PROSPECTIVE EVALUATION OF A PREVENTION PROTOCOL FOR LYMPHEDEMA FOLLOWING SURGERY FOR BREAST CANCER

Abstract

Lymphedema is a common complicationof axillary dissection and thus emphasisshould be placed on prevention. Fifty-fivewomen who had breast-conserving surgery ormodified radical mastectomy for breast cancerwith axillary dissection were randomlyassigned to either the preventive protocol (PG)or control group (CG) and assessments weremade preoperatively and at 1,3,6,12 and 24months postoperatively. Arm volume (VOL)was used as measurement of arm lymphedema.Clinically significant lymphedema wasconfirmed by an increase of at least 200 mlfrom the preoperative difference between thetwo arms. The preventive protocol for thePG women included preoperative upper limblymphscintigraphy (LS), principles forlymphedema risk minimization, and earlymanagement of this condition when it wasidentified. Assessments at 2 years postoperativelywere completed for 89% of the 55women who were randomly assigned to eitherPG or CG. Of the 49 women with unilateralbreast cancer surgery who were measured at24 months, 10 (21%) were identified withsecondary lymphedema using VOL with anincidence of 8% in PG women and 33% in CGwomen. These prophylactic strategies appearto reduce the development of secondarylymphedema and alter its progression incomparison to the CG women.