Morbidity associated with axillary surgery for breast cancer

Taylor, Kim O.

doi:10.1111/j.1445-1433.2004.02992.x

Cited by 49 publications

(48 citation statements)

References 12 publications

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“…In accordance with these findings, preliminary observations with nerve-sparing techniques [19][20][21][23][24][25] may suggest such approaches to reduce the risk of developing a chronic neuropathic pain state. However, such studies need to be larger and more detailed taking all the different subgroups as studied in our investigation into consideration.…”

Section: Commentsupporting

confidence: 76%

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Gärtner¹,

Jensen²,

Nielsen³

et al. 2009

JAMA

747

537

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Context Persistent pain and sensory disturbances following surgical treatment for breast cancer is a significant clinical problem. The pathogenic mechanisms are complex and may be related to patient characteristics, surgical technique, and adjuvant therapy.Objective To examine prevalence of and factors associated with persistent pain after surgical treatment for breast cancer. Design, Setting, and PatientsA nationwide cross-sectional questionnaire study of 3754 women aged 18 to 70 years who received surgery and adjuvant therapy (if indicated) for primary breast cancer in Denmark between January 1, 2005, and December 31, 2006. A study questionnaire was sent to the women between January and April 2008.Main Outcome Measures Prevalence, location, and severity of persistent pain and sensory disturbances in 12 well-defined treatment groups assessed an average of 26 months after surgery, and adjusted odds ratio (OR) of reported pain and sensory disturbances with respect to age, surgical technique, chemotherapy, and radiotherapy.Results By June 2008, 3253 of 3754 eligible women (87%) returned the questionnaire. A total of 1543 patients (47%) reported pain, of whom 201 (13%) had severe pain, 595 (39%) had moderate pain, and 733 (48%) had light pain. Factors associated with chronic pain included young age (18-39 years:

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Section: Commentsupporting

confidence: 76%

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Gärtner¹,

Jensen²,

Nielsen³

et al. 2009

JAMA

747

537

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“…Nossos resultados corroboram achados de estudo prévio de nosso grupo 5 e de outros autores que a não preservação do nervo ICB está associada a maior déficit sensorial 3,11 . Há poucos trabalhos na literatura que avaliaram a importância da preservação do nervo ICB durante a DA e eles mostraram resultados semelhantes aos nossos 3,12 . A análise univariada mostrou que as pacientes dos grupos de BLS e DA-NP não apresentaram diferenças estatisticamente significantes na avaliação sensorial para nenhum dos monofilamentos de SemmesWeinstein.…”

Section: Discussionunclassified

Morbidade entre a pós-biópsia de linfonodo sentinela e a dissecção axilar no câncer de mama

Ferreira¹,

Pimentel²,

Santos³

et al. 2008

Rev. Assoc. Med. Bras.

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RESUMOOBJETIVO. O objetivo deste estudo foi avaliar a morbidade cirúrgica pós-biópsia de linfonodo sentinela (BLS) ou dissecção axilar com (DA-NP) e sem preservação do nervo intercostobraquial (DA-NS). MÉTODOS. Fez-se estudo coorte prospectivo com 108 pacientes divididas em três grupos: BLS (n=35), DA-NP (n=36) e DA-NS (n=37). Foram avaliadas ocorrência de déficit sensorial, dor, linfedema, seroma e infecção no membro superior homolateral à cirurgia. Monofilamentos de Semmes-Weinstein foram usados para avaliar o déficit sensorial, perimetria braquial foi feita para avaliação da presença de linfedema e aplicado questionário de dor. Para análise estatística foram utilizados os testes ANOVA e Kruskal-Wallis. Foi feita análise bivariada e multivariada. RESULTADOS. Pelo menos uma complicação pós-cirúrgica, imediata ou tardia, ocorreu em 45/108 (41,7%) pacientes avaliadas. A complicação mais comum foi dor. Houve diferença estatisticamente significante entre os três grupos somente quanto ao déficit sensorial (p=0,04). Dor, linfedema e déficit sensorial ocorreram com maior freqüência no grupo DA-NS. As pacientes dos grupos BLS e DA-NP não apresentaram diferenças estatisticamente significantes para nenhuma das variáveis analisadas. A pesquisa com os monofilamentos mostrou sensibilidade cutânea preservada em 28/35 pacientes do grupo BLS, em 25/36 pacientes do grupo DA-NP e em 10/37 pacientes do grupo DA-NS (p<0,001). CONCLUSÃO. A secção do nervo está relacionada a maior déficit sensorial havendo diferença estatisticamente significante entre os três grupos, o que não demonstrou ser significante com os demais critérios avaliados dentre os grupos analisados. UNITERMOS INTRODUÇÃOO estadiamento axilar é importante etapa no tratamento do câncer de mama. A dissecção axilar (DA) foi durante anos técnica padrão para a maioria dos casos, e ainda é muito útil em grande número de pacientes afetadas pelo câncer de mama. O status axilar é fator prognóstico potente e um dos mais importantes para predizer recorrência e sobrevida 1 . A abordagem cirúrgica da axila no tratamento do câncer de mama mudou mais recentemente e o conceito de conservação, aplicado anteriormente ao tratamento cirúrgico da mama com o desenvolvimento da quadrantectomia, agora também envolve os linfonodos axilares 1 . No final dos anos 90, a introdução da biópsia do linfonodo sentinela (BLS) revolucionou a cirurgia para estadiamento axilar por câncer de mama. Resultados de vários estudos mostraram alto valor preditivo do não-acometimento axilar nos casos em que a avaliação do linfonodo sentinela não evidenciou metástase. A BLS está associada à menor morbidade, melhor preservação da função do braço e melhor qualidade de vida das pacientes comparadas àquelas com DA 2 . No entanto, no Brasil, como ainda predomina diagnóstico de casos mais avançados, cirurgias mais extensas e DA ainda são muito utilizados. Em algumas mulheres, tais procedimentos estão associados à ocorrência de complicações a curto e longo prazos. As mais comuns são hemorragias, infecções, seromas, linf...

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“…Preoperative risk factors associated with persistent pain following breast surgery include depression [172], anxiety [173], pain in any anatomic location [174] [110,[185][186][187][188][189]. Postoperative risk factors include radiation therapy [4,8,110,190,191] and increased severity of pain in the immediate postoperative period [4,191,192].…”

Section: Persistent Post-surgical (Chronic) Painmentioning

confidence: 99%

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

Cheng

2016

Pain Med

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Objective. To review the published evidence regarding perioperative analgesic techniques for breast cancer-related surgery.Design. Topical review.Methods. Randomized, controlled trials (RCTs) were selected for inclusion in the review. Also included were large prospective series providing estimates of potential risks and technical reports and small case series demonstrating a new technique or approaches of interest to clinicians.Results. A total of 514 abstracts were reviewed, with 284 studies meeting criteria for full review. The evidence regarding preemptive ketamine, scheduled opioids, perioperative non-steroidal anti-inflammatory drugs (NSAIDs), and intravenous lidocaine is mixed and deserves further investigation. There is strong evidence that both pregabalin and gabapentin provide analgesic benefits following breast surgery. There is minimal and conflicting data from highquality randomized, controlled studies suggesting that directly infiltrating and/or infusing local anesthetic (liposome encapsulated or unencapsulated) into the surgical wound is a reliably effective analgesic. In contrast, there is a plethora of data demonstrating the potent analgesia, opioid sparing, and decreased opioid-related side effects from thoracic epidural infusion and both single-injection and continuous paravertebral nerve blocks (the latter two demonstrating decreased persistent post-surgical pain between 2.5 and 12 months). Techniques with limited-yet promising-data deserving additional investigation include brachial plexus blocks, cervical epidural infusion, interfascial plane blocks, and interpleural blocks.Conclusions. While there are currently multiple promising analgesic techniques for surgical procedures of the breast that deserve further study, the only modalities demonstrated to provide potent, consistent perioperative pain control are thoracic epidural infusion and paravertebral nerve blocks.

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Morbidity associated with axillary surgery for breast cancer

Abstract: Axillary lymph node dissection for breast cancer has a high long-term morbidity. Preservation of the ICBN during the axillary procedure significantly reduces this morbidity.

Cited by 49 publications

References 12 publications

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Morbidade entre a pós-biópsia de linfonodo sentinela e a dissecção axilar no câncer de mama

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

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