INTERDISCIPLINARY APPROACH TO THE TREATMENT OF POSTMASTECTOMY LYMPHEDEMA

Abstract

A prospective randomized controlled clinical study included 80 women aged 54.9 ± 8 years, who underwent radical surgery for breast cancer and had late postmastectomy lymphedema (II–IV degree). No evidence of erysipelas was observed for the last 3 months. Material and methods.The severity of lymphedema and treatment outcomes were assessed using water plethysmography in relative units (in %). Changes in the subcutaneous adipose tissue thickness were measured by ultrasound. To assess the severity of liposuction complications, the Clavien–Dindo classification was used. Three homogeneous groups of patients were treated. In Group 1 (n=30), conservative methods (intermittent pneumatic compression of the arm, electrostimulation of skeletal muscles, magnetic therapy, massage, therapeutic exercises, compression bandaging) were performed in the preoperative period; in group 2 (n=30) – in the late postoperative period of liposuction; in group 3 (n=20) liposuction was followed by compression bandaging. Results. The average volume excess in the edematous upper extremity significantly decreased, being 84.2 ± 10.0 % in group1 patients, 87.8 ± 9.3 % in group 2 and 72.2 ± 9.6 % in group 3 (p<0.001). The regression rate of grade 2 lymphedema was 94.8 ± 1.2 % in group 1 patients, 96.1 ± 0.7 % in group 2 patients and 82.1 ± 2.5 % in group 3 patients. The regression rate of grades 3 lymphedema was 81.7 ± 2.2 % in group 1, 86.9 ± 2.2% in group 2 and 65.2 ± 0.8 % in group 3. The regression rate of grades 4 lymphedema was 71.0 ± 2.8% in group 1, 73.4 ± 2.2% in group 2 and 62.6 ± 4.2% in group 3 (p<0.001). Early complications of grade 1 liposuction occurred in 5% patients. Favorable immediate treatment outcome (reduction in lymphedema by 50100 % and reduction in the thickness of subcutaneous fat by 50 %) was noted in 100% of patients of groups 1 and 2 and in 90 % patients of group 3. A good long-term result (after 12–18 months) was observed in 93.3 % of group 1 patients, in 100 % of group 2 patients and in 55 % of group 3 patients. Conclusions. The results obtained show that the elimination of excess adipose component without improving the drainage function of the lymphatic system does not lead to good long-term treatment outcomes for late lymphedema.

Keywords

• breast cancer
• lymphedema
• liposuction
• physiotherapy
• rehabilitation