Resection of the axillary vein in radical mastectomy: Its relation to the mechanism of lymphedema

E V I D E N C E to be offered in this communication will indicate the frequent necessity for axillary-vein resection in the operative treatment of mammary carcinoma and will also suggest the possibility of eventually including this anatomical extension of radical mastectomy as a routine measure.The absolute indication for axillary-vein resection should be the presence of apparent lymphnode metastases attached, or in close proximity, to the sheath of the vessel.Resection of the vein in such instances provides a real approach to the adequate en-bloc dissection of the axillary space.Its inclusion as a routine step should be equally as desirable, if it can be shown that the postoperative sequelae, particularly lymphedema of the homolateral extremity, are no greater, or even less severe, than those of the conventional procedure.The early results in a small group of patients, reported herewith, constitute tentative confirmation of the latter possibility.The diminished degree of lymphedema consequent upon axillary-vein resection will be discussed in terms of the possible mechanism of its production.Neuhof, in I 938, reported eleven patients in whom he had resected the axillary vein in the presence of adherent lymph-node metastases.Two of these women had "some" lymphedema, two had fluctuating edema of the hand, the others were reported as having developed no lymphedema.I n 1932, nine cases that had had resection of the axillary vein were reported by Costantini, who observed immediate, transient edema in some patients but concluded that the late results were as good as, or better than, in those with conservation of the vein.Costantini suggested