Incidence Of Postoperative Lymphedema Research Articles

Clinical issues of surgery for uterine endometrial cancer in Japan.

The mainstay of treatment for uterine endometrial cancer is surgery, and recurrent-risk cases require multidisciplinary treatment, including surgery, chemotherapy and radiation therapy. The standard surgery for uterine endometrial cancer is hysterectomy and bilateral salpingooophorectomy, with additional retroperitoneal lymph node dissection and omentectomy, depending on the case. The appropriate treatment is determined based on the risk classification, such as the depth of invasion into the myometrium, diagnosis of histological type and grade, and risk assessment of lymph node metastasis. Recently, minimally invasive surgery has been widely used not only in low-risk patients but also in intermediate- and high-risk patients. In low-risk patients, the possibility of ovarian preservation is discussed from a healthcare perspective for young women. Determining the need for retroperitoneal lymph node dissection based on sentinel lymph node evaluation may contribute in minimizing the incidence of post-operative lymphedema while ensuring accurate diagnosis of lymph node metastasis. Recently, many studies using sentinel lymph nodes have been reported for patients with uterine endometrial cancer, and the feasibility of sentinel lymph node mapping surgery has been proven. Unfortunately, sentinel lymph node biopsy and sentinel lymph node mapping surgery have not been widely adopted in surgery for uterine cancer in Japan. In addition, the search for biomarkers, such as RNA sequencing using The Cancer Genome Atlas, metabolic profile and lipidomic profile for early detection and prognostic evaluation, has been actively pursued. Gynecologic oncologists expect to be able to provide uterine endometrial cancer patients with appropriate treatment that preserves their quality of life without compromising oncologic outcomes in the near future.

The Effect of Oncoplastic Reduction on The Incidence of Post-Operative Lymphedema in Breast Cancer Patients Undergoing Lumpectomy

In patients with macromastia, breast conservation surgery (BCS) followed by radiation therapy (RT) may be associated with increased radiation exposure and a different complication profile than those without macromastia. The oncoplastic reduction mammoplasty (ORM) procedure includes breast reduction at the time of BCS. The purpose of this study is to determine if women with macromastia who undergo ORM have a different complication profile compared to those who undergo BCS followed by RT. We performed a retrospective chart review on patients who underwent lumpectomy with RT from 2014 to 2017. Chronic breast lymphedema (CBL) was defined as swelling that persisted >1-year post-RT. Breast volumes (BV) were determined by contoured breast volumes or, if unavailable, estimated by the 95% isodose volumes from the RT treatment planning system. Univariate analysis was used to evaluate various patient factors and treatment outcomes in women with BV ≥1300 cc compared to <1300 cc. These same factors were compared in women who underwent ORM vs. BCS. Multivariate regression analysis was used to evaluate factors associated with ≥1 complication. Logistic regression was performed to identify factors associated with the development of CBL. The total population included 785 patients, of which 28 (3.6%) underwent ORM and 757 (96.4%) underwent BCS. The total population was stratified into two groups, in which 289 (36.8%) patients had BV ≥1300 cc and 496 (63.2%) patients had a BV <1300 cc. Compared to patients with BV<1300 cc, those with BV ≥1300 cc had a higher percentage of African Americans (52.6% vs. 41.5%, P = 0.002), higher median BMI (34.96 vs. 27.87, P<0.001), higher incidence of diabetes (39.8% vs. 27.2%, P<0.001), higher incidence of hypertension (75.4% vs. 63.1%, P<0.001), and higher incidence of CBL (12.5% vs. 4.2%, P<0.001). Compared to BCS patients, ORM patients with BV ≥1300 cc had increased incidence of CBL (36.4% vs. 11.5%, P = 0.035). Logistic regression showed that the incidence of ≥1 complication was associated with BMI, presence of SLNB, and the number of lymph nodes removed in either SLNB or ALND. However, factors such as ORM and BV were not associated with an increased risk of ≥1 complication. Logistic regression demonstrated that having a BV ≥1300 cc was associated with 2.5 times increased odds of CBL compared to those with BV <1300 cc. Even though those who underwent ORM did not change the risk for CBL for the entire cohort, ORM patients with BV ≥1300 had a higher risk of CBL. Ultimately, logistic regression demonstrates that ORM does not increase the risk of CBL when adjusting for BV. In conclusion, axillary surgery contributed most significantly to the incidence of having ≥1 complication. However, BV was associated with an increased risk of CBL, regardless of the presence of ORM. Therefore, women with BV ≥1300 cc should be offered ORM at the time of lumpectomy in order to reduce their future risk of CBL.

Discussion of relationships among changes of pathological indicators, postoperative lymphedema of the upper limb, and prognosis of patients with breast cancer.

Objectives: The present study aimed to discuss the impacts of changes to pathological indicators of patients with breast cancer upon the incidence of postoperative lymphedema of the upper limb and prognosis. Methods: 2597 female patients with breast cancer who received surgical treatment in our hospital were enrolled in the present study to evaluate the incidence of these patients’ postoperative lymphedema of the upper limb. Results: For patients with breast cancer, the incidence of postoperative lymphedema of the upper limb was related to T stage of breast cancer, lymph node metastasis, the number of metastatic lymph nodes, pTNM stage, and pathological types of breast cancer (P<0.05). Lymph node metastasis was an independent risk factor of lymphedema of the upper limb; lymph node metastasis and Ki-67 expression level were independent factors that impacted pathologic complete response rate of neoadjuvant chemotherapies. Patients’ mortality was correlated to pathological and molecular subtypes, Ki-67 expression level, ER expression level, PR expression level, and pTNM stage (P<0.05), among which the pTNM stage, Ki-67 expression level, and PR expression level were independent factors that affected prognosis of patients with breast cancer. Conclusion: Patients with lymph node metastasis were more prone to lymphedema of the upper limb, while it was easier for those whose Ki-67 expression level was high and who were not subject to lymph node metastasis to get a pathological complete response after receiving neoadjuvant chemotherapies. The prognosis was poorer among patients whose progesterone receptors were negative and Ki-67 expression levels were high at the advanced pTNM stage.

Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials.

BackgroundLymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD) could prevent or manage limb edema in women after breast-cancer surgery.MethodsWe performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro), SCOPUS, and Cochrane Central Register of Controlled Trials electronic databases were searched for articles on MLD published before December 2012, with no language restrictions. The primary outcome for prevention was the incidence of postoperative lymphedema. The outcome for management of lymphedema was a reduction in edema volume.ResultsIn total, 10 RCTs with 566 patients were identified. Two studies evaluating the preventive outcome of MLD found no significant difference in the incidence of lymphedema between the MLD and standard treatment groups, with a risk ratio of 0.63 and a 95% confidence interval (CI) of 0.14 to 2.82. Seven studies assessed the reduction in arm volume, and found no significant difference between the MLD and standard treatment groups, with a weighted mean difference of 75.12 (95% CI, −9.34 to 159.58).ConclusionsThe current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema. However, clinical and statistical inconsistencies between the various studies confounded our evaluation of the effect of MLD on breast-cancer-related lymphedema.