Study of Incidence of Lymphedema in Indian Patients Undergoing Axillary Dissection for Breast Cancer

Abstract

Lymphedema of the upper extremity, in addition to being unsightly, can be painful, can limit the arm movements, increases the risk of infection and is psychologically distressing, serving as a constant reminder of cancer. 1. To ascertain the incidence of lymphedema in a hospital based population (in patients undergoing axillary dissection for breast cancer. 2. To determine the clinicoepidemilogical factors associated with the occurrence of lymphedema in these patients. For all patients undergoing axillary dissection, arm measurements were taken in the pre-& post-operative period from at least 3 sites; one in the arm, forearm and wrist (points fixed in reference to fixed bony landmarks). Patients included in this study were followed up for at least 12 months. Circumference difference of more than 5% was taken as mild lymphedema; more than 10% as moderate lymphedema and more than 15% as severe lymphedema. Data was analyzed using SPSS 11.0 statistical software. Of the 231 patients in this study mean age was 51.2 years, majority were housewives (71.9%) and postmenopausal (58.5%). Modified radical mastectomy (MRM), was performed on 203 (87.9%) patients. 57.2% patients had positive lymph nodes. The mean number of positive nodes was 6.52. Majority of the patients received chemo and radio therapy. Overall incidence of lymphedema was 41.1%. The definition of 5-10% increase as mild lymphedema may be a bit severe as in most patients with this increase, lymphedema is not clinically apparent. The incidence of moderate and severe lymphedema in our series is only 7.4%. The incidence of clinically significant lymphedema (moderate to severe lymphedema & symptomatic mild lymphedema) was 16.8%. Only axillary irradiation and pathological nodal status (pN3) emerged as significant risk factors for lymphedema development on multivariate analysis. Lymphedema once established is difficult to treat. Combination of axillary dissection with radiation and more nodal positivity seems to predispose to lymphedema. Prevention by means of sentinel node biopsy in early cases, good surgical technique, arm care post surgery, exercises and massage therapy may help reducing the incidence and/or severity.

Upper limb lymphedema related to breast cancer therapy: incidence, risk factors, diagnostic techniques, risk reduction and optimal management

“…10 Lymphedema, following breast cancer treatment, occurs due to lymphatic interruption following surgical trauma or radiotherapy induced fibrosis that leads to chronic inflammation and consequent fibrosis of the hypodermal and dermal connective tissue. 11 In the present study, the overall cumulative incidence of lymphedema has increased from 4% at 3 months to 7% at 6 months to 14% at 12 months to 18% at 24 months postoperatively which is quite different to a study by Warren et al 12 in which only 6.8% of patients developed lymphedema at 24 months and 13.7% at 60 months postoperatively.…”

Surgical Technique can Prevent Arm Lymphoedema After Level III Clearance for Breast Cancer

“…Pillai et al found axillary radiation and the number of positive axillary lymph nodes to be the only two factors responsible for development of lymphoedema, in a prospective study from India. 7 Our study also analysed a few common factors which have been implicated in the causation of lymphoedema after axillary dissection. However, our premise based on our own experience is that significant lymphoedema of the arm is quite uncommon after axillary surgery although minor increase in the circumference of the arm or forearm is not uncommon.…”

“…This is in tune with the incidence reported by other Indian cancer institutes. 7,8 In world literature, the incidence of lymphoedema reported varies widely. This is because there is no standard definition of lymphoedema and no universally accepted method of measurement of arm lymphoedema.…”

Lymphoedema after mastectomy for breast cancer: Importance of supportive care

“…Some studies classify axillary dissection and radiotherapy as risk factors for lymphoedema. [13,14] Clark and Sitzia [1] reported that axillary dissection and radiotherapy have no effect on lymphoedema formation; however, they found that 80% of their patients who developed lymphoedema within 3 years had developed it within the first year. Purushotham et al [2] found no association between adjuvant treatment and lymphoedema in patients who had undergone the same treatment.…”