General Surgery

Axillary Node Clearance

OPERATION: Axillary Node Clearance (Level II / Level III)
ANAESTHETIC: General anaesthesia
POSITION: Supine with ipsilateral arm abducted, forearm suspended [or on arm board]

INDICATION:
Breast cancer with confirmed axillary nodal metastases. [Positive sentinel node biopsy / palpable axillary nodes / prior sampling positive].

PROCEDURE:
WHO Checklist performed. Transverse lower axillary incision / extension of previous breast wound. Skin flaps elevated.

Axillary vein identified and cleared along its inferior border — axillary vein preserved. Dissection carried medially along the axillary vein. Lateral border of pectoralis minor identified. [For level II: dissection taken to the lateral border of pectoralis minor; for level III: dissection taken medial to pectoralis minor].

Long thoracic nerve (nerve to serratus anterior) identified on the chest wall and preserved throughout. Thoracodorsal nerve and vessels to latissimus dorsi identified and preserved [unless involved by tumour].

Intercostobrachial nerve(s) identified and preserved [/ divided if involved in tumour clearance]. Subscapular vessels preserved.

Axillary contents including all fatty and nodal tissue cleared from the defined anatomical space as one specimen. Haemostasis confirmed.

[Suction drain placed]. Wound closed with subcuticular absorbable suture.

FINDINGS:
[Describe nodes palpated, presence of matted nodes / extranodal extension].

SPECIMEN: Axillary contents to histopathology.
EBL: [Volume] ml. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Arm exercises commenced day one. Drain removed when output <30 ml/day. Physiotherapy referral. Lymphoedema precautions discussed. Results at MDT.