Bhimani Fardeen, McEvoy Maureen, Chen Yu, Gupta Anjuli, Pastoriza Jessica, Cavalli Arianna, Obaid Liane, Rachofsky Carolyn, Fruchter Shani, Feldman Sheldon
Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, United States.
Albert Einstein College of Medicine, Bronx, NY, United States.
Front Oncol. 2024 Jul 16;14:1418610. doi: 10.3389/fonc.2024.1418610. eCollection 2024.
Breast cancer-related lymphedema (BCRL) profoundly impacts patients' quality of life, causing heightened depression, anxiety, and physical limitations. Surgical removal of the axillary nodes, combined with radiation therapy, is a significant risk factor for BCRL. Smarter axillary surgery, coupled with early detection and fostering lymphedema education, significantly improves BCRL management, promoting timely diagnosis and treatment. A lymphedema prevention program encompassing all these factors can significantly aid in preventing, treating, and reducing the severity of BCRL cases. Therefore, our study aims to share our insights and experiences gained from implementing a lymphedema prevention program at our institution.
METHODS & RESULTS: At our institution, axillary reverse mapping (ARM) is performed on all patients undergoing axillary surgery. We surveil these patients with pre- and postoperative SOZO measurements using bioimpedance spectroscopy to detect sub-clinical lymphedema. Concerning education, we use a 3-pronged approach with surgeons, nurse practitioners, and video representation for patients. We have had 212 patients undergo the ARM procedure since 2019, with three (1.41%) developing persistent lymphedema.
Our study underscores the significance of a comprehensive lymphedema prevention program, integrating smarter axillary surgery, early detection, and patient education. The lymphedema rate of 1.41% not only validates the success rate of these interventions but also advocates for their widespread adoption to enhance the holistic care of breast cancer survivors. As we continue to refine and expand our program, further research, and long-term follow-up are crucial to improve prevention strategies continually and enhance the overall well-being of individuals at risk of BCRL.
乳腺癌相关淋巴水肿（BCRL）对患者的生活质量产生深远影响，导致抑郁、焦虑加剧以及身体功能受限。腋窝淋巴结的手术切除联合放射治疗是BCRL的一个重要危险因素。更智能的腋窝手术，结合早期检测并加强淋巴水肿教育，可显著改善BCRL的管理，促进及时诊断和治疗。包含所有这些因素的淋巴水肿预防计划能够显著有助于预防、治疗BCRL病例并减轻其严重程度。因此，我们的研究旨在分享我们在本机构实施淋巴水肿预防计划过程中获得的见解和经验。
在本机构，对所有接受腋窝手术的患者进行腋窝反向映射（ARM）。我们使用生物电阻抗光谱法通过术前和术后的SOZO测量对这些患者进行监测，以检测亚临床淋巴水肿。在教育方面，我们采用一种三管齐下的方法，即由外科医生、执业护士进行教育，并为患者提供视频演示。自2019年以来，我们有212例患者接受了ARM手术，其中3例（1.41%）出现持续性淋巴水肿。
我们的研究强调了综合淋巴水肿预防计划的重要性，该计划整合了更智能的腋窝手术、早期检测和患者教育。1.41%的淋巴水肿发生率不仅验证了这些干预措施的成功率，也倡导广泛采用这些措施以加强对乳腺癌幸存者的整体护理。随着我们继续完善和扩大我们的计划，进一步的研究和长期随访对于不断改进预防策略以及提高有BCRL风险个体的整体健康状况至关重要。
