RESUMEN
BACKGROUND: Despite the growing use of immediate lymphatic reconstruction (ILR) for preventing lymphedema, prospective long-term data on its efficacy remain limited. OBJECTIVE: This study aimed to analyze long-term, prospective outcomes of ILR, utilizing all available outcome measures. METHODS: Outcome data included the pooled cumulative incidence of lymphedema (assessed by limb measurements), odds ratio (OR), and relative risk (RR) for lymphedema development in patients who underwent ILR versus those who did not. Only prospective clinical trials with a minimum of 12 months of follow-up were included. RESULTS: Nine prospective studies (2011-2024) were included, totaling 791 patients, with 460 undergoing ILR and an average follow-up of 20.6 ± 4.8 months. On average, 1.9 ± 0.4 anastomoses were performed per patient. ILR was associated with a significantly lower incidence of lymphedema: 9% (95% confidence interval [CI] 1-16%) compared with 29% (95% CI 11-46%) in the non-ILR group. Patients who received ILR had 69% lower odds of developing lymphedema compared with those without ILR (OR 0.31, 95% CI 0.19-0.51). A 58% reduction in lymphedema risk was also observed among ILR recipients (RR 0.42, 95% CI 0.26-0.68). CONCLUSION: This meta-analysis summarizing prospective data with a minimum of 12-month follow-up represents the largest evaluation to date of ILR with extended follow-up for lymphedema prevention. The findings demonstrate that ILR significantly reduces the incidence, odds, and risk of lymphedema, supporting its role as an effective preventive strategy in at-risk patients.
Asunto(s)
Neoplasias de la Mama , Vasos Linfáticos , Linfedema , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias , Humanos , Linfedema/prevención & control , Linfedema/etiología , Estudios Prospectivos , Vasos Linfáticos/cirugía , Procedimientos de Cirugía Plástica/métodos , Ensayos Clínicos como Asunto , Femenino , Pronóstico , Complicaciones Posoperatorias/prevención & control , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patologíaRESUMEN
INTRODUCTION: Lymphedema (LE) is chronic swelling due to inadequate lymphatic function, which can occur after therapeutic lymph node dissection (TLND) for melanoma. At our institution, the risk of LE is 12% for axillary and 38% for ilioinguinal lymph node dissection. This study investigated LE rates in patients undergoing TLND with immediate lymphatic reconstruction (ILR) using lymphaticovenous anastomosis (LVA), a microsurgical technique aimed at preventing LE. METHODS: Patients with melanoma requiring TLND were recruited prospectively from the Tom Baker Cancer Center and were consented to undergo ILR at the time of their node dissection. Institutional ethics board approval was obtained (Ethics ID HREBA. cc-20-9426). This study was not a registered clinical trial; the ongoing randomized LYMbR trial (NCT05136079) is registered but does not include this cohort. The main objective was to assess the development of LE, which was defined as a 10% increase in postsurgical limb volume compared with the contralateral limb. In addition, participants completed the Lymphoedema Quality of Life Questionnaire (LYMQoL), a validated LE-specific quality of life patient-reported outcome measure (PROM) before surgery and at each 6-month assessment, to assess for any changes in quality of life related to LE. A direct comparison was made to historical institutional rates of LE after TLND without ILR. Kaplan-Meier analysis assessed overall survival and lymphedema-free survival, while Mann-Whitney U test compared quality of life between patients with and without lymphedema. RESULTS: Between August 2020 and October 2022, 22 patients (14 men and 8 women) with a median age of 68 (range 43-80) were included in the study and underwent TLND for melanoma with ILR. 16 patients underwent ALND, and 6 patients underwent ILND with ILR. There were no complications directly related to the ILR part of the procedure. All disease was at least stage III. At a median follow-up of 34 months (range: 0-51 months), three patients met the criteria for LE, one who underwent ALND and two ILND. Of these three patients, two had regional recurrence and one suffered from a DVT and a postoperative wound infection in the affected limb. LYMQoL scores were equal or better (p = NS) in patients without LE than those with LE across all domains except for mood: function (median IQR 1.0 vs 1.0, p = 0.78), appearance (1.0 vs 1.6, p = 0.19), symptom burden (1.1 vs 1.6, p = 0.52), and mood (1.1 vs 1.0, p = 0.87). CONCLUSION: This study aligns with other cohort studies demonstrating the usefulness of ILR in TLND patients with melanoma, which will be further examined in an ongoing randomized trial (LYMbR - NCT05136079).
Asunto(s)
Escisión del Ganglio Linfático , Ganglios Linfáticos , Vasos Linfáticos , Linfedema , Melanoma , Procedimientos de Cirugía Plástica , Neoplasias Cutáneas , Humanos , Melanoma/cirugía , Melanoma/patología , Escisión del Ganglio Linfático/efectos adversos , Escisión del Ganglio Linfático/métodos , Masculino , Femenino , Persona de Mediana Edad , Proyectos Piloto , Linfedema/prevención & control , Linfedema/etiología , Estudios de Factibilidad , Anciano , Adulto , Calidad de Vida , Estudios Prospectivos , Procedimientos de Cirugía Plástica/métodos , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Ganglios Linfáticos/cirugía , Ganglios Linfáticos/patología , Vasos Linfáticos/cirugía , Anastomosis Quirúrgica/métodos , Estudios de Seguimiento , Anciano de 80 o más Años , Metástasis LinfáticaRESUMEN
BACKGROUND: Axillary lymph node dissection (ALND) may result in breast cancer-related lymphedema in up to one-third of patients. ALND creates axillary dead space and contributes to decreased range of motion. Immediate lymphatic reconstruction (ILR) is a preventive microsurgical axillary lymphovenous anastomosis to reduce postsurgical lymphedema. This study evaluates the effect of a buried dermal flap as an adjacent local flap on functional limb outcomes in patients after ALND. STUDY DESIGN: A single-center retrospective review was performed for patients who underwent mastectomy, ALND, and ILR (from 2023 to 2024). Patients were divided into 2 groups: group 1 (prophylactic buried dermal flap with ILR) and group 2 (ILR with no flap filling the axillary dead space). Active range of motion (shoulder flexion, shoulder abduction) was the variable of interest. RESULTS: The study included 57 patients who underwent mastectomy, ALND, and ILR: group 1 (24 patients) and group 2 (33 patients). Group 1 had greater active range of motion during shoulder abduction (142.4 ± 29.1 degrees) compared with 113.3 ± 31.7 degrees in group 2 (p = 0.0271). Among group 1 patients, shoulder abduction in the postsurgical limb was 142.4 ± 29.1 degrees compared with 160.1 ± 12.1 degrees in the contralateral limb (p = 0.054). In group 2, shoulder abduction was 113.3 ± 31.7 degrees in the postsurgical limb compared with 161.6 degrees in the contralateral limb (p = 0.0006). No patients developed lymphedema. The follow-up time was 249.7 days. CONCLUSIONS: ALND results in decreased shoulder flexion and abduction. Patients who undergo a prophylactic buried dermal flap have greater preservation of shoulder abduction by 28 degrees compared with those who have ALND without a buried dermal flap.
Asunto(s)
Linfedema del Cáncer de Mama , Neoplasias de la Mama , Escisión del Ganglio Linfático , Linfedema , Complicaciones Posoperatorias , Colgajos Quirúrgicos , Humanos , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Axila/cirugía , Escisión del Ganglio Linfático/efectos adversos , Escisión del Ganglio Linfático/métodos , Neoplasias de la Mama/cirugía , Mastectomía/efectos adversos , Colgajos Quirúrgicos/trasplante , Rango del Movimiento Articular , Adulto , Anciano , Resultado del Tratamiento , Complicaciones Posoperatorias/prevención & control , Linfedema del Cáncer de Mama/prevención & control , Linfedema del Cáncer de Mama/etiología , Linfedema/prevención & control , Linfedema/etiologíaRESUMEN
Background and Objectives: The axillary lateral vessel thoracic junction (ALTJ) is a key lymphatic drainage pathway for the arm and a potential structure to spare during regional nodal irradiation (RNI) to reduce lymphedema risk in breast cancer patients. This study aims to demonstrate the feasibility of ALTJ-sparing radiation therapy (RT) planning using Tomotherapy. Materials and Methods: Ten breast cancer patients who had undergone axillary lymph node dissection and whose dissected axillary levels were excluded from the RNI target volume were included. A TomoDirect intensity-modulated RT plan was generated at a dose of 50 Gy in 25 fractions. The dissected axilla was not designated as an organ at risk (OAR) in the original treatment plan. For this study, the axillary lymph node level I (AXL1) and the ALTJ were delineated retrospectively, with the ALTJ considered an OAR in the newly generated study plan. A total of 20 RT plans (10 per group) were statistically compared using various dose-volume parameters. Results: Compared to the original plans, the study plans with ALTJ as an OAR significantly reduced the incidental dose to both the ALTJ (mean: 41.7 ± 3.4 Gy vs. 27.2 ± 1.3 Gy; p = 0.005) and the AXL1 (mean: 43.9 ± 2.0 Gy vs. 37.7 ± 1.9 Gy; p = 0.005). All other dosimetric parameters (V25Gy, V35Gy, V40Gy, Dmin, Dmax) for the ALTJ were also significantly lower in the study plans. This ALTJ sparing was achieved while maintaining all required dose-volume constraints for target volumes and standard OARs such as the lung and heart. Conclusions: This study demonstrates that simply excluding the dissected axilla from the target volume without designating it as an OAR still results in a substantial incidental dose to this region. Our findings also show the feasibility of using Tomotherapy to selectively spare the axilla, particularly the ALTJ subregion of AXL1, which is critical for lymphedema risk in breast cancer patients.
Asunto(s)
Neoplasias de la Mama , Linfedema , Radioterapia de Intensidad Modulada , Humanos , Femenino , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/cirugía , Radioterapia de Intensidad Modulada/métodos , Axila , Persona de Mediana Edad , Estudios de Factibilidad , Estudios Retrospectivos , Anciano , Linfedema/prevención & control , Linfedema/etiología , Adulto , Dosificación Radioterapéutica , Radiometría/métodos , Ganglios Linfáticos/efectos de la radiación , Órganos en Riesgo , Planificación de la Radioterapia Asistida por Computador/métodos , Escisión del Ganglio Linfático/métodosRESUMEN
Arm lymphoedema after breast cancer treatment is preventable and can be reversible if caught early. Many risk factors are modifiable and lifestyle changes adopted by patients can reduce incidence substantially. Education in risk reduction is a central tenet of specialist lymphoedema prevention programmes, however, non-specialist healthcare professionals commonly get requests for instructions and advice by breast cancer patients. In general, healthcare professionals receive inadequate education and training on the lymphatic system and may feel ill-equipped to issue advice, despite being best placed to provide it. Low-risk patients are unlikely to require lifestyle modifications to prevent lymphoedema once the treatment phase is over, unless cording or adherent axillary scars persist, but high- and medium-risk patients need education in lifetime prevention and self-treatment strategies. This article discusses risk stratification and outlines self-management strategies for at-risk cohorts. By gaining knowledge about lymphoedema prevention, healthcare professionals can confidently guide their patients on how to prevent lymphoedema and its physical and psychological sequelae.
Asunto(s)
Brazo , Linfedema del Cáncer de Mama , Neoplasias de la Mama , Linfedema , Humanos , Neoplasias de la Mama/cirugía , Femenino , Linfedema/prevención & control , Linfedema/etiología , Educación del Paciente como Asunto , Factores de Riesgo , Autocuidado , Linfedema del Cáncer de Mama/prevención & controlRESUMEN
Lymphedema is a common complication after breast cancer surgery, often causing functional limitations and reduced quality of life. Prophylactic compression sleeves have been suggested as a preventive strategy, but their effectiveness remains unclear. We conducted a systematic review of randomized controlled trials to evaluate whether early use of compression sleeves lowers the risk of lymphedema in this population. Comprehensive searches of major medical databases were performed, and eligible studies were analyzed. The findings showed that prophylactic compression sleeves did not significantly reduce the incidence of lymphedema compared with standard care. Some studies reported smaller increases in arm volume among sleeve users, but these results were inconsistent. Overall, compression sleeves appear to have limited value for lymphedema prevention, though they may provide modest benefit in reducing early swelling. Further high-quality research is needed to establish clear recommendations for clinical practice.
Asunto(s)
Linfedema del Cáncer de Mama , Neoplasias de la Mama , Vendajes de Compresión , Linfedema , Mastectomía , Humanos , Neoplasias de la Mama/cirugía , Femenino , Linfedema/prevención & control , Linfedema/etiología , Mastectomía/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Linfedema del Cáncer de Mama/prevención & controlRESUMEN
BACKGROUND: Compression sleeves are widely used for breast cancer-related lymphedema, but evidence on their effectiveness of prevention and treatment in volume reduction is limited. OBJECTIVE: To compare the effects of compression sleeves and conventional care on breast cancer-related lymphedema, providing evidence-based support for clinical application. METHODS: A systematic search of 9 databases was conducted up to June 9, 2025. Meta-analysis was performed using RevMan 5.4, and evidence quality was assessed with GRADE profiler 3.6. RESULTS: 1532 patients were included. Compression sleeves significantly reduced lymphedema incidence post-surgery (P =0 .02) and edema volume/circumference (P <0 .001), and improved shoulder flexion (P =0.02). No significant effects were seen on shoulder abduction (P =0 .18), subjective symptoms (P =0.62), or quality of life (P = 0.32). Evidence quality was moderate for incidence and volume/circumference reduction, and low for other outcomes. CONCLUSION: This meta-analysis shows that compression sleeves reduce lymphedema incidence and volume/circumference, and improve shoulder flexion. They should be considered in lymphedema management, though further research is needed for other outcomes.
Asunto(s)
Linfedema del Cáncer de Mama , Neoplasias de la Mama , Vendajes de Compresión , Linfedema , Medias de Compresión , Humanos , Femenino , Linfedema del Cáncer de Mama/prevención & control , Linfedema del Cáncer de Mama/terapia , Linfedema del Cáncer de Mama/etiología , Calidad de Vida , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/cirugía , Incidencia , Mastectomía/efectos adversos , Linfedema/prevención & control , Linfedema/etiología , Linfedema/terapia , Resultado del TratamientoRESUMEN
AIMS: This systematic review and meta-analysis aims to provide an up-to-date assessment of the efficacy of intermittent pneumatic compression (IPC) devices in preventing and treating breast cancer-related lymphedema (BCRL). METHODS: From establishment to 2025-03-21, randomized controlled trials of IPC in the prevention and treatment of BCRL were searched and included in the databases of PubMed, Embase, Web of Science, The Cochrane Library, CNKI, WanFang Data Knowledge Service (WanFang), and SinoMed. Two researchers used inclusion and exclusion criteria to choose literature and assess its quality. RevMan 5.4 software was used for meta-analysis. RESULTS: We found 14 randomized controlled studies with 1397 patients after conducting a thorough search across several databases. Meta-analysis showed that IPC significantly reduced the incidence of BCRL after breast cancer surgery (P < 0.01, RR = 0.36, 95%CI = [0.22, 0.58]) and improved the extension function of the affected limb (P = 0.02, SMD = 2.77, 95%CI = [0.41, 5.12]). Subgroup analyses indicated that lymphedema duration ≤ 24 months, IPC pressure ≤ 40 mmHg, treatment time > 2 weeks, and evaluation time ≤ 2 months were associated with better limb volume outcomes (all P < 0.05). However, no significant effects were observed on other joint movements or the patient's subjective symptoms. CONCLUSION: IPC devices can effectively prevent the occurrence of BCRL, likely due to enhanced lymphatic return and reduced interstitial fluid accumulation, and early IPC intervention (≤ 40 mmHg pressure, > 2-week duration) is recommended for prevention, while combined therapies may be needed for established lymphedema. However, its limited therapeutic efficacy in chronic lymphedema may be related to irreversible structural damage in advanced cases. We need further rigorous, multicenter studies to optimize IPC protocols and clarify its role in BCRL management. TRIAL REGISTRATION: PROSPERO has registered this study under the CRD42025631301.
Asunto(s)
Linfedema del Cáncer de Mama , Neoplasias de la Mama , Aparatos de Compresión Neumática Intermitente , Linfedema , Femenino , Humanos , Linfedema del Cáncer de Mama/prevención & control , Linfedema del Cáncer de Mama/terapia , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/cirugía , Linfedema/prevención & control , Linfedema/terapia , Linfedema/etiología , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Simple lymphatic drainage (SLD) is a self-administered technique for managing lymphedema; however, its efficacy in preventing lower limb lymphedema (LLE) following pelvic lymphadenectomy remains unclear. This prospective study evaluated the preventive effects of SLD at a single institution. A total of 224 patients were enrolled who underwent gynecological cancer surgery with pelvic lymphadenectomy between April 2011 and May 2012. After excluding patients with deep vein thrombosis, age ≥ 80 years, refusal to participate, and those with uncertain malignancy, 190 patients remained. A subset of 87 patients without adjuvant therapy was divided into two groups based on their preference: 24 in the SLD group and 63 in the control group. SLD group patients performed daily SLD for one year, and a 5-year follow-up was conducted. No significant differences were observed between groups in the change ratio of the lower limb circumference and the impedance method for the extracellular water: total body water ratio. The 5-year cumulative incidence of lymphedema (ISL stage I or more) was 37.5% in the SLD group and 23.5% in the control group, with no significant difference between the two groups. SLD does not contribute to the prevention of LLE following gynecological cancer surgery with pelvic lymphadenectomy.
Asunto(s)
Drenaje , Neoplasias de los Genitales Femeninos , Extremidad Inferior , Linfedema , Drenaje Linfático Manual , Humanos , Femenino , Linfedema/prevención & control , Linfedema/etiología , Neoplasias de los Genitales Femeninos/cirugía , Neoplasias de los Genitales Femeninos/complicaciones , Neoplasias de los Genitales Femeninos/patología , Estudios Prospectivos , Persona de Mediana Edad , Extremidad Inferior/patología , Escisión del Ganglio Linfático/efectos adversos , Anciano , Drenaje/métodos , Adulto , Drenaje Linfático Manual/métodos , Anciano de 80 o más AñosRESUMEN
INTRODUCTION: Breast cancer-related lymphedema affects 21.9% of patients. The role of breast reconstruction in lymphedema prevention remains unclear. This review aimed to assess the relative risk of breast cancer-related lymphedema after breast reconstruction compared with mastectomy and breast-conserving surgery, which has thus far been inconclusively assessed. METHODS: We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, EMBASE, Cochrane Central, and gray literature searches identified studies reporting lymphedema outcomes after mastectomy, breast-conserving surgery, and breast reconstruction. We calculated incidence rate ratios using random-effects models. Subgroup analyses compared reconstruction timing (immediate compared with delayed), types (autologous compared with implant-based), and immediate implant stages (1-stage compared with 2-stage). RESULTS: Twenty-three studies with 15,670 patients were included in the qualitative analysis, and 14 were included in the meta-analysis. Patients with breast reconstruction had a significantly lower risk of lymphedema than those without reconstruction (incidence rate ratio, 0.58; 95% confidence interval, 0.38-0.87, P < .001). However, this effect was less pronounced when only studies with baseline lymphedema measurements were included. We found no significant differences between autologous and implant-based reconstructions, immediate and delayed reconstruction, or 1- and 2-stage implant-based reconstruction. CONCLUSION: Breast reconstruction does not increase the risk for breast cancer-related lymphedema, and the risk of lymphedema is similar across different types of breast reconstruction. Breast reconstruction may reduce the risk of breast cancer-related lymphedema compared with mastectomy alone. The lack of baseline lymphedema measurements in most studies and studies with follow-up less than 4 years limits the strength of these findings.
Asunto(s)
Linfedema del Cáncer de Mama , Neoplasias de la Mama , Linfedema , Mamoplastia , Complicaciones Posoperatorias , Humanos , Mamoplastia/métodos , Mamoplastia/efectos adversos , Femenino , Mastectomía/efectos adversos , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/complicaciones , Linfedema del Cáncer de Mama/etiología , Linfedema del Cáncer de Mama/epidemiología , Linfedema del Cáncer de Mama/prevención & control , Linfedema/etiología , Linfedema/prevención & control , Linfedema/epidemiología , Incidencia , Mastectomía Segmentaria/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & controlRESUMEN
AIM: Postoperative lymphedema was a common and debilitating complication following breast cancer surgery, which significantly affects quality of life. This study analyzes the risk factors associated with lymphedema and evaluates the effectiveness of axillary reverse mapping (ARM) in reducing its incidence and improving quality of life. METHODS: For this retrospective cohort study, 232 breast cancer patients who underwent axillary dissection between January 2022 and January 2023 were recruited. Patients were classified into the lymphedema group (n = 54) and the control group (n = 178) based on edema occurrence. Influencing factors such as body mass index, surgical techniques, and adjuvant therapies were analyzed. To assess ARM's impact on lymphedema and quality of life, patients were also divided into a mapping group (n =133) and the control group (n = 99). Lymphedema stages were evaluated according to the International Lymphatic Society consensus, and quality of life was assessed using the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS), Breast Cancer Survivors Resilience Scale (BCRS), and Strategies Used by People to Promote Health (SUPPH) scale. RESULTS: The results showed that chemotherapy (odds ratios [OR]: 4.063; p < 0.001) and radiotherapy (OR: 3.358; p < 0.001) were significant risk factors for lymphedema. ARM was associated with a reduced risk of lymphedema (OR: 0.322, p = 0.004). A higher proportion of patients in the mapping group were classified as having Stage 0 lymphedema (86.46%) compared to the control group (63.67%). For the mapping group, the QWLQ-CS was 71.04 ± 12.31 (p = 0.041), BCRS was 23.89 ± 6.32 (p = 0.003), and SUPPH was 85.65 ± 12.57 (p = 0.001), which were significantly higher than the control group. CONCLUSIONS: Postoperative lymphedema risk in breast cancer patients is influenced by chemotherapy and radiotherapy, with ARM proving beneficial in reducing incidence and enhancing postoperative quality of life.
Asunto(s)
Neoplasias de la Mama , Escisión del Ganglio Linfático , Linfedema , Complicaciones Posoperatorias , Calidad de Vida , Humanos , Femenino , Estudios Retrospectivos , Neoplasias de la Mama/cirugía , Persona de Mediana Edad , Linfedema/etiología , Linfedema/epidemiología , Linfedema/prevención & control , Axila , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Escisión del Ganglio Linfático/métodos , Escisión del Ganglio Linfático/efectos adversos , Factores de Riesgo , Anciano , Mastectomía/métodos , Mastectomía/efectos adversos , Adulto , Incidencia , Quimioterapia Adyuvante/efectos adversos , Radioterapia Adyuvante/efectos adversosRESUMEN
BACKGROUND: Immediate lymphatic reconstruction (ILR) is a technique in which lymphatics are visualized and lymphovenous bypass is done at the time of axillary lymph node dissection (ALND) to prevent breast cancer-related lymphedema (BCRL). This meta-analysis estimates the benefit of ILR in preventing lymphedema by incorporating double- and single-arm studies and stratifying by length of follow-up time. METHODS: Three databases were queried for studies with primary data on ILR. Both double- and single-armed studies were included, and papers with small sample sizes, overlapping samples, and unreported data were excluded. Treatment effects were calculated with risk ratios and converted to a logarithmic scale. A meta-analysis was performed using the inverse variance method and a random-effects model, with further analysis done by study design and length of follow-up time. RESULTS: A total of 17 studies were included (9 double-arm and 8 single-arm; n = 2607). The pooled treatment effect of ILR, expressed as log risk ratio (95% CI), was -0.89 (-1.18, -0.60; p < 0.0001). This corresponds to a relative risk of 0.41 (0.31, 0.55) and a number needed to treat of 9. Double- and single-arm studies showed no significant differences in effect sizes. Studies with < 1-year follow-up demonstrated a larger effect size than those with longer follow-up, and the benefits of ILR were no longer significant past 3 years. CONCLUSION: Patients receiving ILR were significantly less likely to develop BCRL than those receiving ALND alone. Further work is needed to examine whether benefits can truly be sustained long-term.
Asunto(s)
Linfedema del Cáncer de Mama , Neoplasias de la Mama , Escisión del Ganglio Linfático , Vasos Linfáticos , Linfedema , Humanos , Femenino , Escisión del Ganglio Linfático/efectos adversos , Vasos Linfáticos/cirugía , Neoplasias de la Mama/cirugía , Linfedema del Cáncer de Mama/prevención & control , Linfedema/prevención & control , Linfedema/etiología , Axila , Resultado del TratamientoRESUMEN
BACKGROUND: This systematic review and meta-analysis aim to evaluate the effects of exercise interventions on pain, lymphoedema, shoulder joint range of motion (ROM), muscle strength, and quality of life in postoperative breast cancer patients, and to provide evidence-based recommendations for clinical practice. METHODS: This systematic review and meta-analysis adhered to PRISMA guidelines and was registered on PROSPERO (CRD420251045309). A thorough search was performed in PubMed, Web of Science, Cochrane Library, and Embase for randomized controlled trials evaluating the effect of exercise on postoperative recovery in breast cancer patients. Data on pain, lymphoedema, ROM, muscle strength, and quality of life were extracted and analyzed using RevMan 5.4 software. The results were synthesized using weighted mean differences and odds ratios. RESULTS: A total of 22 randomized controlled trials with 2305 patients were included in the meta-analysis. Exercise interventions significantly reduced postoperative pain (mean difference = -0.49, 95% confidence interval: -0.71 to -0.27, P < .0001) and improved muscle strength across various muscle groups. Exercise was also effective in reducing the incidence of lymphoedema (odds ratio = 0.34, 95% confidence interval: 0.19-0.61, P = .0003) and improving shoulder ROM, particularly in flexion, extension, abduction, and adduction. In terms of quality of life, exercise enhanced physical function, role function, and emotional well-being, and reduced fatigue and appetite loss. CONCLUSION: Exercise interventions are beneficial for improving pain management, lymphoedema control, upper limb function, muscle strength, and overall quality of life in postoperative breast cancer patients. These findings support the inclusion of exercise as a key component of postoperative rehabilitation. Future research should focus on optimizing exercise protocols and exploring long-term effects on breast cancer survivors.
Asunto(s)
Neoplasias de la Mama , Terapia por Ejercicio , Humanos , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/rehabilitación , Femenino , Ensayos Clínicos Controlados Aleatorios como Asunto , Terapia por Ejercicio/métodos , Rango del Movimiento Articular , Calidad de Vida , Fuerza Muscular , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/rehabilitación , Linfedema/prevención & control , Linfedema/rehabilitación , Linfedema/etiología , Complicaciones Posoperatorias/prevención & control , Mastectomía/rehabilitaciónRESUMEN
BACKGROUND: Secondary lymphedema, a common complication following lymph node dissection, affecting up to 53% of cancer survivors, imposes significant morbidity and reduced quality of life. Immediate lymphatic reconstruction (ILR) has emerged as a preventive strategy; however, its efficacy remains unclear. METHODS: We conducted a PRISMA/AMSTAR-compliant systematic review and meta-analysis. A comprehensive search of PubMed, EMBASE, and Web of Science (2009-2024) identified studies evaluating ILR for lymphedema prevention. Random-effects models were used to calculate pooled odds ratios (ORs) for comparative studies and pooled incidence proportions for single-arm studies, each with 95% confidence intervals (CIs). Subgroup analyses examined extremity site, follow-up duration, BMI, and study design. Publication bias was assessed with funnel plots and Egger's test. RESULTS: We included 42 studies with a total of 4539 patients. Among comparative studies, ILR was associated with roughly a 75% reduction in lymphedema risk (pooled OR = 0.25, 95% CI 0.17-0.36, p=0.004). A temporal decline in ILR's protective effect was observed: OR 0.11 at <1 year follow-up versus OR 0.41 at ≥2 years (p=0.003). Across 19 single-arm studies, the pooled lymphedema incidence after ILR was 7.34% (95% CI 4.97-10.71%), rising to â¼20% in studies with >2 years of follow-up. Heterogeneity among studies was moderate (I² = 51%). Funnel plots indicated potential publication bias in comparative studies (Egger's test: z=-2.14, p=0.032), but not in single-arm studies (p=0.105). CONCLUSION: ILR reduces the risk of cancer-related secondary lymphedema, particularly for breast cancer patients in the early postoperative period. Standardized surgical protocols and prolonged follow-up are needed to optimize and confirm long-term benefits.
Asunto(s)
Escisión del Ganglio Linfático , Vasos Linfáticos , Linfedema , Neoplasias , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias , Humanos , Linfedema/prevención & control , Linfedema/etiología , Escisión del Ganglio Linfático/efectos adversos , Neoplasias/cirugía , Complicaciones Posoperatorias/prevención & control , Procedimientos de Cirugía Plástica/métodos , Vasos Linfáticos/cirugíaRESUMEN
PURPOSE: This study aimed to investigate the association between internet-based nursing guidance frequency and postoperative upper limb lymphedema risk in breast cancer patients, and identify influencing factors. METHODS: A retrospective cohort study included 208 female patients who underwent breast and lymph node surgery (2020-2021). Univariate and multivariate logistic regression analyses were used to assess associations with lymphedema, defined as an arm circumference difference ≥ 2 cm. Internet-based guidance via WeChat included daily education manuals, weekly video exercises, and monthly assessments, with frequency categorized as 0, 1-2, or ≥ 3 times/week. RESULTS: During a 12-month period, 24% (50/208) developed lymphedema. Multivariate analysis identified the following independent risk factors: high BMI (OR 7.924, 95% CI 3.197-19.638), axillary lymph node dissection (OR 6.144, 95% CI 2.117-17.838), radiotherapy (OR 4.209, 95% CI 1.615-10.971). Urban residents had a lower risk of lymphedema compared to rural residents (OR 0.394, 95% CI 0.168-0.923). Receiving guidance 1-2 times per week, compared with ≥3 times per week, was associated with a higher risk of lymphedema (OR 9.752, 95% CI 3.158-30.111); receiving no guidance, compared with ≥3 times per week, was also associated with an increased risk (OR 4.068, 95% CI 1.346-12.296). Socioeconomic factors (including lower education level and income) were correlated with a higher risk. CONCLUSION: High BMI, axillary lymph node dissection, and radiotherapy are highly associated with the occurrence of lymphedema after breast cancer surgery, while urban residence and high-frequency internet-based nursing guidance are associated with a lower probability of lymphedema. Future randomized controlled trials are needed to validate the preventive effects of digital health interventions.
Asunto(s)
Neoplasias de la Mama , Intervención basada en la Internet , Linfedema , Complicaciones Posoperatorias , Humanos , Femenino , Neoplasias de la Mama/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Linfedema/prevención & control , Linfedema/etiología , Linfedema/enfermería , Escisión del Ganglio Linfático/efectos adversos , Anciano , Adulto , Complicaciones Posoperatorias/prevención & control , Factores de Riesgo , Índice de Masa Corporal , Estudios de Cohortes , InternetRESUMEN
BACKGROUND: There is currently no proven surgical approach that prevents breast cancer related arm lymphedema (BCRAL). We hypothesized that the lymphatic microsurgical preventive healing approach (LyMPHA) during axillary lymph node dissection (ALND) could reduce BCRAL development. STUDY DESIGN: We conducted a single-center retrospective cohort study of patients with breast cancer who underwent ALND with or without immediate LyMPHA between 2016 and 2022. Primary outcomes were development of BCRAL and quality of life measures within 4 years of surgery. Secondary outcomes were days to drain removal and postoperative complications. Kaplan-Meier analysis determined risk of BCRAL over time. Cox regression analysis was used to determine risk factors associated with development of BCRAL. RESULTS: Of 187 patients who underwent ALND, 121 (64.7 %) received LyMPHA and 66 (35.3 %) underwent ALND only. The mean age was 56.4 ± 13.6 years. Patients who underwent LyMPHA had lower risk of lymphedema over time (p = 0.003), lower median percent functional impairment (4.7 % vs 11.6 %, p = 0.045), and shorter median drain duration (13.0 vs 15.0 days; p = 0.042). Regression analysis showed that those who received LyMPHA were half as likely to develop BCRAL (hazard ratio 0.53; 95 % CI 0.28-0.98; p = 0.043). Groups did not differ in the rate of postoperative complications. No other factors were associated with BCRAL, including age, body mass index, smoking status, or history of other cancer therapies. CONCLUSION: Performing immediate lymphatic reconstruction with LyMPHA after ALND may prevent arm lymphedema and reduce morbidity in patients with breast cancer.
Asunto(s)
Linfedema del Cáncer de Mama , Neoplasias de la Mama , Escisión del Ganglio Linfático , Linfedema , Microcirugia , Complicaciones Posoperatorias , Humanos , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Escisión del Ganglio Linfático/métodos , Escisión del Ganglio Linfático/efectos adversos , Neoplasias de la Mama/cirugía , Microcirugia/métodos , Linfedema del Cáncer de Mama/prevención & control , Linfedema del Cáncer de Mama/etiología , Anciano , Brazo , Axila/cirugía , Adulto , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Calidad de Vida , Linfedema/prevención & control , Linfedema/etiología , Factores de Riesgo , Vasos Linfáticos/cirugía , Resultado del Tratamiento , Estimación de Kaplan-MeierRESUMEN
Purpose: To investigate the knowledge-belief-practice (KBP) regarding lymphedema prevention among postoperative breast cancer patients and identify its psychosocial determinants. Methods: Postoperative patients were selected using a convenience sampling method. A general information collection, questionnaires, a Chinese version of the Distress Disclosure Index (DDI), and the Hospital Anxiety and Depression Scale (HADS) were used. Multivariate linear regression was used. Results: The total scoring rate of knowledge, belief, and practice was 58.51%, with the lowest for knowledge and highest for belief. The level of knowledge, belief, and practice was positively correlated with self-representation and negatively with anxiety and depression. The multivariate linear regression showed that receiving health education on the knowledge, family income, anxiety, depression, and self-expression levels were the critical factors influencing lymphedema. Conclusion: The level of knowledge, belief, and practice is at the lower-to-middle level in China, with poor knowledge mastery, and the level of practice needs to be improved. Healthcare personnel should conduct health education to improve patients' knowledge level related to lymphedema and enhance the correct health beliefs of the patients. Meanwhile, they should also pay attention to their psychological health status to help them improve the level of self-expression and carry out personalized interventions according to the influencing factors.
Asunto(s)
Neoplasias de la Mama , Conocimientos, Actitudes y Práctica en Salud , Linfedema , Complicaciones Posoperatorias , Humanos , Femenino , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/psicología , Persona de Mediana Edad , Linfedema/prevención & control , Linfedema/psicología , China , Adulto , Encuestas y Cuestionarios , Anciano , Ansiedad , Complicaciones Posoperatorias/prevención & control , DepresiónRESUMEN
BACKGROUND: Immediate lymphatic reconstruction (ILR) has emerged as an effective intervention to reduce breast cancer-related lymphedema, which affects 2-30% of patients who undergo axillary lymph node dissection (ALND). Our previous research validated ILR's effectiveness over 14 months, but the duration was short and warranted further study. This study provides long-term evidence of its benefits in a well-defined patient cohort. METHOD: This retrospective cohort study included unilateral breast cancer patients who underwent ALND between November 2019 and February 2021 with ≥ 24 months of follow-up. Patients were grouped by whether ILR was attempted intraoperatively. Exclusion criteria were recurrence, prophylactic mastectomy, and pre-existing lymphedema. The primary outcome was lymphedema incidence at ≥ 24 months; the secondary was lymphedema-free survival. Outcomes were evaluated using Cox regression models. RESULTS: Among 73 patients, we analyzed ALND patients divided into a control group (n = 57, defined as no-try or failure) and an ILR group (n = 16). The pooled median follow-up was 37 months. (range, 26~47 months). Among the ILR group, 13 underwent end-to-end anastomosis and 3 end-to-side. Postoperative lymphedema was higher in the control group (24.6%) compared to the ILR group (6.3%). Multivariate Cox regression analysis showed a significantly lower hazard ratio for the ILR group (HR: 0.117, 95% CI: 0.014-0.965), emphasizing ILR's effectiveness in reducing lymphedema risk post-ALND. Additionally, survival plots illustrating lymphedema-free survival showed a significant difference. CONCLUSION: Our study emphasizes ILR's efficacy over extended follow-up. The ILR group exhibited a lower rate of postoperative lymphedema, supporting ILR as an effective preventive measure against Breast Cancer-Related Lymphedema (BCRL) following ALND.
Asunto(s)
Linfedema del Cáncer de Mama , Neoplasias de la Mama , Escisión del Ganglio Linfático , Vasos Linfáticos , Linfedema , Complicaciones Posoperatorias , Humanos , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Estudios de Seguimiento , Escisión del Ganglio Linfático/efectos adversos , Neoplasias de la Mama/cirugía , Adulto , Linfedema/prevención & control , Linfedema/etiología , Anciano , Linfedema del Cáncer de Mama/prevención & control , Vasos Linfáticos/cirugía , Axila , Complicaciones Posoperatorias/prevención & control , IncidenciaRESUMEN
OBJECTIVE: We sought to perform a systematic review and meta-analysis on the efficacy and safety of immediate lymphovenous anastomosis (ILA) in breast cancer. SUMMARY BACKGROUND DATA: Breast cancer-related lymphedema (BCRL) affects 1 out of 5 patients who undergo treatment for breast cancer and is an incurable and chronic disease. ILA has emerged as a strategy for BCRL prevention with negligible increase in surgical time and high intraoperative success rates. METHODS: We systematically searched the PubMed, Embase, and Cochrane databases from inception to May 2024. Inclusion was restricted to: (1) randomized controlled trials (RCTs), prospective, and retrospective controlled studies; (2) comparison of patients with breast cancer who underwent axillary lymph node dissection (ALND) with and without ILA; and (3) reporting outcomes of interest. The primary outcome was BCRL incidence. Secondary outcomes included (1) seroma, (2) hematoma, (3) infection, (4) need for reoperation, (5) distant recurrence, and (5) mortality rates. RESULTS: In the pooled ILA group, 98 of 1026 patients (9.6%) developed lymphedema, in contrast to 584 of 1405 patients (41.6%) in the control group, demonstrating a protective effect of ILA on BCRL rate (risk ratios [RR] 0.35 [0.27-0.47]; p < 0.001; I² = 30%) and yielding a number needed to treat of 3.4. CONCLUSIONS AND RELEVANCE: ILA has a protective effect on BCRL rates in patients undergoing ALND. Further studies are necessary to stratify the subgroups that would benefit the most from ILA and evaluate its effect on long-term cancer recurrence.
Asunto(s)
Anastomosis Quirúrgica , Linfedema del Cáncer de Mama , Neoplasias de la Mama , Vasos Linfáticos , Linfedema , Complicaciones Posoperatorias , Humanos , Anastomosis Quirúrgica/métodos , Femenino , Vasos Linfáticos/cirugía , Neoplasias de la Mama/cirugía , Linfedema del Cáncer de Mama/prevención & control , Linfedema del Cáncer de Mama/etiología , Escisión del Ganglio Linfático/efectos adversos , Linfedema/prevención & control , Linfedema/etiología , Venas/cirugía , Complicaciones Posoperatorias/prevención & controlRESUMEN
BACKGROUND: The ipsilateral arm is not used for blood pressure, phlebotomy, or IV access postmastectomy or post-lymph node removal or biopsy. The non-evidence-based practice of blanket forbidding of ipsilateral arm use can result in inaccurate calf blood pressure measurements, foot stick blood draw orders, and an increased need for tunneled central venous catheters. OBJECTIVES: This project piloted a practice change and allowed for the use of the ipsilateral arm in patients with breast cancer. METHODS: The team used the Johns Hopkins Evidence-Based Practice Model to implement a practice change for hematology-oncology inpatients with breast cancer and lymph node involvement, removal, or biopsy, or mastectomy history. FINDINGS: Twelve months after implementation, more than 100 patients with breast cancer participated with zero incidences of resulting lymphedema. There were no foot stick orders or calf blood pressures in patients when the ipsilateral arm was used. After 16 months, the practice change became a systemwide policy.