Surgical versus Nonsurgical Management of Postmastectomy Lymphedema: A Prospective Quality of Life Investigation

Abstract

<jats:title>Abstract</jats:title><jats:p> Background Postmastectomy secondary lymphedema can cause substantial morbidity. However, few studies have investigated longitudinal quality of life (QoL) outcomes in patients with postmastectomy lymphedema, especially with regard to surgical versus nonoperative management. This study prospectively investigated QoL in surgically versus nonsurgically managed patients with postmastectomy upper extremity lymphedema.</jats:p><jats:p> Methods This was a longitudinal cohort study of breast cancer-related lymphedema patients at a single institution, between February 2017 and January 2020. Lymphedema Quality of Life Instrument (LyQLI) and RAND-36 QoL instrument were used. Mann–Whitney U and Fisher's exact tests were used for descriptive statistics. Wilcoxon's signed-rank testing and linear modeling were used to analyze longitudinal changes in QoL.</jats:p><jats:p> Results Thirty-two lymphedema patients were recruited to the study (20 surgical and 12 nonsurgical). Surgical and nonsurgical cohorts did not significantly differ in clinical/demographic characteristics or baseline QoL scores, but at the 12-month time point surgical patients had significantly greater LyQLI overall health scores than nonsurgical patients (79.3 vs. 58.3, p = 0.02), as well as higher composite RAND-36 physical (68.5 vs. 38.3, p = 0.04), and mental (77.0 vs. 52.7, p = 0.02) scores. Furthermore, LyQLI overall health scores significantly improved over time in surgical patients (60.0 at baseline vs. 79.3 at 12 months, p = 0.04). Besides surgical treatment, race, and age were also found to significantly impact QoL on multivariable analysis.</jats:p><jats:p> Conclusion Our results suggest that when compared with nonoperative management, surgery improved QoL for chronic, secondary upper extremity lymphedema patients within 12-month postoperatively. Our results also suggested that insurance status may have influenced decisions to undergo lymphedema surgery. Further study is needed to investigate the various sociodemographic factors that were also found to impact QoL outcomes in these lymphedema patients.</jats:p>

Lymphaticovenular Anastomosis in Breast Cancer Treatment-Related Lymphedema: A Short-Term Clinicopathological Analysis from Indonesia

“…Although attaining an objective lymphedema reduction is a necessary issue, relieving intractable symptoms will also be a significant goal of treatment. In a recent cohort study by Darrach et al, 64 it was clearly shown that in BCRL, the combination of physiotherapy and microsurgical treatment (i.e., LVA and vascularized lymph node transfer) improved the quality of life when compared with nonsurgical management only. In 1-year follow-up, the Lymphedema Quality of Life Instrument had greater overall health scores and improved over time.…”

Quality‐of‐life outcomes after operative management of primary and secondary lymphoedema: a systematic review

“…Twenty‐five studies were selected for review following the search strategy outlined in the PRISMA flow diagram. Complete results of the included articles are provided in Table 2 14,35–58 …”

“…Disease‐specific or region‐specific HRQOL scoring systems were utilized in 16 studies 12,33–43,45,47,48,50 . LYMQOL scores showed significantly increased overall perceived QOL in nine studies, with significant reduction in all four assessed domains, compared to pre‐operative QOL as early as 1‐month post‐intervention 40,42,47,51,54,56 .…”

“…Disease-specific or region-specific HRQOL scoring systems were utilized in 16 studies. 12,[33][34][35][36][37][38][39][40][41][42][43]45,47,48,50 LYMQOL scores showed significantly increased overall perceived QOL in nine studies, with significant reduction in all four assessed domains, compared to preoperative QOL as early as 1-month post-intervention. 40,42,47,51,54,56 Similarly, four studies utilizing Visual Analogue Scale pain scores showed improvement at 1-year follow-up compared to preoperative QOL, with two of these studies additionally demonstrating statistically significant increased HRQOL when compared with a control group undergoing only conservative and non-operative treatments.…”

The Association between Breast Cancer Related Lymphedema and Area Deprivation Index

“…In addition, the RATE-L risk assessment tool has yet to be externally validated on additional populations beyond its development dataset, so the risk categories presented here may not represent the true risk of lymphedema due to baseline differences between the patient populations. 18 Lastly, no patients in this study underwent surgical treatment or prevention of lymphedema, which have been shown to be safe and effective procedures that significantly improve quality of life; 37,38 further study may elucidate a disparity in the utilization of these newer, more complex treatment techniques.…”