number of positive lymph nodes dissected in a cohort of 183
patients treated with breast-conserving surgery and breast radiation
therapy. Yeoh et al. (52), in a study of 187 patients after
surgery and radiation therapy, found that the degree of arm
dysfunction (arm edema and limitation of shoulder mobility)
was predicted by the extent of axillary surgery. The 30-month
actuarial rate of arm edema ranged from 25% for patients without
axillary surgery, to 50% for patients with axillary sampling,
to 84% for patients with axillary dissection. In a cohort of 223
patients after surgery for nonrecurrent breast cancer, Maunsell et
al. (5) found that, regardless of the type of mastectomy, women
who had undergone axillary dissection had significantly more
self-reported arm problems (24%–64%) than women who had
not undergone axillary dissection (0%–33%). In a recent prospective
study comparing morbidity following sentinel node biopsy
versus that following axillary node dissection in 70 patients,
Schrenk et al. (31) reported no significant difference in
arm circumference in the sentinel node biopsy group but a significant
(P .0001) increase in arm dimension in the axillary
dissection group.
The combination of axillary radiation therapy and axillary
surgery substantially increases the risk of arm edema. In a randomized
controlled trial of 100 patients treated either with axillary
dissection or with axillary sampling with or without radiation
therapy, Borup Christensen and Lundgren (46) found
that the incidence of arm edema was significantly higher in the
group with axillary dissection and axillary radiation therapy
(44%) than in the group with axillary dissection alone (10%) or