Lymphedema after Axillary Dissection in Breast Surgery; A Prospective Study.

Abstract

Background- Lymphedema is a common and significant complication following axillary lymph node dissection (ALND) in breast cancer surgery. ALND involves the removal of lymph nodes at various levels, typically classified as Level I, II, and III, based on their anatomical location relative to the pectoralis minor muscle. The procedure is crucial for staging and managing breast cancer but carries a risk of disrupting normal lymphatic drainage, leading to lymphedema. Lymphedema can result in chronic swelling, pain, and decreased limb function, severely impacting the quality of life. This study aimed to evaluate the prevalence, risk factors, and demographic characteristics associated with lymphedema in patients undergoing breast-conserving surgery (BCS) or modified radical mastectomy (MRM).
Aims- lymphedema after axillary dissection in breast surgery; A prospective study.
Methods and materials- This study included 60 breast cancer patients who had undergone either BCS or MRM with ALND. Data collection involved reviewing medical records and conducting direct patient assessments over a one-year period from January 2023 to January 2024. The inclusion criteria were women who underwent surgery for biopsy- proven breast cancer and agreed to participate in follow-up assessments.
Exclusion criteria included patients with pre-existing lymphedema or conditions confounding the diagnosis. Limb girth measurements at four specific points (A, B, C, D) were taken at baseline, and then at 1, 3, and 6 months post-operatively. Descriptive statistics summarized demographic and clinical characteristics, while inferential statistics identified significant risk factors for lymphedema using Chi-square tests for categorical variables and t-tests for continuous variables.
Results- The study population consisted mainly of homemakers (73.3%), with most participants being right-handed (76.7%). Comorbidities included diabetes (21.7%) and hypertension (13.3%). Left-sided breast cancer was slightly more common (53.3%) than right-sided (46.7%), with most patients being diagnosed at stage T2(61.7%). The overall prevalence of lymphedema was 16.7%, with 10 out of 60 patients developing the condition. Factors significantly associated with lymphedema included obesity, post-operative seroma (58.8% incidence of lymphedema in those with seroma) and wound infections (81.7% incidence in those with infections). Additionally, a high proportion of patients received postoperative chemotherapy (98.3%) and radiotherapy (80%), which could also influence the incidence of lymphedema.
Conclusions- Lymphedema is a notable complication following breast cancer surgery with ALND, affecting approximately 16.7% of patients in this study. The development of post-operative seroma and wound infections significantly increases the risk of lymphedema. The high rates of neo adjuvant chemotherapy and adjuvant radiotherapy among the study population may also contribute to lymphedema incidence. These findings underscore the need for vigilant post-operative monitoring and proactive management of complications to mitigate the risk of lymphedema in breast cancer patients. Effective strategies should include early identification and treatment of seroma and wound infections, as well as tailored rehabilitation programs to support lymphatic health.