Outcome of Level III Axillary Node Dissection in Breast Cancer: 20 years Single Unit Experience in a Comprehensive Cancer Centre in Eastern India.

Axillary dissection and radiation to the axilla are known to cause significant morbidity especially in the form of lymphoedema, paraesthesia, and shoulder dysfunction. Our aim was to study our results of axillary surgery related to complications. Secondary objective was to find out the local recurrence. Records of detailed operation notes and radiotherapy of all patients who underwent surgery for breast cancer in a single unit were kept since January 2001 to December, 2020. Prospectively different parameters like the age, sex, extent of axillary dissection, the structures preserved during axillary nodal dissection, and short-term and long-term complications were recorded. The results were then analyzed to correlate the incidence of long- or short-term complications as mentioned above and also the local recurrence. A total of 1054 patients underwent surgeries for breast cancer during this period; 99% were females and the average age was 42 years. 75.5% underwent modified radical mastectomies (MRM), and the remaining 25% underwent oncoplastic breast surgeries (BCS) and toilet mastectomies. In 1006, patients who underwent level III axillary dissection and LD pedicle were preserved in 100% cases, nerve to serratus anterior in 989 cases (98.3%), medial pectoral vessels and nerve in 957 (95.1%), and intercostobrachial nerves in 872 cases (86.7%). Only 11 (1%) patients had local infection, 13 (1.31%) had seroma needing aspiration, and 57 (5.66%) had long-term paraesthesia in the upper ipsilateral arm and all were related to sacrifice of intercostobrachial nerves. None had long-term shoulder dysfunction. Minor lymphoedema was seen in 20 patients (1.83%), while major lymphoedema with more than 2-cm difference in the mid or wrist circumferences was seen in 5 patients (0.45%). Four of them had radiation in other Institutes which included the axilla. None of our patients had recurrence in the axilla. Management of axilla has been ever evolving. The morbidities arising from axillary dissection has always been a matter of concern and sentinel lymph node biopsy (SLNB) is becoming a standard of care in early breast cancer. However, in India, where we see mostly locally advanced disease, and the affordability and access to healthcare for many patients remain a challenge, optimal surgery is required to avoid axillary recurrence and at the same time minimize the morbidities. Our study has tried to address both and the results of our 20-year data is found to be encouraging.