PRS AAPS Oral Proofs 2016
Heather L. Baltzer, MD,* Christine Oh, MD,† Jamison Harvey, BSc,† Steven L. Moran, MD†
From the *University of Toronto, Toronto, ON, Canada; and †Mayo Clinic, Rochester, Minn.
PURPOSE: To evaluate the risk of developing “late-onset” upper extremity lymphedema after hand surgery among breast cancer (BC) survivors who had ipsilateral axillary lymph node dissection (ALND), sentinel lymph node biopsy, and/or radiation therapy (RT).
METHODS: A retrospective cohort of BC survivors treated with ALND, sentinel lymph node biopsy, and/or RT was identified between 1997 and 2012. Survivors with ipsilateral hand surgery with ≥1 year of follow-up were included. The primary outcome was documented lymphedema after hand surgery (defined as requiring intervention). Demographic data and clinical information pertaining to hand surgery and BC treatment were compared between patients with and without lymphedema.
RESULTS: Of the 142 survivors included, 12 (8.4%) developed lymphedema after hand surgery. BC survivors with and without lymphedema were similar in age, body mass index, and tourniquet use. Average tourniquet time was greater among women with lymphedema (63 vs 34 minutes, P = 0.02). On univariate analysis, lymphedema was associated with a surgery for hand trauma (75% vs 23%, P = 0.002), RT (91% vs 50%, P < 0.01), ALND (75% vs 34%, P = 0.01), number of nodes removed (15 vs 7, P = 0.002), and chemotherapy (91% vs 34%, P = 0.02).
CONCLUSIONS: These data suggest that BC survivors, particularly after more extensive nodal dissection and adjuvant therapies, who have hand surgery for trauma may benefit from prophylactic antilymphedema modalities. Larger population studies of this high-risk population are needed to further address this question.