Arm edema after lumpectomy and breast irradiation

Frequency of Early-Stage Lymphedema and Risk Factors in Postoperative Patients with Breast Cancer

OBJECTIVE

Lymphedema is a chronic major complication that is seen frequently post-operatively and has negative effects on quality of life. In our study, determining the early-stage postoperative lymphedema frequency and specifying the risk factors in its development has been aimed.

MATERIALS AND METHODS

One hundred one cases that were operated on for breast cancer were evaluated regarding the 12-month control of their clinical specifications, histopathological specifications, and specifications related with the surgical intervention retrospectively. The data related to the parameters envisioned as risk factors were evaluated.

RESULTS

Lymphedema development was found in 7 (6.9%) out of 101 cases constituting the study group. No significant difference (p>0.05) in terms of lymphedema development was determined among age, body mass index (BMI), chemotherapy (CT), postoperative seroma or infection, mastectomy with the dominant arm, and breast-conserving surgery (BCS), which were evaluated as risk factors. There was a significance (p<0.05) between the other risk factors, which were axillary dissection (AD), number of positive lymph nodes (LN), radiotherapy (RT), the tumor size (T), and lymphedema existence. In every case in which lymphedema was determined, it was seen that there was axillary LN involvement and 15≤LN were ablated in the dissection (p<0.05).

CONCLUSION

It is seen that AD, RT applied to the breast cancer patients, and T are important risk factors in early-stage lymphedema development. No early-stage lymphedema development was determined in any of the patients to whom sentinel lymph node dissection (SLND) was applied.

Estimating the probability of lymphedema after breast cancer surgery

OBJECTIVES

Lymphedema is a common complication of breast cancer surgery, leading to a decreased quality of life. The risk and severity of lymphedema were associated with surgery side upper extremity infection, ≥25 kg/m(2) body mass index (BMI), and the level of hand use (LHU). Our aim was to estimate the probability of lymphedema after breast cancer surgery by using previously published incidence rates and these 3 risk factors.

METHODS

The design was a n:m matched case control study; data were analyzed on 51 patients with lymphedema and 126 available controls matched on age, radiation therapy, and operation type. In conjunction with published estimates of lymphedema, incidence rates, and estimates of the proportions of risk factor combinations in cases and controls, the Bayes' theorem was used to estimate the probability of developing lymphedema.

RESULTS

Lymphedema probabilities of 7 combinations for 6 different published calculations were used. With the assumption of 16% LE incidence rate of lymphedema, a BMI<25, no infection, and a low LHU, the estimated probability of lymphedema was 6.8%. With the assumption of 46.3% LE incidence a BMI ≥25, infection, and a high LHU led to an estimated lymphedema probability of 93.7%.

CONCLUSIONS

This study shows that control of predisposing factors in both high and low incidence rates has a marked effect on the probability of LE development. In other words, patients with low incidence for LE are more prone to develop LE if the predisposing factors are controlled poorly compared to the high incidence patients whom the predisposing factors are avoided.

Fatores de risco para linfedema após câncer de mama: uma revisão da literatura

O linfedema representa uma das principais seqüelas do câncer de mama. Esta revisão da literatura visou discutir os principais fatores associados ao linfedema após o tratamento do câncer de mama. Foram selecionados 26 artigos publicados entre janeiro de 2000 e março de 2008 nas bases Medline e Lilacs, utilizando os descritores breast neoplasms, lymphedema, upper extremity, arm e risk factors. Sua revisão permitiu discutir os fatores relacionados ao linfedema, quanto a: clínica e paciente (tabagismo, escolaridade, etnia, comorbidades, hipertensão arterial, diabetes melito, menopausa, idade, peso corporal, índice de massa corporal, atividade física, membro dominante, restrição articular, infecção, seroma e trauma no membro superior); tratamento do câncer de mama (cirurgia, reconstrução mamária, número de linfonodos retirados, nível da linfadenectomia axilar, radioterapia, quimioterapia, hormonioterapia e tempo transcorrido após o tratamento); tumor (tamanho, grau, localização, comprometimento dos linfonodos axilares e estadiamento). A revisão feita indica que a linfadenectomia axilar, a radioterapia em cadeias de drenagem e a obesidade são fatores preponderantes do risco para desenvolvimento do linfedema.

The incidence of arm edema in women with breast cancer randomized on the National Surgical Adjuvant Breast and Bowel Project study B-04 to radical mastectomy versus total mastectomy and radiotherapy versus total mastectomy alone

PURPOSE

To determine the incidence and factors associated with the development of arm edema in women who participated in the National Surgical Adjuvant Breast and Bowel Project (NSABP) study B-04.

METHODS AND MATERIALS

Between 1971 and 1974, the NSABP protocol B-04 randomized 1,665 eligible patients with resectable breast cancer to either (1) the Halstead-type radical mastectomy; (2) total mastectomy and radiotherapy to the chest wall, axilla, supraclavicular region, and internal mammary nodes if by clinical examination axillary nodes were involved by tumor; and (3) for patients with a clinically uninvolved axilla, a third arm, total mastectomy alone. Measurements of the ipsilateral and contralateral arm circumferences were to be performed every 3 months.

RESULTS

There was at least one recorded measurement of arm circumferences for 1,457 patients (87.5% of eligible patients). There were 674 women (46.3%) who experienced arm edema at some point during the period of follow-up until February 1976. For radical mastectomy patients, total mastectomy and radiotherapy patients, and total mastectomy patients alone, arm edema was recorded at least once in 58.1%, 38.2%, and 39.1% of patients, respectively (p<.001) and at last recorded measurement in 30.7%, 14.8%, and 15.5%, respectively (p=or<.001). Increasing body mass index (BMI) also showed a statistically significant correlation with arm edema at any time (p=.001) and at last assessment (p=.005).

CONCLUSIONS

Patients who undergo mastectomy, including those whose treatment plans do not include axillary dissection or postoperative radiotherapy, suffer an appreciable incidence of arm edema.