Darrach Halley, Yesantharao Pooja S, Persing Sarah, Kokosis George, Carl Hannah M, Bridgham Kelly, Seu Michelle, Stifler Samantha, Sacks Justin M
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
J Reconstr Microsurg. 2020 Oct;36(8):606-615. doi: 10.1055/s-0040-1713667. Epub 2020 Jul 5.
Postmastectomy secondary lymphedema can cause substantial morbidity. However, few studies have investigated longitudinal quality of life (QoL) outcomes in patients with postmastectomy lymphedema, especially with regard to surgical versus nonoperative management. This study prospectively investigated QoL in surgically versus nonsurgically managed patients with postmastectomy upper extremity lymphedema.
This was a longitudinal cohort study of breast cancer-related lymphedema patients at a single institution, between February 2017 and January 2020. Lymphedema Quality of Life Instrument (LyQLI) and RAND-36 QoL instrument were used. Mann-Whitney and Fisher's exact tests were used for descriptive statistics. Wilcoxon's signed-rank testing and linear modeling were used to analyze longitudinal changes in QoL.
Thirty-two lymphedema patients were recruited to the study (20 surgical and 12 nonsurgical). Surgical and nonsurgical cohorts did not significantly differ in clinical/demographic characteristics or baseline QoL scores, but at the 12-month time point surgical patients had significantly greater LyQLI overall health scores than nonsurgical patients (79.3 vs. 58.3, = 0.02), as well as higher composite RAND-36 physical (68.5 vs. 38.3, = 0.04), and mental (77.0 vs. 52.7, = 0.02) scores. Furthermore, LyQLI overall health scores significantly improved over time in surgical patients (60.0 at baseline vs. 79.3 at 12 months, = 0.04). Besides surgical treatment, race, and age were also found to significantly impact QoL on multivariable analysis.
Our results suggest that when compared with nonoperative management, surgery improved QoL for chronic, secondary upper extremity lymphedema patients within 12-month postoperatively. Our results also suggested that insurance status may have influenced decisions to undergo lymphedema surgery. Further study is needed to investigate the various sociodemographic factors that were also found to impact QoL outcomes in these lymphedema patients.
乳房切除术后继发性淋巴水肿可导致严重的发病率。然而，很少有研究调查乳房切除术后淋巴水肿患者的纵向生活质量（QoL）结果，特别是关于手术治疗与非手术治疗方面。本研究前瞻性地调查了接受手术治疗与非手术治疗的乳房切除术后上肢淋巴水肿患者的生活质量。
这是一项对2017年2月至2020年1月期间在单一机构的乳腺癌相关淋巴水肿患者进行的纵向队列研究。使用了淋巴水肿生活质量量表（LyQLI）和兰德36项生活质量量表。采用曼-惠特尼检验和费舍尔精确检验进行描述性统计。使用威尔科克森符号秩检验和线性模型分析生活质量的纵向变化。
32名淋巴水肿患者被纳入研究（20名接受手术治疗，12名接受非手术治疗）。手术组和非手术组在临床/人口统计学特征或基线生活质量评分方面无显著差异，但在12个月时间点，手术患者的LyQLI总体健康评分显著高于非手术患者（79.3对58.3，P = 0.02），以及兰德36项综合身体评分（68.5对38.3，P = 0.04）和精神评分（77.0对52.7，P = 0.02）更高。此外，手术患者的LyQLI总体健康评分随时间显著改善（基线时为60.0，12个月时为79.3，P = 0.04）。除了手术治疗外，种族和年龄在多变量分析中也被发现对生活质量有显著影响。
我们的结果表明，与非手术治疗相比，手术改善了慢性继发性上肢淋巴水肿患者术后12个月内的生活质量。我们的结果还表明，保险状况可能影响了接受淋巴水肿手术的决策。需要进一步研究以调查在这些淋巴水肿患者中也发现会影响生活质量结果的各种社会人口学因素。
