Axillary Lymphadenectomy and Lymphaticovenous Bypass

Introduction

British surgeon Sir Berkeley Moynihan stated, “Surgery of cancer is not the surgery of the organs; it is the surgery of the lymphatic system.” This statement is especially true of breast cancer and melanoma, in which specific operations are carried out to remove regional lymph node metastases. Axillary lymph node dissection (ALND) was traditionally the standard of care for staging as well as treating these patients. However, in the 1990s sentinel lymph node biopsy (SLNB) changed the way surgeons stage and treat both breast cancer and melanoma (see Chapter 58 , Sentinel Lymph Node Biopsy).

Patients who undergo ALND have either had an SLNB performed, which has shown metastatic disease in lymph nodes, or have locally advanced disease with cancer in their lymph node(s) (LN) at the time of their presentation. Cancer that has spread to LN is at a more advanced stage with possibility of distant metastatic spread and higher risk of local/regional recurrence.