Excision of axillary lymph nodes is a surgical procedure commonly performed in the evaluation and treatment of breast cancer. The axillary lymph nodes, located in the armpit region, play a crucial role in the lymphatic drainage of the breast. When breast cancer spreads, the axillary lymph nodes are often the first sites of metastasis. Excision of axillary lymph nodes allows for accurate staging of breast cancer and provides important information for treatment planning.

The procedure typically takes place during a surgical intervention called axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB). The choice between ALND and SLNB depends on factors such as the size and location of the tumor, the stage of the cancer, and the individual patient's circumstances.

Axillary lymph node dissection involves the removal of multiple lymph nodes from the axilla. It is usually performed under general anesthesia. An incision is made in the armpit, allowing access to the axillary lymph node basin. The surgeon carefully identifies and dissects the lymph nodes from the surrounding tissues. The number of nodes removed varies depending on the extent of the disease and the surgeon's assessment.

During the procedure, the surgeon also examines the lymph nodes for any visible signs of metastasis, such as enlargement, firmness, or abnormal appearance. These visual findings provide immediate information regarding the spread of cancer to the axillary lymph nodes.

Following the removal of the lymph nodes, the incision is closed with sutures or staples, and a sterile dressing is applied. Drainage tubes may be inserted to prevent fluid buildup in the surgical site. The patient is then taken to the recovery area to awaken from anesthesia.

Sentinel lymph node biopsy is a less invasive alternative to axillary lymph node dissection. It involves the identification and removal of the first few lymph nodes that receive drainage from the breast tumor. These sentinel nodes are the most likely to contain metastatic cancer cells if the cancer has spread. By examining these nodes, surgeons can assess the status of the axillary lymph nodes without performing a more extensive dissection.

To identify the sentinel lymph nodes, a radioactive tracer or blue dye is injected near the tumor site or around the nipple. The tracer or dye travels through the lymphatic channels to the sentinel nodes, making them easier to locate during surgery. The surgeon then makes a small incision in the armpit and removes the sentinel nodes. These nodes are sent to the pathology laboratory for examination.

If the sentinel nodes are negative for cancer cells, it is unlikely that cancer has spread to other lymph nodes in the axilla. This information helps guide further treatment decisions, potentially avoiding the need for more extensive lymph node dissection. However, if cancer cells are detected in the sentinel nodes, additional lymph nodes may be removed through axillary lymph node dissection to further assess the extent of the disease.

Excision of axillary lymph nodes provides critical staging information in the management of breast cancer. The presence or absence of cancer cells in the lymph nodes affects treatment decisions and prognosis. Lymph node involvement is an essential factor in determining the need for additional therapies, such as adjuvant chemotherapy, radiation therapy, or targeted therapies.

The removal of axillary lymph nodes also serves a therapeutic purpose. By eliminating the cancer cells present in the nodes, surgeons aim to reduce the risk of recurrence and improve patient outcomes. However, it is important to note that axillary lymph node dissection is associated with potential side effects and complications.

Complications of axillary lymph node dissection include pain, numbness, and tingling in the arm and shoulder region, known as post-mastectomy pain syndrome. Lymphedema, the buildup of fluid in the arm, is another common complication. It can cause swelling, discomfort, and limited mobility. Seroma, the collection of fluid at the surgical site, and infection are also possible risks.

To minimize the risk of complications and promote optimal recovery, patients are often advised to engage in specialized exercises and physical therapy after surgery. These exercises can help improve arm strength and mobility, reduce the risk of lymphedema, and facilitate the healing process.

In recent years, there has been a shift towards minimizing the extent of axillary lymph node surgery in certain cases. This approach is known as selective lymph node dissection or tailored axillary surgery. It involves individualized assessment based on factors such as tumor characteristics, patient age, and presence of other medical conditions. By avoiding unnecessary removal of lymph nodes, this approach aims to reduce the risk of complications while still providing accurate staging information.

In conclusion, excision of axillary lymph nodes is a crucial component of breast cancer management. Whether through axillary lymph node dissection or sentinel lymph node biopsy, the removal and examination of these nodes provide vital staging information and guide treatment decisions. While the procedure carries potential risks and complications, advancements in surgical techniques and tailored approaches aim to minimize these concerns. Excision of axillary lymph nodes plays a significant role in optimizing patient outcomes and improving the overall management of breast cancer.