From the Department of Surgery, Yale University School of Medicine, New Haven, CT.
Ann Plast Surg. 2021 Sep 1;87(3):248-252. doi: 10.1097/SAP.0000000000002630.
Lymphedema is a known complication after the surgical management of breast cancer, yet the incidence is poorly defined after breast conserving therapy and oncoplastic reduction. The primary aim of this study was to define lymphedema incidence in this population. Furthermore, we sought to correlate demographic factors, surgical approach, and complementary treatment modalities with incidence.
Data were collected retrospectively on patients who underwent breast conserving therapy at our institution from 2012 to 2015 with greater than 1 year of follow-up. Patients were excluded if they underwent breast surgery before treatment, completion mastectomy, delayed breast reconstruction, or delayed breast reduction.
Five hundred and eighty-four patients met study criteria with a 11% lymphedema rate. Patients developing lymphedema had higher preoperative body mass index (P = 0.02), larger breast mass resection volume (P < 0.01), higher rate of axillary dissection (P < 0.01), increased rate of adjuvant whole-breast radiation (P = 0.03), supraclavicular radiation (P < 0.01), axillary radiation (P < 0.01), and neoadjuvant medical therapy (P < 0.01). Multivariate analysis showed breast specimen mass, axillary radiation, and neoadjuvant medical therapy, which were associated with lymphedema (P < 0.05). There was no difference in lymphedema incidence between partial mastectomy and oncoplastic reduction cohorts with independent multivariate analyses for each showing axillary radiation and neoadjuvant medical therapy were significantly associated with lymphedema (P < 0.05), although breast specimen mass was not.
Elevated preoperative body mass index, radiation, axillary dissection, and neoadjuvant medical therapy are associated with an increased risk of lymphedema after breast conserving surgery. Oncoplastic reconstruction is not a risk factor for lymphedema.
淋巴水肿是乳腺癌手术后的一种已知并发症，但在保乳治疗和肿瘤整形缩小术后的发病率定义不清。本研究的主要目的是确定该人群的淋巴水肿发病率。此外，我们还试图将人口统计学因素、手术方法和补充治疗方式与发病率相关联。
对 2012 年至 2015 年在我院接受保乳治疗且随访时间超过 1 年的患者进行回顾性数据收集。如果患者在治疗前接受过乳房手术、完成乳房切除术、延迟乳房重建或延迟乳房缩小，则排除在外。
584 例患者符合研究标准，淋巴水肿发生率为 11%。发生淋巴水肿的患者术前体质量指数较高（P=0.02），乳房肿块切除体积较大（P<0.01），腋窝清扫率较高（P<0.01），辅助全乳放疗率较高（P=0.03），锁骨上放疗率较高（P<0.01），腋窝放疗率较高（P<0.01），新辅助药物治疗率较高（P<0.01）。多变量分析显示，乳房标本质量、腋窝放疗和新辅助药物治疗与淋巴水肿相关（P<0.05）。部分乳房切除术和肿瘤整形缩小术队列的淋巴水肿发生率无差异，独立多变量分析显示，腋窝放疗和新辅助药物治疗与淋巴水肿显著相关（P<0.05），尽管乳房标本质量无差异。
术前体质量指数升高、放疗、腋窝清扫和新辅助药物治疗与保乳手术后淋巴水肿风险增加相关。肿瘤整形重建不是淋巴水肿的危险因素。
