Awan Muhammad Usman, Schwartz Gary, Shifchik Anastassia, Harmon Skylar, Malisetyan Tatevik
Allopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA.
Anatomy, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA.
Cureus. 2022 Jul 29;14(7):e27461. doi: 10.7759/cureus.27461. eCollection 2022 Jul.
To determine if patients with a prior history of axillary lymph node dissection (ALND) secondary to breast cancer surgery and other procedures are at an increased risk of postoperative complications including lymphedema and infection following elective upper extremity surgery. Furthermore, the study aimed to evaluate the extent of patient education regarding lymphedema as a possible complication of upper extremity surgery.
A review of 312 patients presenting to the clinic with upper extremity pathologies was performed of which 15 patients had a history of surgeries secondary to breast cancer and 297 had no prior history of breast cancer. Nine out of 15 patients with prior breast procedures and 66 out of 297 patients with no such history underwent elective hand surgeries, with 22 out of the 75 patients having a history of ALND. Incidences of postoperative complications including lymphedema and infection were recorded. Afterward, a survey inquiring about patient education was conducted to assess whether the patients were educated regarding lymphedema and if so, when and from whom they received the counseling.
No patients with a prior history of ALND secondary to breast cancer or other surgeries developed a postoperative infection or onset of lymphedema, and no patients with preoperative lymphedema had any worsening of lymphedema or infection postoperatively. The survey conducted afterward revealed that 61% of the patients with a prior history of breast cancer-related procedures including lymph node dissection were never counseled regarding lymphedema as a possible complication of hand surgery. Furthermore, 75% of the survey participants wished they were given more information about possible causes and complications of, and ways to prevent or minimize the possibility of lymphedema developing postoperatively.
Prior history of ALND did not make patients more susceptible to postoperative complications, thus a history of isolated ALND or breast cancer surgery including ALND should not preclude elective hand surgical procedures from being performed ipsilaterally. Additionally, improvements in the degree of patient counseling regarding postoperative complications following hand surgery are needed as increased patient education is shown to be associated with a lower rate of complications and faster recovery times.
确定因乳腺癌手术及其他手术而有腋窝淋巴结清扫术（ALND）既往史的患者，在接受择期上肢手术后发生包括淋巴水肿和感染在内的术后并发症的风险是否增加。此外，该研究旨在评估患者对作为上肢手术可能并发症的淋巴水肿的教育程度。
对312例因上肢病变前来就诊的患者进行回顾性研究，其中15例有乳腺癌继发手术史，297例无乳腺癌既往史。15例有既往乳腺手术史的患者中有9例，297例无此类病史的患者中有66例接受了择期手部手术，75例患者中有22例有腋窝淋巴结清扫术病史。记录包括淋巴水肿和感染在内的术后并发症发生率。之后，进行了一项关于患者教育的调查，以评估患者是否接受过关于淋巴水肿的教育，如果是，他们何时以及从谁那里接受了咨询。
既往因乳腺癌或其他手术有腋窝淋巴结清扫术病史的患者均未发生术后感染或淋巴水肿，术前有淋巴水肿的患者术后淋巴水肿或感染均未加重。随后进行的调查显示，61%有包括淋巴结清扫术在内的既往乳腺癌相关手术史的患者从未接受过关于淋巴水肿作为手部手术可能并发症的咨询。此外，75%的调查参与者希望能得到更多关于淋巴水肿的可能病因、并发症以及预防或尽量减少术后发生淋巴水肿可能性的方法的信息。
腋窝淋巴结清扫术既往史并未使患者更易发生术后并发症，因此孤立的腋窝淋巴结清扫术或包括腋窝淋巴结清扫术在内的乳腺癌手术史不应妨碍同侧进行择期手部手术。此外，手部手术后患者咨询术后并发症的程度需要改善，因为研究表明增加患者教育与较低的并发症发生率和更快的恢复时间相关。
