Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY, USA.
Hand (N Y). 2024 Sep;19(6):995-1001. doi: 10.1177/15589447231155583. Epub 2023 Feb 21.
The purpose of this study was to evaluate the incidence of lymphedema onset or exacerbation in patients undergoing upper extremity interventions, both nonoperative and operative, after breast cancer surgery.
The study inclusion criteria were the following: (1) prior history of breast cancer surgery or lymphedema from the cancer; (2) upper extremity intervention, ipsilateral to the breast cancer side; and (3) follow-up of at least 1 month. Patients were evaluated for demographic information, type of breast cancer procedure and hand intervention, number of lymph nodes dissected, preexisting lymphedema, exacerbation of lymphedema, and new-onset lymphedema.
A total of 161 patients undergoing 385 hand interventions (300 injections, 85 surgeries) were reviewed. Median follow-up was 31 months (range: 1-110). Nineteen patients had preexisting lymphedema ipsilateral to the hand procedure and none experienced an exacerbation of their lymphedema. Three patients developed new-onset lymphedema ipsilateral to their hand intervention at an average follow-up of 30 months (range: 4-67). One patient had a single injection and developed lymphedema over 5 years later. One had 2 injections in the same hand on the same date and developed lymphedema 3 months later. The third patient had 2 injections in the right hand, 1 injection and 1 surgery in the left hand, and developed either lymphedema or swelling due to rheumatoid arthritis in the right hand 1 year after the injections.
Patients who have undergone breast cancer surgery can safely undergo upper extremity intervention with low risk of lymphedema exacerbation or onset.
本研究旨在评估乳腺癌手术后行上肢干预（包括非手术和手术）的患者发生淋巴水肿发作或加重的发生率。
本研究的纳入标准为：（1）既往有乳腺癌手术或癌症相关淋巴水肿史；（2）同侧上肢干预；（3）随访时间至少 1 个月。患者的评估内容包括人口统计学信息、乳腺癌手术和手部干预的类型、淋巴结清扫数量、是否存在预先存在的淋巴水肿、淋巴水肿加重以及新发生的淋巴水肿。
共 161 例患者接受了 385 次手部干预（300 次注射，85 次手术），中位随访时间为 31 个月（范围：1-110）。19 例患者同侧手部手术存在预先存在的淋巴水肿，无患者出现淋巴水肿加重。3 例患者在平均随访 30 个月（范围：4-67）时同侧手部干预后新发生淋巴水肿。1 例患者单次注射后 5 年后发生淋巴水肿，1 例患者同侧手部同日接受 2 次注射，3 个月后发生淋巴水肿，第 3 例患者右手接受了 2 次注射、左手接受了 1 次注射和 1 次手术，1 年后右手出现淋巴水肿或因类风湿关节炎引起的肿胀。
行乳腺癌手术的患者可安全地行上肢干预，发生淋巴水肿加重或新发病的风险较低。
