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Upper Extremity Lymphedema Following Elective And Trauma Hand Surgery In Breast Cancer Survivors
Heather L. Baltzer, MD1, Christine Oh, MD2, Jamison Harvey, BSc2, Steven L. Moran, MD2.
1University of Toronto, Toronto, ON, Canada, 2Mayo Clinic, Rochester, MN, USA.

PURPOSE:
To evaluate the risk of developing "late onset" upper extremity lymphedema following hand surgery among breast cancer (BC) survivors who had ipsilateral axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), and/or radiation therapy (RT).
METHODS:
Method
A retrospective cohort of BC survivors treated with ALND, SLNB and/or RT was identified between 1997-2012. Survivors with ipsilateral hand surgery with ≥1 year of follow up were included. The primary outcome was documented lymphedema following hand surgery (defined as requiring intervention). Demographic data and clinical information pertaining to hand surgery and BC treatment were compared between patients with and without lymphedema.
RESULTS:
Of the 142 survivors included, 12 (8.4%) developed lymphedema following hand surgery. BC survivors with and without lymphedema were similar in age, BMI and tourniquet use. Average tourniquet time was greater among women with lymphedema (63 vs. 34 minutes, p=0.02). On univariate analysis, lymphedema was associated with a surgery for hand trauma (75% vs 23%, p=0.002), RT (91% vs. 50%, p<0.01), ALND (75% vs. 34%, p=0.01), number of nodes removed (15 vs. 7, p=0.002) and chemotherapy (91% vs. 34%, p=0.02).
CONCLUSION:
These data suggest that BC survivors, particularly after more extensive nodal dissection and adjuvant therapies, that have hand surgery for trauma may benefit from prophylactic anti-lymphedema modalities. Larger population studies of this high-risk population are needed to further address this question.


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