Factors affecting the incidence of postmastectomy lymphedema in patients with locally advanced breast cancer

Abstract

Objectives. To determine the risk factors for the development of secondary postmastectomy lymphedema in patients with locally advanced breast cancer. Material and methods. The study included patients with stages IIIB-IIIC of locally advanced breast cancer who underwent complex treatment with the use of a standard mastectomy (control group) and a developed surgical technique (main group), when the stage of axillary lymph node dissection was carried out with preventive removal of the clavicular part of the pectoralis major muscle and the sternum - clavicular fascia. Radiation and chemotherapy were similar in both groups. The frequency and severity of secondary postmastectomy edema of the upper limb and its relationship with comorbidities were assessed. Results. The results were evaluated in 90 patients of the main group and 86 patients of the control group, the follow up period was more than one year after the operation. The groups were comparable in terms of the main clinical and biological parameters. In the main group, 21 cases of secondary postmastectomy edema were revealed (23.3±4.5%), in the control group – 36 (41.9±5.3%, p=0.009). When assessing the effect of obesity on the incidence of lymphedema, development the data were obtained that indicated an increase of its frequency in patients with obesity (47.8±5.3%) when compared to patients with normal weight (16.3±4.0%, p<0.001). Similar data were obtained both among patients of the control (p<0.001) and main groups (p=0.005). Among obese patients who had been operated according to the standard technique, the edema of the upper limb developed significantly more often (58.7±7.3%) when compared with the main group (36.4±7.3%, p=0.034). Conclusions. A statistically significant influence on the development of postmastectomy lymphedema was exerted by such factors as the presence of obesity in patients (p<0.001) and the method of surgical intervention (p=0.011). According to the monovariant analysis, the developed technique of surgical intervention enables 2.4 times reduction in the incidence of lymphedema when compared to standard treatment (p=0.009).

Keywords

• breast cancer
• surgical treatment technique
• postmastectomy lymphedema
• obesity
• risk factors