What is the duration of Modified Radical Mastectomy (MRM) and Axillary Lymph Node Dissection (ALND)?

Duration of Modified Radical Mastectomy (MRM) and Axillary Lymph Node Dissection (ALND)

Modified Radical Mastectomy (MRM) typically takes approximately 105 minutes to complete, while Axillary Lymph Node Dissection (ALND) is a component of this procedure that adds to the overall operative time.

Operative Time

• MRM with ALND has a mean operative time of 105 ± 7 minutes according to surgical data 1
• The procedure is commonly performed as a single surgical session
• Factors affecting duration include:
  • Surgical technique used (conventional electrocautery vs. newer technologies)
  • Extent of axillary dissection required
  • Patient-specific anatomical considerations

Hospital Stay Duration

• Most patients can be discharged within 23 hours of surgery 2

  • 50% of patients can be discharged the same day
  • 44% require overnight observation
  • Only 6% require hospitalization for 2 or more days

• When using modern techniques like electrothermal bipolar vessel sealing systems:

  • Mean hospital stay is 3.7 ± 0.6 days 1
  • Drainage duration for mastectomy site: 1.3 ± 0.2 days
  • Drainage duration for axillary site: 2.7 ± 0.5 days

Surgical Techniques and Impact on Duration

Different surgical techniques can significantly impact the duration of MRM and ALND:

• Conventional electrocautery vs. ultracision:
  • Ultracision reduces drain days for axilla (3 days vs 6 days) 3
  • Ultracision reduces drain days for breast (2 days vs 3 days) 3
  • Ultracision significantly reduces drainage volumes, potentially enabling earlier discharge

Extent of the Procedure

The extent of ALND affects both operative time and recovery:

• Complete ALND involves removal of all axillary tissue with a median of 23 lymph nodes 4
• Distribution of lymph nodes by level:
  • Level I: 39% of lymph nodes
  • Level II: 41% of lymph nodes
  • Level III: 20% of lymph nodes

Complications and Recovery

• Complications occur in approximately 9-13% of patients undergoing ALND 5
• Common complications include:
  • Lymphedema (2-13% with ALND vs 1% with SNB)
  • Nerve damage (intercostobrachial nerve, long thoracic nerve)
  • Shoulder dysfunction
  • Sensory deficits

Current Trends

It's important to note that current guidelines have shifted toward less invasive approaches:

• Sentinel Lymph Node Biopsy (SLNB) has largely replaced ALND for clinically node-negative patients 6
• SLNB is associated with significantly lower complication rates (1% vs 2-13%) 5
• ALND is now primarily reserved for patients with positive sentinel nodes or those with clinically positive nodes confirmed by biopsy 6

This shift in practice has reduced the number of patients requiring full ALND, but the procedure duration remains similar when it is performed.