3628 upper extremity melanoma cutaneous patients, 934 met inclusion criteria, including 22 ALND and 912 control patients. Level I axillary SLN drainage was observed in 98% of controls and 27% of ALND patients (p 
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Understanding these alterations is important as they may change standard surgical and radiation treatment in recurrent breast cancer or upper extremity skin cancers, including melanoma. Utilizing a single-institution planar and single photon emission computed tomography/computed tomography lymphoscintigraphy database, we identified patients with a diagnosis of upper extremity cutaneous melanoma from 2008 to 2023 who previously underwent ALND for cancer treatment and did not develop upper extremity cancer-related lymphedema. ALND patients were matched to control patients presenting with cutaneous melanomas at the same anatomic sites. Sentinel lymph nodes (SLNs) were compared between both groups. Of 3628 upper extremity melanoma cutaneous patients, 934 met inclusion criteria, including 22 ALND and 912 control patients. Level I axillary SLN drainage was observed in 98% of controls and 27% of ALND patients (p &lt; 0.001). Level II axillary SLN drainage was observed in 3% of controls and 27% of ALND patients (p &lt; 0.001). Level III axillary SLN drainage was observed in 1% of controls and 32% of ALND patients (p &lt; 0.001). Epitrochlear SLN drainage was observed in 9% of controls and 32% of ALND patients, respectively (p &lt; 0.046). Brachial SLN drainage was observed in 4% of controls and 23% of ALND patients (p &lt; 0.001). Distinct changes in functional lymphatic drainage were seen between the arms of patients who previously underwent ALND versus control patients. 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Level II axillary SLN drainage was observed in 3% of controls and 27% of ALND patients (p &lt; 0.001). Level III axillary SLN drainage was observed in 1% of controls and 32% of ALND patients (p &lt; 0.001). Epitrochlear SLN drainage was observed in 9% of controls and 32% of ALND patients, respectively (p &lt; 0.046). Brachial SLN drainage was observed in 4% of controls and 23% of ALND patients (p &lt; 0.001). Distinct changes in functional lymphatic drainage were seen between the arms of patients who previously underwent ALND versus control patients. 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title Collateralization of the upper extremity lymphatic system after axillary lymph node dissection
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