Rebegea L, Firescu D, Dumitru M, Anghel R
Chirurgia (Bucur). 2015 Jan-Feb;110(1):33-7.
The arm lymphedema is reported as being the most frequent late reaction and complication that influences breast cancer patients' quality of life after lymph node dissection and radiotherapy. The aim of the study is to identify the risk factors in arm lymphedema occurrence in breast cancer patients who performed radical conservatory surgery, chemotherapy and radiotherapy.
We analysed 305 breast cancer patients who underwent treatment in the "Sf. Ap. Andrei" Emergency Clinical Hospital, Galati, Radiotherapy and Oncology Department, between the 1st of January 2010 and 31st of December 2012. We tried to find the risk factors for arm lymphedema development after treatment of breast cancer: the association of adjuvant radiotherapy with surgery, chemotherapy,hormonal therapy, number of removed lymph nodes,and number of lymph nodes with metastases, the co-morbid illnesses (obesity, diabetes mellitus and high blood pressure).
Our study evidences that the association of adjuvant radiotherapy, including the lymph node regions, with radical or conservatory surgery with lymph node dissection represents a statistically significant risk factor, with relative risk, RR =1.87, 95%C.I.=1.39-3.51, p<0.001. The number of removed lymph nodes was found to be a risk factor with statistical significance. For more than 25 removed lymph nodes, the relative risk for arm lymphedema development was RR=1.95(95%C.I. =1.79-4.51) and for 16-25 removed lymph nodes the relative risk, RR = 1.78, 95% C.I. = 1.46 - 3.23. Other analysed risk factors, which did not influence lymphedema development, were: associated chemotherapy or hormonal therapy,presence of co-morbid illnesses.
The development of arm lymphedema is an unpredictable occurrence that can happen years after axillary surgery.Breast and arm oedema continue to be late reactions that can be reduced by use of biopsy sentinel technique with avoiding of axillary lymph node dissection, when the sentinel lymph node is negative, knowing that lymphedema risk after sentinel lymph node is 5% comparative with lymphedema risk after axillary lymph node dissection which is 16%, by avoiding obesity, and performing modern therapy techniques.
手臂淋巴水肿被报道为淋巴结清扫和放疗后影响乳腺癌患者生活质量的最常见晚期反应和并发症。本研究的目的是确定接受根治性保乳手术、化疗和放疗的乳腺癌患者发生手臂淋巴水肿的危险因素。
我们分析了2010年1月1日至2012年12月31日期间在加拉茨“圣安德烈”紧急临床医院放疗与肿瘤科接受治疗的305例乳腺癌患者。我们试图找出乳腺癌治疗后手臂淋巴水肿发生的危险因素：辅助放疗与手术、化疗、激素治疗的联合，切除淋巴结的数量，以及有转移的淋巴结数量，合并疾病（肥胖、糖尿病和高血压）。
我们的研究表明，包括淋巴结区域的辅助放疗与根治性或保乳性淋巴结清扫手术联合是一个具有统计学意义的危险因素，相对危险度RR = 1.87，95%置信区间= 1.39 - 3.51，p < 0.001。发现切除淋巴结的数量是一个具有统计学意义的危险因素。切除超过25个淋巴结时，发生手臂淋巴水肿的相对危险度RR = 1.95（95%置信区间= 1.79 - 4.51），切除16 - 25个淋巴结时，相对危险度RR = 1.78，95%置信区间= 1.46 - 3.23。其他分析的危险因素，即不影响淋巴水肿发生的因素有：联合化疗或激素治疗，合并疾病的存在。
手臂淋巴水肿的发生是不可预测的，可能在腋窝手术后数年出现。乳房和手臂水肿仍然是晚期反应，当前哨淋巴结为阴性时，可通过使用前哨活检技术避免腋窝淋巴结清扫来降低其发生率，要知道前哨淋巴结活检后淋巴水肿的风险为5%，而腋窝淋巴结清扫后淋巴水肿的风险为16%，通过避免肥胖以及采用现代治疗技术来实现。
