Figueira Patricia V G, Haddad Cinira A S, de Almeida Rizzi Samantha K L, Facina Gil, Nazario Afonso C P
Breast Diseases Division of Universidade Federal de São Paulo, Sao Paulo, Brazil.
Am J Clin Oncol. 2018 Oct;41(10):992-996. doi: 10.1097/COC.0000000000000411.
Axillary web syndrome (AWS) is a complication after breast cancer surgery associated with the axillary approach. We defined a diagnosis tool as well as evaluated cord frequency, characteristics, and risk factors.
A prospective cohort study of 173 women followed-up at Breast Diseases Division of Universidade Federal de São Paulo between July 2014 and September 2015 was established as an evaluation protocol to diagnose AWS. Sociodemographic status, anthropometric values, range of motion, comorbidities, pain, cord frequency, and characteristics (localization, number, palpable, and/or visible) among other data were collected at different time points before and after surgery.
The majority of the cords appeared by the seventh day (66.1%), and the total incidence of the cords was 90.9% at the 180th day. The axilla was the place for 80% of the occurrence of AWS, and >70% of the cords were palpable. Flexion and abduction of the shoulder showed reduced range of motion. Pain was present in 39.7% of the patients. Lymphadenectomy as well as hypertension were associated with increased risk of cord development; diabetes was associated with a decreased risk.
The evaluation protocol applied here showed a high incidence of AWS, with palpable cords more frequent than visible ones. The significance of hypertension and diabetes mellitus as risk factors for cord development in AWS should be evaluated in future studies. The evaluation protocol developed in this study seems to be of great importance for early detection of AWS and could also be valuable for future treatment planning.
腋窝网状综合征（AWS）是乳腺癌手术采用腋窝入路后的一种并发症。我们定义了一种诊断工具，并评估了条索的发生率、特征及危险因素。
在2014年7月至2015年9月期间，对圣保罗联邦大学乳腺疾病科随访的173名女性进行了一项前瞻性队列研究，以此作为诊断AWS的评估方案。在手术前后的不同时间点收集社会人口统计学状况、人体测量值、活动范围、合并症、疼痛、条索发生率及特征（定位、数量、可触及和/或可见）等其他数据。
大多数条索在术后第7天出现（66.1%），在第180天时条索的总发生率为90.9%。腋窝是AWS发生的80%的部位，且>70%的条索可触及。肩部的屈曲和外展活动范围减小。39.7%的患者存在疼痛。淋巴结清扫术以及高血压与条索形成风险增加相关；糖尿病与风险降低相关。
本研究应用的评估方案显示AWS发生率较高，可触及的条索比可见的条索更常见。高血压和糖尿病作为AWS中条索形成的危险因素的意义应在未来研究中进行评估。本研究制定的评估方案似乎对AWS的早期检测非常重要，对未来的治疗规划也可能有价值。
