Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients
Identifieur interne : 005954 ( Istex/Corpus ); précédent : 005953; suivant : 005955Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients
Auteurs : Lucy K. Helyer ; Marie Varnic ; Lisa W. Le ; Wey Leong ; David MccreadySource :
- The Breast Journal [ 1075-122X ] ; 2010-01.
Abstract
Abstract: Lymphedema (LE) is a well‐known postoperative complication after axillary node dissection (ALND). Although, sentinel lymph node dissection (SLND) involves more focused surgery and less disruption of the axilla, early reports show up to 13% of patients experience some symptoms of LE. The purpose of this study was to determine predictors of arm LE in our patients under going SLND with or without an ALND. One hundred and thirty‐seven breast cancer patients were treated at a comprehensive cancer center. Prospective measurement of arm volume was carried every 6 months from date of diagnosis. This data base was retrospectively reviewed for tumor stage, treatment, and subjective complaints of LE. Objective LE was defined as a change greater than 200 mL compared with the control arm. Univariate and multivariate analyses were performed. Arm volume changes were measured over 24 months (median follow‐up 20 months) in 137 women: 82 stage I, 48 stage II, and 5 stage III; median age 56 years. Breast‐conserving surgery was performed in 133 patients. All patients underwent SLND for axillary staging and for 52 patients this was the only axillary staging procedure. All node‐positive patients (31) and 54 node‐negative patients under went an immediate completion ALND, the latter as part of a study protocol. At 24 months, 16 (11.6%) patients were found to have objective LE (>200 mL increase). Patient age, tumor size, number of nodes harvested, or adjuvant chemotherapy was not found to be predictive of LE by univariate analysis. The risk of developing postoperative LE was primarily and significantly related to the patients’ BMI (p = 0.003). Multivariate analysis revealed patients with a BMI >30 (obese) had an odds ratio of 2.93 (95% CI 1.03–8.31) compared with those with a BMI of <25 of having LE. Symptomatic LE (SLE), as defined by patient complaints was recorded in six of the above 16 patients, no SLE was recorded in patients without objective signs of edema. Univariate subgroup analysis compared the symptomatic to the nonsymptomatic patients and revealed the median number of nodes removed was higher in the symptomatic patients (17 verses 9, p = 0.045); however, these patients had a lower BMI (p = 0.0012). The mean change in arm volume was not significantly different between the groups. SLE occurs in one third of patients with objective arm swelling and most likely is multi‐factorial in etiology. Although patients undergoing SLN were recorded as having objective LE, none reported SLE. The development of LE within 2 years of surgery is associated with the patient’s BMI and this should be considered in preoperative counseling.
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DOI: 10.1111/j.1524-4741.2009.00855.x
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients</title><author><name sortKey="Helyer, Lucy K" sort="Helyer, Lucy K" uniqKey="Helyer L" first="Lucy K." last="Helyer">Lucy K. Helyer</name><affiliation><mods:affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Varnic, Marie" sort="Varnic, Marie" uniqKey="Varnic M" first="Marie" last="Varnic">Marie Varnic</name><affiliation><mods:affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Le, Lisa W" sort="Le, Lisa W" uniqKey="Le L" first="Lisa W." last="Le">Lisa W. Le</name><affiliation><mods:affiliation>Department of Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Leong, Wey" sort="Leong, Wey" uniqKey="Leong W" first="Wey" last="Leong">Wey Leong</name><affiliation><mods:affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Mccready, David" sort="Mccready, David" uniqKey="Mccready D" first="David" last="Mccready">David Mccready</name><affiliation><mods:affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:BE506E521979ADA0625F0BC4E79EDE1821FC5206</idno><date when="2010" year="2010">2010</date><idno type="doi">10.1111/j.1524-4741.2009.00855.x</idno><idno type="url">https://api.istex.fr/document/BE506E521979ADA0625F0BC4E79EDE1821FC5206/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">005954</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">005954</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main">Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients</title><author><name sortKey="Helyer, Lucy K" sort="Helyer, Lucy K" uniqKey="Helyer L" first="Lucy K." last="Helyer">Lucy K. Helyer</name><affiliation><mods:affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Varnic, Marie" sort="Varnic, Marie" uniqKey="Varnic M" first="Marie" last="Varnic">Marie Varnic</name><affiliation><mods:affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Le, Lisa W" sort="Le, Lisa W" uniqKey="Le L" first="Lisa W." last="Le">Lisa W. Le</name><affiliation><mods:affiliation>Department of Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Leong, Wey" sort="Leong, Wey" uniqKey="Leong W" first="Wey" last="Leong">Wey Leong</name><affiliation><mods:affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Mccready, David" sort="Mccready, David" uniqKey="Mccready D" first="David" last="Mccready">David Mccready</name><affiliation><mods:affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">The Breast Journal</title><title level="j" type="alt">BREAST JOURNAL</title><idno type="ISSN">1075-122X</idno><idno type="eISSN">1524-4741</idno><imprint><biblScope unit="vol">16</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="48">48</biblScope><biblScope unit="page" to="54">54</biblScope><biblScope unit="page-count">7</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2010-01">2010-01</date></imprint><idno type="ISSN">1075-122X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1075-122X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Abstract: Lymphedema (LE) is a well‐known postoperative complication after axillary node dissection (ALND). Although, sentinel lymph node dissection (SLND) involves more focused surgery and less disruption of the axilla, early reports show up to 13% of patients experience some symptoms of LE. The purpose of this study was to determine predictors of arm LE in our patients under going SLND with or without an ALND. One hundred and thirty‐seven breast cancer patients were treated at a comprehensive cancer center. Prospective measurement of arm volume was carried every 6 months from date of diagnosis. This data base was retrospectively reviewed for tumor stage, treatment, and subjective complaints of LE. Objective LE was defined as a change greater than 200 mL compared with the control arm. Univariate and multivariate analyses were performed. Arm volume changes were measured over 24 months (median follow‐up 20 months) in 137 women: 82 stage I, 48 stage II, and 5 stage III; median age 56 years. Breast‐conserving surgery was performed in 133 patients. All patients underwent SLND for axillary staging and for 52 patients this was the only axillary staging procedure. All node‐positive patients (31) and 54 node‐negative patients under went an immediate completion ALND, the latter as part of a study protocol. At 24 months, 16 (11.6%) patients were found to have objective LE (>200 mL increase). Patient age, tumor size, number of nodes harvested, or adjuvant chemotherapy was not found to be predictive of LE by univariate analysis. The risk of developing postoperative LE was primarily and significantly related to the patients’ BMI (p = 0.003). Multivariate analysis revealed patients with a BMI >30 (obese) had an odds ratio of 2.93 (95% CI 1.03–8.31) compared with those with a BMI of <25 of having LE. Symptomatic LE (SLE), as defined by patient complaints was recorded in six of the above 16 patients, no SLE was recorded in patients without objective signs of edema. Univariate subgroup analysis compared the symptomatic to the nonsymptomatic patients and revealed the median number of nodes removed was higher in the symptomatic patients (17 verses 9, p = 0.045); however, these patients had a lower BMI (p = 0.0012). The mean change in arm volume was not significantly different between the groups. SLE occurs in one third of patients with objective arm swelling and most likely is multi‐factorial in etiology. Although patients undergoing SLN were recorded as having objective LE, none reported SLE. The development of LE within 2 years of surgery is associated with the patient’s BMI and this should be considered in preoperative counseling.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>node</json:string><json:string>axillary</json:string><json:string>lymphedema</json:string><json:string>alnd</json:string><json:string>slnd</json:string><json:string>surg</json:string><json:string>breast cancer</json:string><json:string>morbidity</json:string><json:string>oncol</json:string><json:string>lymph</json:string><json:string>surg oncol</json:string><json:string>postoperative</json:string><json:string>sentinel</json:string><json:string>sentinel node biopsy</json:string><json:string>axillary lymph node dissection</json:string><json:string>median</json:string><json:string>lymph nodes</json:string><json:string>breast cancer patients</json:string><json:string>biopsy</json:string><json:string>axillary surgery</json:string><json:string>multivariate analysis</json:string><json:string>completion alnd</json:string><json:string>percentage change</json:string><json:string>symptomatic patients</json:string><json:string>sentinel lymph node biopsy</json:string><json:string>risk factor</json:string><json:string>postoperative lymphedema</json:string><json:string>volume measurements</json:string><json:string>axillary dissection</json:string><json:string>sentinel lymph nodes</json:string><json:string>dissection</json:string><json:string>volume increase</json:string><json:string>menopausal status</json:string><json:string>positive nodes</json:string><json:string>tumor size</json:string><json:string>volume change</json:string><json:string>sentinel lymph node dissection</json:string><json:string>chart review</json:string><json:string>metastatic disease</json:string><json:string>body mass index</json:string><json:string>total number</json:string><json:string>preoperative counseling</json:string><json:string>study protocol</json:string><json:string>volume preop</json:string><json:string>median number</json:string><json:string>subgroup analysis</json:string><json:string>lumpectomy mastectomy</json:string><json:string>objective lymphedema</json:string><json:string>axillary nodes</json:string><json:string>odds ratio</json:string><json:string>radiation therapy</json:string><json:string>univariate analysis</json:string><json:string>more lymph nodes</json:string><json:string>breast surgery</json:string><json:string>side effects</json:string><json:string>lymphatic drainage</json:string><json:string>axillary node dissection</json:string><json:string>sentinel lymph node</json:string><json:string>princess margaret hospital</json:string><json:string>breast cancer treatment</json:string><json:string>primary treatment</json:string><json:string>breast carcinoma</json:string><json:string>surgical oncology</json:string><json:string>early breast cancer</json:string><json:string>surgical complications</json:string><json:string>world health organization</json:string></teeft></keywords><author><json:item><name>Lucy K. Helyer MD, MSc, FRCSC</name><affiliations><json:string>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Marie Varnic RN</name><affiliations><json:string>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Lisa W. Le MSc</name><affiliations><json:string>Department of Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Wey Leong MD, PhD, FRCSC</name><affiliations><json:string>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>David McCready MD, MSc, FRCS, FRCSC</name><affiliations><json:string>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>lymphedema</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>obesity</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>sentinel node biopsy</value></json:item></subject><articleId><json:string>TBJ855</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>Abstract: Lymphedema (LE) is a well‐known postoperative complication after axillary node dissection (ALND). Although, sentinel lymph node dissection (SLND) involves more focused surgery and less disruption of the axilla, early reports show up to 13% of patients experience some symptoms of LE. The purpose of this study was to determine predictors of arm LE in our patients under going SLND with or without an ALND. One hundred and thirty‐seven breast cancer patients were treated at a comprehensive cancer center. Prospective measurement of arm volume was carried every 6 months from date of diagnosis. This data base was retrospectively reviewed for tumor stage, treatment, and subjective complaints of LE. Objective LE was defined as a change greater than 200 mL compared with the control arm. Univariate and multivariate analyses were performed. Arm volume changes were measured over 24 months (median follow‐up 20 months) in 137 women: 82 stage I, 48 stage II, and 5 stage III; median age 56 years. Breast‐conserving surgery was performed in 133 patients. All patients underwent SLND for axillary staging and for 52 patients this was the only axillary staging procedure. All node‐positive patients (31) and 54 node‐negative patients under went an immediate completion ALND, the latter as part of a study protocol. At 24 months, 16 (11.6%) patients were found to have objective LE (>200 mL increase). Patient age, tumor size, number of nodes harvested, or adjuvant chemotherapy was not found to be predictive of LE by univariate analysis. The risk of developing postoperative LE was primarily and significantly related to the patients’ BMI (p = 0.003). Multivariate analysis revealed patients with a BMI >30 (obese) had an odds ratio of 2.93 (95% CI 1.03–8.31) compared with those with a BMI of >25 of having LE. Symptomatic LE (SLE), as defined by patient complaints was recorded in six of the above 16 patients, no SLE was recorded in patients without objective signs of edema. Univariate subgroup analysis compared the symptomatic to the nonsymptomatic patients and revealed the median number of nodes removed was higher in the symptomatic patients (17 verses 9, p = 0.045); however, these patients had a lower BMI (p = 0.0012). The mean change in arm volume was not significantly different between the groups. SLE occurs in one third of patients with objective arm swelling and most likely is multi‐factorial in etiology. Although patients undergoing SLN were recorded as having objective LE, none reported SLE. The development of LE within 2 years of surgery is associated with the patient’s BMI and this should be considered in preoperative counseling.</abstract><qualityIndicators><score>7.258</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595.276 x 782.362 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>2663</abstractCharCount><pdfWordCount>4258</pdfWordCount><pdfCharCount>25958</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>411</abstractWordCount></qualityIndicators><title>Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients</title><genre><json:string>article</json:string></genre><host><title>The Breast 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Patients</title></titleStmt><publicationStmt><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><availability><licence>© 2009 Wiley Periodicals, Inc.</licence></availability><date type="published" when="2010-01"></date></publicationStmt><notesStmt><note type="content-type" subtype="article" source="article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</note><note type="publication-type" subtype="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="article"><analytic><title level="a" type="main">Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients</title><title level="a" type="short">Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients</title><author xml:id="author-0000"><persName><forename type="first">Lucy K.</forename><surname>Helyer</surname><roleName type="degree">MD, MSc, FRCSC</roleName></persName><affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada<address><country key="CA"></country></address></affiliation></author><author xml:id="author-0001"><persName><forename type="first">Marie</forename><surname>Varnic</surname><roleName type="degree">RN</roleName></persName><affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada<address><country key="CA"></country></address></affiliation></author><author xml:id="author-0002"><persName><forename type="first">Lisa W.</forename><surname>Le</surname><roleName type="degree">MSc</roleName></persName><affiliation>Department of Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada<address><country key="CA"></country></address></affiliation></author><author xml:id="author-0003"><persName><forename type="first">Wey</forename><surname>Leong</surname><roleName type="degree">MD, PhD, FRCSC</roleName></persName><affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada<address><country key="CA"></country></address></affiliation></author><author xml:id="author-0004"><persName><forename type="first">David</forename><surname>McCready</surname><roleName type="degree">MD, MSc, FRCS, FRCSC</roleName></persName><affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada<address><country key="CA"></country></address></affiliation></author><idno type="istex">BE506E521979ADA0625F0BC4E79EDE1821FC5206</idno><idno type="DOI">10.1111/j.1524-4741.2009.00855.x</idno><idno type="unit">TBJ855</idno><idno type="toTypesetVersion">file:TBJ.TBJ855.pdf</idno></analytic><monogr><title level="j" type="main">The Breast Journal</title><title level="j" type="alt">BREAST JOURNAL</title><idno type="pISSN">1075-122X</idno><idno type="eISSN">1524-4741</idno><idno type="book-DOI">10.1111/(ISSN)1524-4741</idno><idno type="book-part-DOI">10.1111/tbj.2009.16.issue-1</idno><idno type="product">TBJ</idno><idno type="publisherDivision">ST</idno><imprint><biblScope unit="vol">16</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="48">48</biblScope><biblScope unit="page" to="54">54</biblScope><biblScope unit="page-count">7</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2010-01"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><p><hi rend="bold">Abstract: </hi> Lymphedema (LE) is a well‐known postoperative complication after axillary node dissection (ALND). Although, sentinel lymph node dissection (SLND) involves more focused surgery and less disruption of the axilla, early reports show up to 13% of patients experience some symptoms of LE. The purpose of this study was to determine predictors of arm LE in our patients under going SLND with or without an ALND. One hundred and thirty‐seven breast cancer patients were treated at a comprehensive cancer center. Prospective measurement of arm volume was carried every 6 months from date of diagnosis. This data base was retrospectively reviewed for tumor stage, treatment, and subjective complaints of LE. Objective LE was defined as a change greater than 200 mL compared with the control arm. Univariate and multivariate analyses were performed. Arm volume changes were measured over 24 months (median follow‐up 20 months) in 137 women: 82 stage I, 48 stage II, and 5 stage III; median age 56 years. Breast‐conserving surgery was performed in 133 patients. All patients underwent SLND for axillary staging and for 52 patients this was the only axillary staging procedure. All node‐positive patients (31) and 54 node‐negative patients under went an immediate completion ALND, the latter as part of a study protocol. At 24 months, 16 (11.6%) patients were found to have objective LE (>200 mL increase). Patient age, tumor size, number of nodes harvested, or adjuvant chemotherapy was not found to be predictive of LE by univariate analysis. The risk of developing postoperative LE was primarily and significantly related to the patients’ BMI (p = 0.003). Multivariate analysis revealed patients with a BMI >30 (obese) had an odds ratio of 2.93 (95% CI 1.03–8.31) compared with those with a BMI of <25 of having LE. Symptomatic LE (SLE), as defined by patient complaints was recorded in six of the above 16 patients, no SLE was recorded in patients without objective signs of edema. Univariate subgroup analysis compared the symptomatic to the nonsymptomatic patients and revealed the median number of nodes removed was higher in the symptomatic patients (17 verses 9, p = 0.045); however, these patients had a lower BMI (p = 0.0012). The mean change in arm volume was not significantly different between the groups. SLE occurs in one third of patients with objective arm swelling and most likely is multi‐factorial in etiology. Although patients undergoing SLN were recorded as having objective LE, none reported SLE. The development of LE within 2 years of surgery is associated with the patient’s BMI and this should be considered in preoperative counseling.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">lymphedema</term><term xml:id="k2">obesity</term><term xml:id="k3">sentinel node biopsy</term></keywords><classCode scheme="tocHeading1">ORIGINAL ARTICLES</classCode></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/BE506E521979ADA0625F0BC4E79EDE1821FC5206/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta 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value="TBJ855"></id></idGroup><countGroup><count type="pageTotal" number="7"></count></countGroup><titleGroup><title type="tocHeading1">ORIGINAL ARTICLES</title></titleGroup><copyright>© 2009 Wiley Periodicals, Inc.</copyright><eventGroup><event type="firstOnline" date="2009-11-02"></event><event type="publishedOnlineFinalForm" date="2010-01-08"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.2 mode:FullText source:FullText result:FullText" date="2010-03-04"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-10"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-11-04"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="48">48</numbering><numbering type="pageLast" number="54">54</numbering></numberingGroup><correspondenceTo>Address correspondence and reprint requests to: Lucy Helyer, MD, MSc, CCFP, FRCSC, 8‐809 Vic Bldg, Queen Elizabeth Health Sciences Centre, 1278 Tower Rd., Halifax NS, Canada B3N 2Y9, or e‐mail: <email>lhelyer@dal.ca</email>.</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:TBJ.TBJ855.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="2"></count><count type="tableTotal" number="2"></count></countGroup><titleGroup><title type="main">Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients</title><title type="shortAuthors">HELYER ET AL.</title><title type="short"><i>Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients</i></title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>Lucy K.</givenNames><familyName>Helyer</familyName><degrees>MD, MSc, FRCSC</degrees></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1"><personName><givenNames>Marie</givenNames><familyName>Varnic</familyName><degrees>RN</degrees></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a2"><personName><givenNames>Lisa W.</givenNames><familyName>Le</familyName><degrees>MSc</degrees></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a1"><personName><givenNames>Wey</givenNames><familyName>Leong</familyName><degrees>MD, PhD, FRCSC</degrees></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a1"><personName><givenNames>David</givenNames><familyName>McCready</familyName><degrees>MD, MSc, FRCS, FRCSC</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="a1" countryCode="CA"><unparsedAffiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</unparsedAffiliation></affiliation><affiliation xml:id="a2" countryCode="CA"><unparsedAffiliation>Department of Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">lymphedema</keyword><keyword xml:id="k2">obesity</keyword><keyword xml:id="k3">sentinel node biopsy</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p><b>Abstract: </b> Lymphedema (LE) is a well‐known postoperative complication after axillary node dissection (ALND). Although, sentinel lymph node dissection (SLND) involves more focused surgery and less disruption of the axilla, early reports show up to 13% of patients experience some symptoms of LE. The purpose of this study was to determine predictors of arm LE in our patients under going SLND with or without an ALND. One hundred and thirty‐seven breast cancer patients were treated at a comprehensive cancer center. Prospective measurement of arm volume was carried every 6 months from date of diagnosis. This data base was retrospectively reviewed for tumor stage, treatment, and subjective complaints of LE. Objective LE was defined as a change greater than 200 mL compared with the control arm. Univariate and multivariate analyses were performed. Arm volume changes were measured over 24 months (median follow‐up 20 months) in 137 women: 82 stage I, 48 stage II, and 5 stage III; median age 56 years. Breast‐conserving surgery was performed in 133 patients. All patients underwent SLND for axillary staging and for 52 patients this was the only axillary staging procedure. All node‐positive patients (31) and 54 node‐negative patients under went an immediate completion ALND, the latter as part of a study protocol. At 24 months, 16 (11.6%) patients were found to have objective LE (>200 mL increase). Patient age, tumor size, number of nodes harvested, or adjuvant chemotherapy was not found to be predictive of LE by univariate analysis. The risk of developing postoperative LE was primarily and significantly related to the patients’ BMI (p = 0.003). Multivariate analysis revealed patients with a BMI >30 (obese) had an odds ratio of 2.93 (95% CI 1.03–8.31) compared with those with a BMI of <25 of having LE. Symptomatic LE (SLE), as defined by patient complaints was recorded in six of the above 16 patients, no SLE was recorded in patients without objective signs of edema. Univariate subgroup analysis compared the symptomatic to the nonsymptomatic patients and revealed the median number of nodes removed was higher in the symptomatic patients (17 verses 9, p = 0.045); however, these patients had a lower BMI (p = 0.0012). The mean change in arm volume was not significantly different between the groups. SLE occurs in one third of patients with objective arm swelling and most likely is multi‐factorial in etiology. Although patients undergoing SLN were recorded as having objective LE, none reported SLE. The development of LE within 2 years of surgery is associated with the patient’s BMI and this should be considered in preoperative counseling.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients</title></titleInfo><name type="personal"><namePart type="given">Lucy K.</namePart><namePart type="family">Helyer</namePart><namePart type="termsOfAddress">MD, MSc, FRCSC</namePart><affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Marie</namePart><namePart type="family">Varnic</namePart><namePart type="termsOfAddress">RN</namePart><affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lisa W.</namePart><namePart type="family">Le</namePart><namePart type="termsOfAddress">MSc</namePart><affiliation>Department of Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Wey</namePart><namePart type="family">Leong</namePart><namePart type="termsOfAddress">MD, PhD, FRCSC</namePart><affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">David</namePart><namePart type="family">McCready</namePart><namePart type="termsOfAddress">MD, MSc, FRCS, FRCSC</namePart><affiliation>Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2010-01</dateIssued><copyrightDate encoding="w3cdtf">2010</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">2</extent><extent unit="tables">2</extent></physicalDescription><abstract>Abstract: Lymphedema (LE) is a well‐known postoperative complication after axillary node dissection (ALND). Although, sentinel lymph node dissection (SLND) involves more focused surgery and less disruption of the axilla, early reports show up to 13% of patients experience some symptoms of LE. The purpose of this study was to determine predictors of arm LE in our patients under going SLND with or without an ALND. One hundred and thirty‐seven breast cancer patients were treated at a comprehensive cancer center. Prospective measurement of arm volume was carried every 6 months from date of diagnosis. This data base was retrospectively reviewed for tumor stage, treatment, and subjective complaints of LE. Objective LE was defined as a change greater than 200 mL compared with the control arm. Univariate and multivariate analyses were performed. Arm volume changes were measured over 24 months (median follow‐up 20 months) in 137 women: 82 stage I, 48 stage II, and 5 stage III; median age 56 years. Breast‐conserving surgery was performed in 133 patients. All patients underwent SLND for axillary staging and for 52 patients this was the only axillary staging procedure. All node‐positive patients (31) and 54 node‐negative patients under went an immediate completion ALND, the latter as part of a study protocol. At 24 months, 16 (11.6%) patients were found to have objective LE (>200 mL increase). Patient age, tumor size, number of nodes harvested, or adjuvant chemotherapy was not found to be predictive of LE by univariate analysis. The risk of developing postoperative LE was primarily and significantly related to the patients’ BMI (p = 0.003). Multivariate analysis revealed patients with a BMI >30 (obese) had an odds ratio of 2.93 (95% CI 1.03–8.31) compared with those with a BMI of <25 of having LE. Symptomatic LE (SLE), as defined by patient complaints was recorded in six of the above 16 patients, no SLE was recorded in patients without objective signs of edema. Univariate subgroup analysis compared the symptomatic to the nonsymptomatic patients and revealed the median number of nodes removed was higher in the symptomatic patients (17 verses 9, p = 0.045); however, these patients had a lower BMI (p = 0.0012). The mean change in arm volume was not significantly different between the groups. SLE occurs in one third of patients with objective arm swelling and most likely is multi‐factorial in etiology. Although patients undergoing SLN were recorded as having objective LE, none reported SLE. The development of LE within 2 years of surgery is associated with the patient’s BMI and this should be considered in preoperative counseling.</abstract><subject lang="en"><genre>keywords</genre><topic>lymphedema</topic><topic>obesity</topic><topic>sentinel node biopsy</topic></subject><relatedItem type="host"><titleInfo><title>The Breast Journal</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1075-122X</identifier><identifier type="eISSN">1524-4741</identifier><identifier type="DOI">10.1111/(ISSN)1524-4741</identifier><identifier type="PublisherID">TBJ</identifier><part><date>2010</date><detail type="volume"><caption>vol.</caption><number>16</number></detail><detail type="issue"><caption>no.</caption><number>1</number></detail><extent unit="pages"><start>48</start><end>54</end><total>7</total></extent></part></relatedItem><identifier type="istex">BE506E521979ADA0625F0BC4E79EDE1821FC5206</identifier><identifier type="DOI">10.1111/j.1524-4741.2009.00855.x</identifier><identifier type="ArticleID">TBJ855</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2009 Wiley Periodicals, Inc.</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Ltd</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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