Prevalence of lymphedema and upper-limb impairments after axillary lymph node dissection or sentinel lymph node dissection in breast cancer: A 2-year follow-up study.

Abstract

9137 Background: Arm lymphedema and limb morbidity in patients going through axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) were investigated pre-operatively and after two years. Aims: to evaluate possible differences in arm morbidities between groups and to examine changes over time within groups. Methods: Two prospective female cohorts (n=393) treated with primary breast cancer surgery with ALND (n=204, mean age 55 ±10) or SLND (n=189, mean age 57 ±10) were examined for arm lymphedema (ALE), defined as > 10% increased arm volume relative to control arm volume, grip strength (kg), shoulder function, shoulder abduction endurance (sec) and BMI (kg/m2). Arm pain and sensation of heaviness in the affected arm was assessed on a 100 mm visual analogue scale (VAS). Descriptive statistics, t-tests and ANCOVA were employed. Results: Of the 393 women, 314 (80%) participated at the two-year follow-up (ALND n=152, SLND n=162). The number of patients with impairments was significantly higher (P< 0.05) in the ALND group after two years; 15 % had developed ALE, 36% reported pain and 32% had a sensation of heaviness, relative to 2% with ALE, 16% with pain and 2% with a sensation of heaviness in the SLND group. There were no significant differences between groups in shoulder function. Grip strength and shoulder abduction endurance in the affected limb significantly decreased from baseline to follow-up in the ALND group with mean reduction of 2.2 kg (CI 1.28-3.03) and 17 sec (CI 5.46- 28.60) (P< 0.05) respectively, while no significant decreases were observed in the SLND group. Both groups had a significant increase in BMI, but with less than 1 unit BMI (P< 0.05). Conclusions: Upper limb impairments two years after breast cancer surgery with ALND were significantly more prevalent compared to SLND surgery. Furthermore, there were significant decreases in grip strength and shoulder abduction endurance in the ALND group only. The ALND group may benefit from post-operative physical therapy focusing on muscle strength and endurance exercises. No significant financial relationships to disclose.