Incidence and risk factors for axillary web syndrome after breast cancer surgery

Abstract

The objective of the study is to estimate the incidence and risk factors of axillary web syndrome (AWS) in early postoperative period (45 days). From the prospective cohort of women undergoing breast cancer surgery, we collected the variables related to patient characteristics, treatment, tumor, and postoperative complications. We performed bivariate and logistic regression. A total of 193 patients are included with a mean age of 58.26 years, majority of which are women who are overweight or obese (72.3%). The incidence of AWS was 28.1%. The presence of pain in the ipsilateral upper-limb associated with AWS was reported in 5.4% of the patients, and the shoulder joint restriction was observed in 11.4%. When controlling for confounding between AWS and the factors that showed statistical significance in bivariate analysis, the variables that explain the occurrence of the AWS were the type of axillary surgery, where women who underwent sentinel lymph node biopsy showed 68% less risk compared with those that underwent axillary lymphadenectomy (AL) (RR = 0.32; 95% CI, 0.13-0.79; P value = 0.014) and numbness in the arm after an injury of the intercostobrachial nerve, which is 3.19 times the risk of the AWS (RR = 3.19; 95% CI, 1.40-7.29, P value = 0.006). From the above findings, we concluded that the incidence of AWS was 28.1%, and it was associated with AL and numbness in the arm after injury of the intercostobrachial nerve.

Anatomical information for intercostobrachial nerve preservation in axillary lymph node dissection for breast cancer

“…Resection or damage to the intercostobrachial nerve (ICBN) during ALND would limit the activities of the upper limbs of patients after surgery and causes post-mastectomy pain syndrome, such as pain, numbness, and sensory disturbances in the lateral thoracic wall, axilla, and arms, which occur in 18-50% of patients (McIntosh and Purushotham, 1998;Carpenter et al, 1999;Bergmann et al, 2012;Kodama et al, 2012;Taira et al, 2014) and seriously reduces the postoperative quality of life for patients with breast cancer. Therefore, an increasing number of surgeons have considered improvements to surgical procedures to protect the ICBN during ALND.…”

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“…The cords usually start at the surgical site in the axilla and may extend down the medial arm to the antecubital fossa and even into the hand. Some cases may present with cording extending down the chest wall into the abdomen wall [2,7,10].…”

El vendaje cohesivo en el tratamiento de la trombosis linfática superficial en mujeres intervenidas de cáncer de mama. Serie de casos

“…Según diversos estudios, no se ha encontrado asociación entre la TLS y el LMS, a pesar de que existen hipótesis acerca de la posible relación entre la fisiopatología de ambas patologías (68,74). Parece razonable pensar en una posible relación entre ambas ya que la TLS supone una sobrecarga linfática, que con el tiempo podría precipitar la aparición del linfedema (48,61,78).…”

“…En algún estudio se cuestiona la necesidad de que el cordón sea tanto visible como palpable para establecer un diagnóstico adecuado de TLS; ya que en algunos casos basta con que sea bien visible o bien palpable (70). La visibilidad y la palpación del cordón se relacionan con la cantidad de tejido adiposo que presente la paciente, siendo menos visible en aquellas con un IMC mayor (67,70,74).…”

“…Dicha mujer, durante el tratamiento de la TLS, fue la única que tuvo que ser vendada desde la mano porque se le hinchaba la misma. A pesar de que diversos estudios publicados no establecen relación alguna entre ambas entidades (68,74,79), este resultado coincide con los expuestos por otros autores acerca de la posible relación entre la presencia de TLS y el riesgo futuro de desarrollar LMS, debido a que la primera ya supone una sobrecarga linfática que podría precipitar la segunda (78,80). Sin embargo, siguen siendo necesarios más estudios a largo plazo, con más muestra, para obtener resultados concluyentes.…”