Evaluating Operative Times for Intraoperative Conversion of Axillary Node Biopsy to Axillary Lymph Node Dissection with Immediate Lymphatic Reconstruction

Shahnur Ahmed; Luci Hulsman; Dylan Roth; Carla Fisher; Kandice Ludwig; Folasade O. Imeokparia; Richard Jason VonDerHaar; Mary E. Lester; Aladdin H. Hassanein

doi:10.1055/s-0044-1787727

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2025; 41(02): 144-148
DOI: 10.1055/s-0044-1787727

Original Article

Evaluating Operative Times for Intraoperative Conversion of Axillary Node Biopsy to Axillary Lymph Node Dissection with Immediate Lymphatic Reconstruction

Shahnur Ahmed

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

,

Luci Hulsman

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

,

Dylan Roth

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

,

Carla Fisher

²Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, Indiana

,

Kandice Ludwig

²Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, Indiana

,

Folasade O. Imeokparia

²Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, Indiana

,

Richard Jason VonDerHaar

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

,

Mary E. Lester

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

,

Aladdin H. Hassanein

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

› Author Affiliations

Abstract

Background Lymphedema can occur in patients undergoing axillary lymph node dissection (ALND) and radiation for breast cancer. Immediate lymphatic reconstruction (ILR) is performed to decrease the risk of lymphedema in patients after ALND. Some patients who ultimately require ALND are candidates for attempted sentinel lymph node biopsy (SLNB) or targeted axillary excision. In those scenarios, ALND can be performed (1) immediately if frozen sections are positive or (2) as a second operation following permanent pathology. The purpose of this study is to evaluate immediate ALND/ILR following positive intraoperative frozen sections to guide surgical decision-making and operative planning.

Methods A single-center retrospective review was performed (2019–2022) for breast cancer patients undergoing axillary node surgery with breast reconstruction. Patients were divided into two groups: immediate conversion to ALND/ILR (Group 1) and no immediate conversion to ALND (Group 2). Demographic data and operative time were recorded.

Results There were 148 patients who underwent mastectomy, tissue expander (TE) reconstruction, and axillary node surgery. Group 1 included 30 patients who had mastectomy, sentinel node/targeted node biopsy, TE reconstruction, and intraoperative conversion to immediate ALND/ILR. Group 2 had 118 patients who underwent mastectomy with TE reconstruction and SLNB with no ALND or ILR. Operative time for bilateral surgery was 303.1 ± 63.2 minutes in Group 1 compared with 222.6 ± 52.2 minutes in Group 2 (p = 0.001). Operative time in Group 1 patients undergoing unilateral surgery was 252.3 ± 71.6 minutes compared with 171.3 ± 43.2 minutes in Group 2 (p = 0.001).

Conclusion Intraoperative frozen section of sentinel/targeted nodes extended operative time by approximately 80 minutes in patients undergoing mastectomy with breast reconstruction and conversion of SLNB to ALND/ILR. Intraoperative conversion to ALND adds unpredictability to the operation as well as additional potentially unaccounted operative time. However, staging ALND requires an additional operation.

Keywords

operative time - ALND - ILR

Full Text

References

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