Helyer LK, Varnic M, Le LW, Leong W, McCready D, et al.
The breast journal. Date of publication 2010 Jan 1;volume 16(1):48-54.
1. Breast J. 2010 Jan-Feb;16(1):48-54. doi: 10.1111/j.1524-4741.2009.00855.x. Epub
2009 Nov 2.
Obesity is a risk factor for developing postoperative lymphedema in breast cancer
patients.
Helyer LK(1), Varnic M, Le LW, Leong W, McCready D.
Author information:
(1)Department of Surgical Oncology, Princess Margaret Hospital, University of
Toronto, Toronto, Ontario, Canada. lhelyer@dal.ca
Lymphedema (LE) is a well-known postoperative complication after axillary node
dissection (ALND). Although, sentinel lymph node dissection (SLND) involves more
focused surgery and less disruption of the axilla, early reports show up to 13%
of patients experience some symptoms of LE. The purpose of this study was to
determine predictors of arm LE in our patients under going SLND with or without
an ALND. One hundred and thirty-seven breast cancer patients were treated at a
comprehensive cancer center. Prospective measurement of arm volume was carried
every 6 months from date of diagnosis. This data base was retrospectively
reviewed for tumor stage, treatment, and subjective complaints of LE. Objective
LE was defined as a change greater than 200 mL compared with the control arm.
Univariate and multivariate analyses were performed. Arm volume changes were
measured over 24 months (median follow-up 20 months) in 137 women: 82 stage I, 48
stage II, and 5 stage III; median age 56 years. Breast-conserving surgery was
performed in 133 patients. All patients underwent SLND for axillary staging and
for 52 patients this was the only axillary staging procedure. All node-positive
patients (31) and 54 node-negative patients under went an immediate completion
ALND, the latter as part of a study protocol. At 24 months, 16 (11.6%) patients
were found to have objective LE (>200 mL increase). Patient age, tumor size,
number of nodes harvested, or adjuvant chemotherapy was not found to be
predictive of LE by univariate analysis. The risk of developing postoperative LE
was primarily and significantly related to the patients' BMI (p = 0.003).
Multivariate analysis revealed patients with a BMI >30 (obese) had an odds ratio
of 2.93 (95% CI 1.03-8.31) compared with those with a BMI of <25 of having LE.
Symptomatic LE (SLE), as defined by patient complaints was recorded in six of the
above 16 patients, no SLE was recorded in patients without objective signs of
edema. Univariate subgroup analysis compared the symptomatic to the
nonsymptomatic patients and revealed the median number of nodes removed was
higher in the symptomatic patients (17 verses 9, p = 0.045); however, these
patients had a lower BMI (p = 0.0012). The mean change in arm volume was not
significantly different between the groups. SLE occurs in one third of patients
with objective arm swelling and most likely is multi-factorial in etiology.
Although patients undergoing SLN were recorded as having objective LE, none
reported SLE. The development of LE within 2 years of surgery is associated with
the patient's BMI and this should be considered in preoperative counseling.
DOI: 10.1111/j.1524-4741.2009.00855.x
PMID: 19889169 [Indexed for MEDLINE]
