TITLE:
The Risk Factors of Lymphedema in Breast Cancer Patients Post Axillary Clearance
AUTHORS:
Fatamah Kahtani, Abdulaziz Alamoudi, Amal Alosaimi, Ayman Kurdi, Ziyad Saifaddin, Zaher Mikwar, Galia Jadkarim
KEYWORDS:
Lymphedema, Breast Cancer, Axillary Lymph Node Clearance, Axillary Lymph Node Dissection, Sentinel Lymph Node Biopsy, Mastectomy, Lumpectomy
JOURNAL NAME:
Surgical Science,
Vol.14 No.10,
October
31,
2023
ABSTRACT: Introduction: Breast cancer is the number one malignancy
affecting females in Saudi Arabia with a prevalence of 22.4%. Breast cancer incidence
increases annually due to the aid of established screening programs, leading to
the discovery of breast cancer in its early stages. Surgical treatment is an
integral part of early breast cancer management to achieve local control.
Axillary surgical interventions such sentinel lymph node biopsy (SLNB) and
axillary lymph node clearance (ALND) aim to stage the axilla as an adjunct to
the management of the primary breast tumor. In this paper, we reviewed female
breast cancer patients aged 30 - 60 who underwent
surgical treatment of SLNB and/or ALND with reporting the prevalence of
lymphedema and other associated complications and risk factors. Methodology: A cross-sectional
non-interventional study, with a sample size of 250 including breast cancer cases
from 2016 to 2019 at National Guard Hospital (NGH) in Jeddah, Saudi Arabia. Results: A total of 253 breast
cancer cases were included in this study, with a mean age of 53 years, 52.7%
were postmenopausal and positive family history was present among 21% of cases.
Further, 90.9% of the cases had unilateral disease. Staging was as follows: stage
I 14.5%, stage II 45.2%, stage III 37.1%, and stage IV 3.2%. Mastectomy was
done in 73.4% cases and lumpectomy was performed in 34.1% of cases. In
addition, 93.3% of patients had SLNB and 49% of them were positive. Axillary
dissection was performed in 69.6% of our patients. Radiotherapy
and chemotherapy were given to 71.8% and 80.4% of cases respectively. Among the
chemotherapy (chemo) recipients, 40.2% received adjuvant chemo, 54.5% received
neoadjuvant chemo, and the remaining 5.3% received both. Further,
the most prevalent complication was pain accounting for 42.1% of total
complications, and the least prevalent was cellulitis 4%. Also, seroma
developed in 18.3% cases, paresthesia noted in 5.6% of cases, winged scapula
was reported as 2%, weakness and necrosis were seen in 6% and 13.1% of cases
respectively. Axillary vein thrombosis and lymphangiosarcoma were reported in
none of the patients (0%). Lymphoedema accounted for 16.1% of overall
complications, 85% of the patients who developed lymphedema had undergone ALND,
and 12.9% and 14.4% received radiotherapy and chemotherapy respectively.
Lymphedema was observed in breast cancer stages as follows: stage
I 1.2%, stage II 7.2%, and stage III 5.2%. Patients with body mass index (BMI)
of 30 - 39 kg/m2 had 7.2%
prevalence of lymphedema compared to other BMI groups. Overall mortality
was 8.3%. Conclusion:
The findings of our study suggest that the prevalence of lymphedema was higher
in ALND patients with locally advanced tumors, and higher BMI, compared to
patients with stage I breast cancer and low BMI. Further, the prevalence of
lymphedema in patients who underwent ALND was significantly lower than those
who were treated by lumpectomy 10.3% (p-value = 0.034) in comparison to
mastectomy 19.3%.