Immediate Lymphatic Reconstruction after Axillary Lymphadenectomy: A Single-Institution Early Experience
- PDF / 364,177 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 76 Downloads / 150 Views
ORIGINAL ARTICLE – BREAST ONCOLOGY
Immediate Lymphatic Reconstruction after Axillary Lymphadenectomy: A Single-Institution Early Experience Julia A. Cook, MD1, Sarah E. Sasor, MD2, Scott N. Loewenstein, MD1, Will DeBrock, MD1, Mary Lester, MD1, Juan Socas, MD1, Kandice K. Ludwig, MD3, Carla S. Fisher, MD1, and Aladdin H. Hassanein, MD, MMSc1 Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN; 2Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI; 3Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 1
ABSTRACT Purpose. Lymphedema is progressive arm swelling from lymphatic dysfunction which can occur in 30% patients undergoing axillary dissection/radiation for breast cancer. Immediate lymphatic reconstruction (ILR) is performed in an attempt decrease the risk of lymphedema in patients undergoing axillary lymph node dissection (ALND). The purpose of this study was to assess the efficacy of ILR in preventing lymphedema rates in ALND patients. Methods. An institutional review board-approved retrospective review was performed of all patients who underwent ILR from 2017 to 2019. Patient demographics, comorbidities, operative and pathologic findings, number of LVAs, limb measurements, complications, and followup were recorded and analyzed. Student’s sample t-test, Fisher’s exact test, and ANOVA were used to analyze data; significance was set at p \ 0.05. Results. Thirty-three patients were included in this analysis. Three patients (9.1%) developed persistent lymphedema, and two patients (6.1%) developed transient arm edema that resolved with compression and massage therapy. A significant effect was found for body mass index and the number of lymph nodes taken on the development of lymphedema (p \ 0.01).
Ó Society of Surgical Oncology 2020 First Received: 20 April 2020 Accepted: 17 August 2020 A. H. Hassanein, MD, MMSc e-mail: [email protected]
Conclusions. The rate of lymphedema in this series was 9.1%, which is an improvement from historical rates of lymphedema. Our findings support ILR as a technique that potentially decreases the incidence of lymphedema after axillary lymphadenectomy. Obesity and number of lymph nodes removed were significant predictive variables for the development of lymphedema following LVA.
Lymphedema is an incurable, progressive limb enlargement caused by lymphatic dysfunction. Chronic accumulation of lymphatic fluid and lymphatic stasis can progress to fibro-adipose deposition, causing an increased risk for recurrent cellulitis, pain, deformity, and decreased function.1,2 Patients requiring lymphadenectomy for oncologic treatment are at risk for iatrogenic lymphedema. Sentinel lymph node biopsies (SLNB) for breast cancer carry up to a 6% risk of lymphedema.3,4 Axillary lymph node dissection (ALND) is reserved for patients with advanced disease and positive sentinel lymph node biopsies, but it carries a substantially higher risk of lymphedema compared with SLNB.5 Patients with the greatest frequency of lymphedema
Data Loading...
