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Quantifying the Development of Breast Cancer Surgery-Associated Lymphedema in High-risk Patients Undergoing Axillary Lymph Node Surgery in Consecutive Patients
Anmol Chattha, BA, Parisa Kamali, MD, Charlotte L. Van Veldhuisen, BSc, Renata Flecha-Hirsch, BSc, Alexandra Bucknor, MD, Adam M. Tobias, MD, Bernard T. Lee, MD, MBA, MPH, FACS, Samuel J. Lin, MD, MBA, FACS.
Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA, USA.

PURPOSE: Lymphedema represents a significant morbidity for patients after breast cancer surgery. However, there is no strong evidence on the predictors of breast cancer surgery-associated lymphedema (BCAL). We aim to evaluate predictors of BCAL in breast cancer patients undergoing surgical treatment.
METHODS: A retrospective review of all consecutive breast cancer patients undergoing lumpectomy and/or mastectomy with axillary lymph node surgery (>4 nodes removed) between 2010-2015 was undertaken. Primary outcome of interest was lymphedema development.
RESULTS: A total of 315 patients were identified, of which 34.3% underwent lumpectomy, 17.1% underwent mastectomy alone, while 48.6% underwent mastectomy and reconstruction (Table 1). Lymphedema was diagnosed in 9.2% (n=19) of mastectomy patients and 27.8% (n=30) of lumpectomy patients. Removing >10 nodes in the both the mastectomy (OR=11.4, p=.000) and lumpectomy (OR=5.51, p=.034) cohort was predictive for lymphedema development. Neoadjuvant radiotherapy was predictive for lymphedema in the mastectomy cohort (OR=6.15, p=.015). Age, BMI, adjuvant radiotherapy, chemotherapy and positive axillary nodes were not predictive of lymphedema development in either group.
CONCLUSION: Results suggest that patients are more at risk of post-operative lymphedema if they have more than ten axillary lymph nodes removed. As expected, patients undergoing mastectomy are at an increased risk for lymphedema if they have had neoadjuvant radiotherapy. These results may help clinicians pre-operatively identify patients at a greater risk of developing lymphedema and to take preventative, anti-lymphedema measures.


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