Incidence Of Lymphedema Research Articles

The Effectiveness of the Sport "Dragon Boat Racing" in Reducing the Risk of Lymphedema Incidence: An Observational Study.

Upper extremity lymphedema is a complication that often occurs in women with breast cancer as a result of surgery and/or radiotherapy. Some studies report that a boating activity known as the "dragon boat" sport can benefit these women. The aim of this study was to assess whether this type of sport prevents or reduces lymphedema, its impact on quality of life (QoL), and the possible predictors of this condition. This was an observational study of 2 groups: group A (women who participated in dragon boat racing for at least 6 months) and group B (women who participated in other forms of physical exercise biweekly). Data were collected at the National Cancer Institute of Rome and the lake of Castel Gandolfo from June to October 2016. The instruments used were a questionnaire created for sociodemographic and clinical data, the European Organisation for Research and Treatment of Cancer Core Questionnaire for evaluating QoL, and a tape measure applied to estimate the local lymphedema. One hundred women participated in the study. Lymphedema incidence in group A was 4.0% (2 of 50), whereas in group B it was 26.0% (13 of 50). Women who participated in dragon boat racing also reported a healthier lifestyle, lower body mass index, and a better QoL (set point: 61.8 group B vs 80.0 group A). The dragon boat sport participants had more positive clinical and QoL outcomes than did the women who did not participate in that sporting activity. It would be important to make women with breast cancer aware of the practice of dragon boat racing.

Risk factors for postoperative lymphedema in breast cancer patients

Objective To investigate the risk factors of lymphedema in patients with breast cancer after operation. Methods From January 2012 to May 2016, the clinical data of 350 patients with breast cancer who underwent surgical treatment in First People′s Hospital of Foshan were collected. According to the occurrence of postoperative lymphedema, the patients were divided into lymphedema group (87 cases) and non lymphedema group (263 cases). The possible risk factors were evaluated from general demographic indicators, pathological data of breast cancer, perioperative related data and preventive action implementation. Results General demographic data: there was no correlation between the incidence of lymphedema and age, preoperative body mass index (BMI), postoperative BMI, educational level, marital status, residence, family income, menopause, hypertension history (P>0.05). Pathological data of breast cancer: the occurrence of lymphe-dema was related with tumor quadrant (χ2=20.039, P 0.05). Comparison of preventive behaviors: avoiding injuries such as cuts and bites (χ2=15.754, P 0.05). Lymphedema as the dependent variable, multivariate logistic regression analysis results showed that tumor located in the upper outer quadrant (OR=3.943, P<0.001), surgical incision for longitudinal incision (OR=3.767, P<0.001) or oblique incision (OR=2.492, P<0.001), Ⅱ (OR=1.707, P=0.003) or Ⅲ (OR=4.211, P<0.001) axillary lymph node dissection, breast/chest wall radiotherapy (OR=2.869, P<0.001) or lymph node radiotherapy (OR=4.829, P<0.001), grabing heavy objects or not (OR=3.264, P<0.001), avoiding injuries such as cuts and bites (OR=2.602, P<0.001) were independent risk in-fluence factors of postoperative lymphedema. Conclusion A variety of factors affect the occurrence of posto-perative lymphedema in breast cancer patients. Tumors located in the upper outer quadrant, longitudinal or oblique incision, high level of axillary lymph node dissection, radiotherapy, having injuries such as cuts and bites, grabing heavy objects are independent risk influence factors of postoperative lymphedema in breast cancer patients. More attention should be paid to the high risk of lymphedema, and the preventive measures should be taken actively. Key words: Breast neoplasms; Lymphedema; Risk factors

Radiation Therapy Field Design and Lymphedema Risk After Regional Nodal Irradiation for Breast Cancer

The occurrence of upper extremity lymphedema after regional nodal irradiation (RNI) for breast cancer treatment varies significantly based on patient and treatment factors. The relationship between the radiation therapy (RT) field design and lymphedema risk is not well-characterized. The present study sought to correlate the variations in RT field design with lymphedema outcomes. Women with stage II-IV breast cancer receiving RNI after breast surgery that included sentinel lymph node biopsy or axillary dissection were identified. Their arm circumference was measured before RT and at each follow-up visit to assess for lymphedema. Nodal RT fields were defined using a trifurcated system. Group 1 excluded the upper level I and II axilla, defined by the lateral border of the nodal field encompassing less than one-third of the humeral head. Group 2 included the upper level I and II axilla, defined by the lateral border of the nodal field encompassing more than one-third of the humoral head treated with an anterior oblique beam. Group 3 included the upper level I and II axilla the same as for group 2 but with parallel-opposed beams delivering a significant dose to the musculature posterior to the axilla. From 1999 to 2013, 526 women received RNI. The median post-RT follow-up was 5.5years. For the 492 women meeting the inclusion criteria, the cumulative incidence of lymphedema was 23.5% at 2years and 31.8% at 5years. On univariate analysis, the patients in group 1 had a lower 5-year lymphedema rate (7.7%) than those in group 2 (37.1%) and group 3 (36.7%; P<.0001). On multivariate analysis, inclusion of the upper level I and II axilla (groups 2 and 3) remained significantly associated with increased lymphedema risk. Variations in the RT field design significantly affect the development of lymphedema after RNI. In particular, the upper level I and II axilla appear to be important regions for lymphedema risk after axillary dissection.

Pre-surgical chemotherapy for breast cancer may be associated with improved outcomes

BackgroundHistorical studies suggest no difference in disease outcome between neoadjuvant and adjuvant approaches in breast cancer. We hypothesize neoadjuvant chemotherapy (NCT) may offer several benefits, possibly improving quality of life outcomes. MethodsRetrospective review of Tumor Registry data of breast cancer patients from 2011 to 2015. Pathologists reviewed cases from 2012 to 2013 to provide additional RCB (residual cancer burden) scores. ResultsFrom 2011 to 2015 there were 2707 breast cancer cases and 455 patients received NCT. RCB score was documented in 348 with excellent outcome in 41% (pCR in 115 patients, 28 RCB I). There were 137 RCB II and 68 RCB III. Clinically positive nodes were present in 202 of 455 and 77 (38%) had clearance of nodal disease. Of these 45 had axillary dissections. DiscussionNeoadjuvant therapy was associated with excellent response rates. Thirty eight percent of patients with positive nodes converted to node negative although over 50% underwent axillary dissection. Higher utilization of NCT could decrease need for axillary dissection thereby lowering incidence of lymphedema and improving quality of life for survivors.

Abstract P5-22-03: Arm node preserving surgery in primary breast cancer patients : 5 year experience

Abstract Background: Lymphedema is one of the major complications of axillary lymph node dissection (ALND) in patients with breast cancer. Axillary reverse mapping (ARM) is the technique to find lymphatic drainage from the arm during ALND. The purpose of this study is to evaluate the efficacy of arm node preserving surgery using ARM for reducing the incidence of lymphedema after axillary lymph node dissection in breast cancer patients and its oncologic safety. Methods: From January 2009 to October 2014, 167 patients with primary breast cancer were included. In all patients, 1 mCi of 99mTc-phytate was injected at the ipsilateral subareolar plexus and for axillary reverse mapping, 2.5mL of methylene blue was injected into the subcutaneous area of the medial intermuscular groove of the ipsilateral upper arm. The injection site was massaged for at least 5 minutes with the arm lifted above the heart level. At least 15 minutes later, ALND was performed and blue-stained arm nodes were identified. Arm nodes that were enlarged, hard or looked suspicious for metastasis were removed and all other arm nodes were preserved. Arm circumference at 10cm proximal to the medial epicondyle were measured pre- and post-operatively for 2 years. Circumference difference between both upper arms (CD) was evaluated and lymphedema was defined as CD of ≥ 2cm. Follow-up studies were performed every 6 months for 5 years and then annually using mammography, ultrasonography, and/or positron emission tomography. Results: Among 167 patients, 125 patients (74.9%) had their arm node preserved (ANP) and 42 (25.1%) patients had their arm node removed (ANR). Statistically significant difference in the mean number of harvested nodes was observed between ANP group (17.85±6.74) and ANR group (20.17±6.08) (p=0.05). The mean number of total identified blue stained arm nodes were 1.35±0.84. The mean follow-up period for measurement of arm circumference was 16.62±8.36 months. The last measured CD between both upper arms was 0.19±0.67cm in ANP group and 0.67±0.92cm in ANP group (p=0.003). 20 patients complained subjective symptoms of lymphedema, 7 patients in ANP group and 13 patients in ANR group (5.6% vs 31%, p&amp;lt;0.001). Among them, one patient in ANP group and 6 patients in ANR group were diagnosed with lymphedema ( 0.8% vs 14.3%, p=0.001). The other 13 patients' CDs between both upper arms were below objective criteria of lymphedema. Follow-up studies were performed for 59.4±22.40 months. There were 16 cases of distant metastasis, 12 cases in ANP group, 4 cases in ANR group (9.6% vs 9.5%, p=1). Two patients in ANP group had distant metastasis and ipsilateral axillary recurrence simultaneously, but their TNM stages were already IIIc and IIb at the diagnosis. There's no solitary axillary recurrence. Conclusion: Arm node preserving surgery using axillary reverse mapping in breast cancer patients can reduce the incidence of lymphedema after axillary lymph node dissection and it simultaneously has oncologic safety. Citation Format: Park JY, Choi JE, Bae YK, Lee SJ. Arm node preserving surgery in primary breast cancer patients : 5 year experience [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-03.

Abstract P6-12-16: L-Dex surveillance of breast cancer-related lymphoedema: A retrospective study

Abstract Objectives: Breast cancer-related lymphoedema involves chronic, progressive, and incurable swelling in the treated breast or ipsilateral arm, hand, and/or trunk. The traditional referall-based model of care involves women being referred to a lymphoedema therapist after the onset of symptoms. Clinical guidelines from the United States, United Kingdom, and Australia have urged that lymphoedema surveillance and early intervention be implemented routinely after breast cancer treatment. Bioimpedance spectroscopy (BIS) is a candidate diagnostic modality for lymphoedema surveillance because BIS may measure the accumulating extracellular fluid that is characteristic of early lymphoedema. This cohort study aimed to determine whether prospective surveillance using BIS resulted in earlier detection and effective management of lymphoedema. Method: The study cohort were women with breast cancer referred to a single lymphoedema therapist at a private multidisciplinary practice in Sydney, Australia. Data was collected prospectively between 1 January 2007 and 31 December 2016, during which 824 women were measured using an ImpediMed L-Dex® U400 BIS device. Women were defined as surveillance if monitoring began pre-surgery (n = 292/824) or within 90 days post-surgery (n = 148/824) and continued for at least 90 days thereafter. Women were defined as referrals if monitoring began after 90 days post-surgery (n = 318/824). Lymphoedema was diagnosed if BIS indicated extracellular fluid levels had increased by &amp;gt;10 L-Dex points from a woman's pre-surgical baseline, or exceeded the normative range by &amp;gt;10 L-Dex points or were maintained below these levels only by ongoing compression use. International Society of Lymphology stage at diagnosis was recorded. Swelling within 90 days of surgery or 270 days of commencing taxane-based chemotherapy was not defined as lymphoedema. Results: Patient chart data was analysed retrospectively. The L-Dex measurements in the referral group were taken significantly longer post-surgery (Med = 784 days, IQR = 356-1977) than the surveillance group (Med = 124 days, IQR = 104-188, p &amp;lt; 0.001). A higher proportion of women in the surveillance group were diagnosed at the subclinical and mild stages of lymphoedema (Stage 0 and Stage 1) in comparison to women in the referral group who were more likely to be diagnosed in the moderate or severe stages of lymphoedema (Stage 2 and Stage 3). Higher median L-Dex values were found for women in the referral group (Med = 4.3, IQR = -0.8-13.6) than those in the surveillance group (Med = 2.2, IQR = -1.9-5.8, p &amp;lt; 0.001). Conclusion: Prospective surveillance may result in earlier intervention with L-Dex measurements, earlier diagnosis of lymphoedema and lower L-Dex values. Ongoing statistical analyses will inform the clinical risk factors leading to increased lymphoedema incidence. This study has important implications for breast cancer clinical practice guidelines. Citation Format: Koelmeyer LA, Borotkanics R, Winch CJ, Prah P, Alcorso JM, Nakhel K, Boyages J. L-Dex surveillance of breast cancer-related lymphoedema: A retrospective study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-16.

The incidence and risk factors of related lymphedema for breast cancer survivors post-operation: a 2-year follow-up prospective cohort study.

To investigate the incidence rate, severity and risk factors of related lymphedema in breast cancer survivors. A 2-year follow-up prospective study of 387 women who had operation from four hospitals from January 1, to December 31, 2014 was conducted. Limb volume was measured by circumference and symptoms were measured using questionnaires pre-treatment and 1, 3, 6, 12, 18, 24months after surgery separately. The incidence rates and the severity of lymphedema were evaluated, respectively. Risk factors for the development of breast cancer-related lymphedema (BCRL) were analyzed using log-rank test and Cox regression. The incidences of BCRL were 4.4, 10.1, 15.2, 28.6, 31.2 and 32.5% at 1, 3, 6, 12, 18, 24months after surgery, respectively, measured by Norman questionnaire. The rates measured by arm circumference were 2.5, 6.7, 13.4, 21.4, 26.3 and 29.4%, respectively. About 114 (29.4% of 387) women were diagnosed with BCRL, and 78 of them got mild lymphedema. Axillary lymph node dissection (ALND) (HR=5.2, 95% CI 1.6-17.3), radiotherapy (HR=3.9, 95% CI 2.0-7.5), modified radical mastectomy (MRM) (HR=2.1, 95% CI 1.3-3.4), the number of positive lymph nodes (HR=1.1, 95% CI 1.0-1.2) and body mass index (BMI) (HR=1.1, 95% CI 1.0-1.1) were independent risk factors for BCRL. BCRL is a common complication for breast cancer patients after surgery. It can be fairly diagnosed only 1month post-operation and the cumulative incidence of BCRL seems to be increasing over time, especially in the first year after surgery. ALND, radiotherapy, MRM, the number of positive axillary lymph nodes and BMI were found to be independent risk factors in the development of BCRL in this study.

The Prevalence, Incidence, and Quality-of-Life Impact of Lymphedema After Treatment for Vulvar or Vaginal Cancer

Background: Incidence of lymphedema appears to be higher in women with vulvar/vaginal cancer than in those with other forms of gynecological cancer. The objective of this work was to determine the point prevalence and incidence of lymphedema in women with vulvar/vaginal cancer and to describe symptom burden and quality of life (QOL). Methods: Prospective longitudinal cohort study conducted in Brisbane, Australia, including adult women with newly diagnosed vulvar/vaginal cancer. The primary outcome was self-reported swelling of the legs, vulvar area, or pelvis/abdomen or a clinical diagnosis of lymphedema. Severity of associated symptoms and QOL (Functional Assessment of Cancer Therapy–General) were also reported. Assessments were conducted over 2 years. Results: All participants (vulvar: n = 20; vaginal: n = 2; mean [SD] age = 57 [12] years) received surgical treatment, and 8 (36%) also received adjuvant therapy. By 24 months postdiagnosis, only 2 (9%) women had no evidence of lymphedema; all others self-reported swelling (n = 10; 45%), had a clinical diagnosis (n = 1; 5%), or both (n = 9; 41%). Three or more symptoms of moderate or greater intensity were reported by 7 (44%) women at 2 years. The presence of lower limb symptoms (including mild intensity) was associated with reduced QOL (any symptom: QOL estimate = −13.29; 95% CI, −19.30 to −7.27; P &lt; .001). Limitations: Small sample size limits interpretation of findings. Conclusion: These findings demonstrate that the majority of women receiving treatment of vulvar/vaginal cancer experience lymphedema and symptoms of swelling are associated with lower QOL. Monitoring of swelling via patient self-report may identify women at risk of low QOL outcomes after treatment of vulvar/vaginal cancer.

Home Exercise Program is an effective tool in improving upper limb function and quality of life in breast cancer survivors: A retrospective observational study

Background: Home Exercise Program is a mainstay of upper limb dysfunction prevention in breast cancer survivors. However, only subjective assessment instruments have been used until now in order to prove its effectiveness. In the present observational retrospective study, we assessed, for the first time, the effects of Home Exercise Program on the upper limb function of breast cancer survivors via tridimensional motion analysis. We also aimed to show that good upper extremity performance positively influenced the quality of life of breast cancer survivors. Methods: From the 2016 database of breast cancer survivors who underwent upper limb tridimensional motion analysis 1 and 3 months after modified radical mastectomy, we enrolled 15 patients who spontaneously refused to undergo the post-surgical 14-day Home Exercise Program (group A). In addition, 15 patients who were homogeneous to those of group A, but who agreed to normally undergo Home Exercise Program were selected from the same database, in order to compare upper limb performance (group B). The Constant-Murley, Brief Fatigue Inventory and European Organization for Research and Treatment of Cancer quality of life scores during follow-up were analysed and compared. Results: Compared to those in group A, on tridimensional motion analysis, patients in group B showed a wider range of motion of the upper limb, with consequently better shoulder and elbow performance, lower incidence of lymphedema, minor fatigue, and better quality of life. Conclusions: We show objectively, by means of tridimensional motion analysis, that Home Exercise Program is an effective tool for preventing upper extremity dysfunction in breast cancer survivors. Hence, it should always be recommended to such patients as it positively influences their quality of life.

Sentinel lymph node biopsy in endometrial cancer—Feasibility, safety and lymphatic complications

ObjectiveTo compare the rate of lymphatic complications in women with endometrial cancer undergoing sentinel lymph node biopsy versus a full pelvic and infrarenal paraaortic lymphadenectomy, and to examine the overall feasibility and safety of the former. MethodsA prospective study of 188 patients with endometrial cancer planned for robotic surgery. Indocyanine green was used to identify the sentinel lymph nodes. In low-risk patients the lymphadenectomy was restricted to removal of sentinel lymph nodes whereas in high-risk patients also a full lymphadenectomy was performed. The impact of the extent of the lymphadenectomy on the rate of complications was evaluated. ResultsThe bilateral detection rate of sentinel lymph nodes was 96% after cervical tracer injection. No intraoperative complication was associated with the sentinel lymph node biopsy per se. Compared with hysterectomy alone, the additional average operative time for removal of sentinel lymph nodes was 33min whereas 91min were saved compared with a full pelvic and paraaortic lymphadenectomy. Sentinel lymph node biopsy alone resulted in a lower incidence of leg lymphedema than infrarenal paraaortic and pelvic lymphadenectomy (1.3% vs 18.1%, p=0.0003). ConclusionThe high feasibility, the absence of intraoperative complications and the low risk of lymphatic complications supports implementing detection of sentinel lymph nodes in low-risk endometrial cancer patients. Given that available preliminary data on sensitivity and false negative rates in high-risk patients are confirmed in further studies, we also believe that the reduction in lymphatic complications and operative time strongly motivates the sentinel lymph node concept in high-risk endometrial cancer.

Post Mastectomy Lymphedema—a Prospective Study of Incidence and Risk Factors

The aim of this study is to document the incidence of early lymphedema and study the risk factors influencing post mastectomy lymphedema. It is a prospective cohort study involving 98 adult women who underwent surgery including axillary lymph node dissection for biopsy-proven breast carcinoma. Serial measurements of the arm were taken preoperatively and postoperatively at 3, 6 and 12 months. Lymphedema was diagnosed if there was an increase in girth by more than 2 cm in the concerned limb. All patients received standard lymphedema prevention advice. Risk factors assessed were age, body mass index, comorbid conditions, hypertension, medications, socioeconomic status, upper limb symptoms, laterality of disease, type of surgery, stage of the disease, histopathology, node status, wound complication, receptor status, seroma volume, duration of seroma drainage, radiotherapy, chemotherapy, post radiation skin reaction and post therapy weight gain. The statistical analysis was done using chi-square test with SPSS version 16. The incidence of lymphedema was 23.47%. The univariate analysis showed that prolonged or high volume seroma, taxane-based chemotherapy, radiotherapy to axilla and skin necrosis following radiation were significantly associated with lymphedema. In the multivariate analysis, only post radiation skin necrosis was significant.

Advances in understanding and management of lymphoedema (cancer, primary).

Despite being neglected both clinically and in research in the past, primary lymphoedema, and lymphoedema secondary to cancer treatment have been the subject of an increasing number of studies in recent years. This review will focus on new developments relevant to clinical practice. The main themes covered by the review include the incidence and prevalence of lymphoedema, early detection and intervention in cancer-related lymphoedema, risk reduction for the development of cancer-related lymphoedema, surgical treatment, palliative care for lymphoedema in advanced cancer and developments in the genetics of primary lymphoedema. Evidence suggests that lymphoedema is more common than has been previously recognized. It continues to be a significant problem for people following cancer treatment. Developments in the early detection and treatment of cancer-related lymphoedema should reduce the future impact for patients. Advice on how to reduce the risk of developing lymphoedema may need to be modified in light of recent research. New treatments such as surgical procedures are still in their infancy but the results seem encouraging for selected patients.

Surgical-site infection following lymph node excision indicates susceptibility for lymphedema: A retrospective cohort study of malignant melanoma patients

Cancer-related lymphedema is a common complication following lymph node excision. Prevention of lymphedema is essential, as treatment options are limited. Known risk factors are firmly anchored to the cancer treatment itself; however potentially preventable factors such as seroma and surgical-site infection (SSI) have yet to be asserted. All malignant melanoma patients treated with sentinel lymph node biopsy (SNB) and/or complete lymph node dissection (CLND) in the axilla or groin between January 2008 and December 2014 were retrospectively identified. Identified patients were followed until March 2017 for the incidence of lymphedema. We identified 70 cases of extremity lymphedema following 640 SNB/CLND. SSI was an independent risk factor for developing lymphedema (HR 8.46, 95%CI 4.37-16.36, p < 0.001), whilst seroma was an independent risk factor for developing SSI (OR 6.92, 95%CI 4.11-12.54, p < 0.001). In addition, the risk of lymphedema was significantly larger following inguinal incisions compared to axillary incisions (HR 2.49, 95%CI 1.36-4.55, p < 0.05). SSI was the greatest independent risk factor for developing lymphedema. Additionally, patients' that developed postoperative seroma were at an increased risk of also developing SSI. Future studies should examine if lymphedema can be prevented, by reducing seroma and SSI.

Changes in volume and incidence of lymphedema during and after treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC) in patients with breast cancer

PurposesThe purposes of this study were to investigate the incidence of lymphedema in patients with breast cancer during and after adjuvant treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC), to identify predictors for development of lymphedema, and to describe consequences in daily life in relation to lymphedema.MethodsThis is a prospective study with measurements before chemotherapy (T0), during chemotherapy before cycle 2 (T1), cycle 4 (T2), and 1 month after completion of treatment (T3). Volume change was monitored using tape measurements. Lymphedema was defined as ≥ 10% volume difference. Linear mixed-effect models were estimated to analyze differences in arm volume and consequences in daily life (total score and domain scores of the Lymph-International Classification of Functioning (ICF) questionnaire) over time and to identify treatment and patient characteristics as predictors for changes in volume.ResultsForty-eight patients completed all measurements. Volume did not change during TAC treatment. One month after treatment, volume was significantly increased compared to T0-T2, and 12 patients (25%) had developed lymphedema. Axillary lymph node dissection was associated with lymphedema (ES 2.9, 95% CI 0.02–5.7; p < 0.05). In patients with and without lymphedema, 1 month after completion (T3), the Lymph-ICF questionnaire showed significant limitations in physical function compared to T0-T2. In patients with lymphedema at T3, a significant association between volume and total score on the Lymph-ICF questionnaire on physical function and mobility activities was observed.ConclusionsOne month after treatment in 12 patients (25%), volume difference increased over 10%. Axillary lymph node dissection was predictive for development of lymphedema. All patients, but more patients with lymphedema, perceived difficulties in activities in daily life after treatment.

Incidence of lower limb lymphedema after vulvar cancer: A systematic review and meta-analysis.

Background:Lower limb lymphedema (LLL) is an important concern for patients with vulvar cancer. Studies of the incidence of vulvar cancer-related lymphedema and its risk factors have substantially increased in the new millennium.Objectives:This article is a meta-analysis that aimed to systematically evaluate the incidence of LLL and its risk factors related to vulvar cancer.Data sources:Data were collected from eligible studies from PubMed, ScienceDirect, and Web of Science.Synthesis methods:Random effects models were used to calculate a pooled overall estimate of LLL incidence, and subgroup analyses were performed to assess the effects of different study designs, countries of study origin, diagnostic methods, and extent of lymph node surgery. Risk factors for lymphedema were also evaluated.Results:Twenty-seven studies met the inclusion criteria for the assessment of lymphedema incidence with a pooled estimate of 28.8% [95% confidence interval (CI) 22.1–35.5]. The estimate was 16.7% (95% CI 9.7–23.7) when data were restricted to prospective cohort studies (7 studies). The incidence of LLL was increased by approximately 5-fold in women who underwent inguinofemoral lymph node dissection compared to those who underwent sentinel lymph node biopsy. The reported risk factors included wound infection, inguinofemoral lymphadenectomy, older age, body mass index (BMI), and radiation therapy.Conclusions:Approximately 3 in 10 women who survive vulvar cancer will develop lower limb lymphedema. More studies are needed to improve the understanding of its risk factors and to develop prevention and management strategies to alleviate this distressing disorder.

Incidence and risk factors of lymphedema after breast cancer treatment: 10 years of follow-up

PurposeTo evaluate the incidence and risk factors of lymphedema 10 years after surgical treatment for breast cancer. MethodsProspective observational hospital-based cohort of women undergoing axillary lymph node dissection. Lymphedema was assessed by indirect volume, measured by circumference, and diagnosed if there was a difference of 200 mL between the arms or if the patient was treated for it. Independent variables were patient, tumour and treatment characteristics. Descriptive statistics were conducted as survival analysis using the Kaplan-Meier estimate. Cox regression was performed, considering a 95% confidence interval (95%CI). ResultsThe study evaluated 964 women. The cumulative incidence of lymphedema observed was 13.5% at two years of follow-up, 30.2% at five years and 41.1% at 10 years. Final model showed an increased risk for lymphedema among women that underwent radiotherapy (HR = 2.19; 95%CI 1.63–2.94), were obese (HR = 1.52; 95%CI 1.20–1.92), had seroma formation after surgery (HR = 1.46; 95%CI 1.14–1.87), underwent chemotherapy infusion in the affected limb (HR = 1.45; 95%CI 1.12–1.87) or advanced disease staging (HR = 1.41; 95%CI 1.11–1.80). ConclusionsCumulative incidence of lymphedema was 41.1%. Women undergoing axillary radiotherapy, obese, who developed seroma, underwent chemotherapy infusion in the affected limb and with advanced disease had a higher risk of lymphedema.

Observational study on the effectiveness of the Dragon Boat in reducing the risk of incidence of lymphedema in women with breast cancer

Observational study on the effectiveness of the Dragon Boat in reducing the risk of incidence of lymphedema in women with breast cancer

Lymphedema, musculoskeletal events and arm function in older patients receiving adjuvant chemotherapy for breast cancer (Alliance A171302).

Musculoskeletal events (MEs) resulting from breast cancer treatment can significantly interfere with the quality of life (QOL) of older adults. We evaluated the incidence of MEs in women 65years and older who had surgery and adjuvant chemotherapy for breast cancer, and the impact of treatment on MEs and arm function. Patient-reported data in Alliance/CALGB 49907 were collected using the EORTC QLQ-BR23 and physician-reported adverse events to characterize self-reported MEs and incidence of lymphedema. EORTC QLQ-BR23 items related to musculoskeletal events were analyzed in this study and data collected at study entry (post-operative) and 12 and 24months post-entry. Lymphedema, arm function, and ME data were available for 321 patients. One or more MEs were reported by 87% (median number=3) and 64% (median number=1) of patients post-operatively and at 24months. At 24months 2% had persistence of six MEs. Seventy-four percent experienced at least≥3/6 types of MEs over the 24-month period. Detection of lymphedema at any time during the study was noted in 7.5% of the patients and appeared to be associated with the type of chemotherapy given: CMF 16.4%, capecitabine 5.8%, and AC 4%. Mastectomy and axillary node dissection were associated with the most MEs. LROM correlated with poorer arm function at all time periods. Potentially debilitating MEs occur in three-fourths of elderly women undergoing standard therapy for breast cancer. Emphasis should be placed on prevention, identification, and treatment of these MEs to improve QOL.

Upper limb lymphedema in breast cancer patients in the era of Z0011, sentinel lymph node biopsy and breast conservation.

Surgical techniques in breast cancer (BCa) have seen a dramatic change recently with breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB). The ACOSOG-Z0011 trial reported equivalence in outcomes for certain patients with SLN metastases treated with axillary lymph node dissection (ALND) or SLNB alone. Our aim was to investigate changes in lymphedema referral patterns in BCa patients over the last 3years in a specialist unit and to elucidate effects of SLNB, BCS, and Z0011 trial publication on such patterns. A retrospective study was performed over a 3-year period (May 2012-May 2015). Patients were identified using a prospectively maintained lymphedema database and newly referred BCa patients with data availability were included. Overall lymphedema incidence was 11% (19.2% in ALND and 5.1% in SLNB cohort). There was a statistically significant difference in lymphedema referral patterns after Z0011, new referrals reduced by 20% (chi-sq; p=0.001). Volume of referrals post ALND was reduced by 40% with concomitant 31% rise in those post SLNB alone, reflecting changing surgical patterns. There was a significant change in extent of lymphnode dissection during ALND (p=0.003). The Z0011 trial in association with wider implementation of SLNB has led to significant changes in the lymphedema referral patterns and extent of ALND.

Role of axillary reverse mapping in decreasing complications after axillary dissection in breast cancer

Background: Breast cancer is one of the most leading causes of cancer deaths in female. Surgical treatment is considered the corner stone in its management. Axillary lymph node dissection (ALND) is an integral step in most of surgeries done, however it has many morbidities like prolonged seroma and lymphedema. Axillary reverse mapping (ARM) procedure was first described in 2007 in a trial to map the axillary lymphatics of the arm and avoid its injury therefore lymph complications.Methods: A prospective, randomized, controlled study over 72 female patients who underwent modified radical mastectomy (MRM). Patients were divided and randomized into study and control groups, thirty-six patients for each. In study group the ARM procedure was done by injecting 2.5 ml of methylen blue dye intra-dermally and subcutaneously in the upper inner ipsilateral arm along the medial intramuscular groove before ALND. Operative and post-operative results were recorded. Follow up was 6 to 24 months.Results: ARM procedure and successful visualization of arm lymphatics was achieved in 31 patients (86.1%). Statistically there was no significant difference between the two groups regarding patient and tumour characteristics, operative time and number of excised L.Ns. There was significant difference favouring the ARM group in decreasing the incidence of seroma (p= 0.040), lymphedema (p= 0.031) and time passed till remove drains (p &lt;0.001).Conclusions: ARM procedure facilitated arm lymphatics visualization. It is easy non-time-consuming procedure. It resulted in significant reduction in incidence of seroma and lymphedema, with considerable reduction in the overall complications rate.