LymphedemaV1, Main, Exploration, bibRecord, 000F90

Immediate implant reconstruction is associated with a reduced risk of lymphedema compared to mastectomy alone: a prospective cohort study

Identifieur interne : 000F90 ( Main/Exploration ); précédent : 000F89; suivant : 000F91

Immediate implant reconstruction is associated with a reduced risk of lymphedema compared to mastectomy alone: a prospective cohort study

Auteurs : Cynthia L. Miller ; Amy S. Colwell ; Nora Horick ; Melissa N. Skolny ; Lauren S. Jammallo ; Jean A. O Oole ; Mina N. Shenouda ; Betro T. Sadek ; Meyha N. Swaroop ; Chantal M. Ferguson ; Barbara L. Smith ; Michelle C. Specht ; Alphonse G. Taghian

Source :

Annals of surgery [ 0003-4932 ] ; 2016.

RBID : PMC:4508247

Descripteurs français

English descriptors

KwdEn :
- Adult, Aged, Aged, 80 and over, Breast Implantation, Breast Neoplasms (surgery), Carcinoma, Ductal, Breast (surgery), Carcinoma, Intraductal, Noninfiltrating (surgery), Female, Follow-Up Studies, Humans, Incidence, Kaplan-Meier Estimate, Lymphedema (epidemiology), Lymphedema (etiology), Lymphedema (prevention & control), Mastectomy, Middle Aged, Multivariate Analysis, Postoperative Complications (epidemiology), Postoperative Complications (etiology), Postoperative Complications (prevention & control), Proportional Hazards Models, Prospective Studies, Risk Factors, Treatment Outcome.
MESH :
- epidemiology : Lymphedema, Postoperative Complications.
- etiology : Lymphedema, Postoperative Complications.
- prevention & control : Lymphedema, Postoperative Complications.
- surgery : Breast Neoplasms, Carcinoma, Ductal, Breast, Carcinoma, Intraductal, Noninfiltrating.
- Adult, Aged, Aged, 80 and over, Breast Implantation, Female, Follow-Up Studies, Humans, Incidence, Kaplan-Meier Estimate, Mastectomy, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Prospective Studies, Risk Factors, Treatment Outcome.

Abstract

STRUCTURED ABSTRACTObjective

We sought to determine the risk of lymphedema associated with immediate breast reconstruction compared to mastectomy alone.

Background

Immediate breast reconstruction is increasingly performed at the time of mastectomy. Few studies have examined whether breast reconstruction impacts development of lymphedema.

Methods

616 breast cancer patients who underwent 891 mastectomies between 2005–2013 were prospectively screened for lymphedema at our institution, with 22.2 months median follow-up. Mastectomies were categorized as immediate implant, immediate autologous, or no reconstruction. Arm measurements were performed pre-operatively and during post-operative follow-up using a Perometer. Lymphedema was defined as ≥10% arm volume increase compared to pre-operative. Kaplan-Meier and Cox regression analyses were performed to determine lymphedema rates and risk factors.

Results

Of 891 mastectomies, 65% (580/891) had immediate implant, 11% (101/891) immediate autologous, and 24% (210/891) no reconstruction. The two-year cumulative incidence of lymphedema was: 4.08% (95% CI: 2.59–6.41%) implant, 9.89% (95% CI: 4.98–19.1%) autologous, and 26.7% (95% CI: 20.4–34.4%) no reconstruction. By multivariate analysis, immediate implant (HR: 0.352, p<0.0001) but not autologous (HR: 0.706, p=0.2151) reconstruction was associated with a significantly reduced risk of lymphedema compared to no reconstruction. Axillary lymph node dissection (p<0.0001), higher Body Mass Index (p<0.0001), and greater number of nodes dissected (p=0.0324) were associated with increased lymphedema risk.

Conclusion

This prospective study suggests that in patients for whom implant-based reconstruction is available, immediate implant reconstruction does not increase the risk of lymphedema compared to mastectomy alone.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508247

DOI: 10.1097/SLA.0000000000001128
PubMed: 25607768
PubMed Central: 4508247

Affiliations:

Le document en format XML

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<author><name sortKey="Miller, Cynthia L" sort="Miller, Cynthia L" uniqKey="Miller C" first="Cynthia L." last="Miller">Cynthia L. Miller</name>
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<author><name sortKey="Jammallo, Lauren S" sort="Jammallo, Lauren S" uniqKey="Jammallo L" first="Lauren S." last="Jammallo">Lauren S. Jammallo</name>
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<author><name sortKey="O Oole, Jean A" sort="O Oole, Jean A" uniqKey="O Oole J" first="Jean A." last="O Oole">Jean A. O Oole</name>
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<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
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<author><name sortKey="Shenouda, Mina N" sort="Shenouda, Mina N" uniqKey="Shenouda M" first="Mina N." last="Shenouda">Mina N. Shenouda</name>
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<author><name sortKey="Swaroop, Meyha N" sort="Swaroop, Meyha N" uniqKey="Swaroop M" first="Meyha N." last="Swaroop">Meyha N. Swaroop</name>
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</affiliation>
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<author><name sortKey="Smith, Barbara L" sort="Smith, Barbara L" uniqKey="Smith B" first="Barbara L." last="Smith">Barbara L. Smith</name>
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</affiliation>
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<author><name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C." last="Specht">Michelle C. Specht</name>
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<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
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<author><name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G." last="Taghian">Alphonse G. Taghian</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Immediate implant reconstruction is associated with a reduced risk of lymphedema compared to mastectomy alone: a prospective cohort study</title>
<author><name sortKey="Miller, Cynthia L" sort="Miller, Cynthia L" uniqKey="Miller C" first="Cynthia L." last="Miller">Cynthia L. Miller</name>
<affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Colwell, Amy S" sort="Colwell, Amy S" uniqKey="Colwell A" first="Amy S." last="Colwell">Amy S. Colwell</name>
<affiliation><nlm:aff id="A2">Department of Plastic & Reconstructive Surgery, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Horick, Nora" sort="Horick, Nora" uniqKey="Horick N" first="Nora" last="Horick">Nora Horick</name>
<affiliation><nlm:aff id="A3">Department of Biostatistics, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Skolny, Melissa N" sort="Skolny, Melissa N" uniqKey="Skolny M" first="Melissa N." last="Skolny">Melissa N. Skolny</name>
<affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Jammallo, Lauren S" sort="Jammallo, Lauren S" uniqKey="Jammallo L" first="Lauren S." last="Jammallo">Lauren S. Jammallo</name>
<affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="O Oole, Jean A" sort="O Oole, Jean A" uniqKey="O Oole J" first="Jean A." last="O Oole">Jean A. O Oole</name>
<affiliation><nlm:aff id="A4">Department of Physical & Occupational Therapy, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Shenouda, Mina N" sort="Shenouda, Mina N" uniqKey="Shenouda M" first="Mina N." last="Shenouda">Mina N. Shenouda</name>
<affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Sadek, Betro T" sort="Sadek, Betro T" uniqKey="Sadek B" first="Betro T." last="Sadek">Betro T. Sadek</name>
<affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Swaroop, Meyha N" sort="Swaroop, Meyha N" uniqKey="Swaroop M" first="Meyha N." last="Swaroop">Meyha N. Swaroop</name>
<affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Ferguson, Chantal M" sort="Ferguson, Chantal M" uniqKey="Ferguson C" first="Chantal M." last="Ferguson">Chantal M. Ferguson</name>
<affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Smith, Barbara L" sort="Smith, Barbara L" uniqKey="Smith B" first="Barbara L." last="Smith">Barbara L. Smith</name>
<affiliation><nlm:aff id="A5">Division of Surgical Oncology, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C." last="Specht">Michelle C. Specht</name>
<affiliation><nlm:aff id="A5">Division of Surgical Oncology, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G." last="Taghian">Alphonse G. Taghian</name>
<affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff>
<wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry>
</affiliation>
</author>
</analytic>
<series><title level="j">Annals of surgery</title>
<idno type="ISSN">0003-4932</idno>
<idno type="eISSN">1528-1140</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
</biblStruct>
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</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Breast Implantation</term>
<term>Breast Neoplasms (surgery)</term>
<term>Carcinoma, Ductal, Breast (surgery)</term>
<term>Carcinoma, Intraductal, Noninfiltrating (surgery)</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Incidence</term>
<term>Kaplan-Meier Estimate</term>
<term>Lymphedema (epidemiology)</term>
<term>Lymphedema (etiology)</term>
<term>Lymphedema (prevention & control)</term>
<term>Mastectomy</term>
<term>Middle Aged</term>
<term>Multivariate Analysis</term>
<term>Postoperative Complications (epidemiology)</term>
<term>Postoperative Complications (etiology)</term>
<term>Postoperative Complications (prevention & control)</term>
<term>Proportional Hazards Models</term>
<term>Prospective Studies</term>
<term>Risk Factors</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Analyse multivariée</term>
<term>Carcinome canalaire du sein ()</term>
<term>Carcinome intracanalaire non infiltrant ()</term>
<term>Complications postopératoires ()</term>
<term>Complications postopératoires (épidémiologie)</term>
<term>Complications postopératoires (étiologie)</term>
<term>Estimation de Kaplan-Meier</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Implantation de prothèse mammaire</term>
<term>Incidence</term>
<term>Lymphoedème ()</term>
<term>Lymphoedème (épidémiologie)</term>
<term>Lymphoedème (étiologie)</term>
<term>Mastectomie</term>
<term>Modèles de hasards proportionnels</term>
<term>Résultat thérapeutique</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Tumeurs du sein ()</term>
<term>Études de suivi</term>
<term>Études prospectives</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Lymphedema</term>
<term>Postoperative Complications</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lymphedema</term>
<term>Postoperative Complications</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Lymphedema</term>
<term>Postoperative Complications</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Breast Neoplasms</term>
<term>Carcinoma, Ductal, Breast</term>
<term>Carcinoma, Intraductal, Noninfiltrating</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Complications postopératoires</term>
<term>Lymphoedème</term>
</keywords>
<keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Complications postopératoires</term>
<term>Lymphoedème</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Breast Implantation</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Incidence</term>
<term>Kaplan-Meier Estimate</term>
<term>Mastectomy</term>
<term>Middle Aged</term>
<term>Multivariate Analysis</term>
<term>Proportional Hazards Models</term>
<term>Prospective Studies</term>
<term>Risk Factors</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Analyse multivariée</term>
<term>Carcinome canalaire du sein</term>
<term>Carcinome intracanalaire non infiltrant</term>
<term>Complications postopératoires</term>
<term>Estimation de Kaplan-Meier</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Implantation de prothèse mammaire</term>
<term>Incidence</term>
<term>Lymphoedème</term>
<term>Mastectomie</term>
<term>Modèles de hasards proportionnels</term>
<term>Résultat thérapeutique</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Tumeurs du sein</term>
<term>Études de suivi</term>
<term>Études prospectives</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><title>STRUCTURED ABSTRACT</title>
<sec id="S1"><title>Objective</title>
<p id="P2">We sought to determine the risk of lymphedema associated with immediate breast reconstruction compared to mastectomy alone.</p>
</sec>
<sec id="S2"><title>Background</title>
<p id="P3">Immediate breast reconstruction is increasingly performed at the time of mastectomy. Few studies have examined whether breast reconstruction impacts development of lymphedema.</p>
</sec>
<sec id="S3"><title>Methods</title>
<p id="P4">616 breast cancer patients who underwent 891 mastectomies between 2005–2013 were prospectively screened for lymphedema at our institution, with 22.2 months median follow-up. Mastectomies were categorized as immediate implant, immediate autologous, or no reconstruction. Arm measurements were performed pre-operatively and during post-operative follow-up using a Perometer. Lymphedema was defined as ≥10% arm volume increase compared to pre-operative. Kaplan-Meier and Cox regression analyses were performed to determine lymphedema rates and risk factors.</p>
</sec>
<sec id="S4"><title>Results</title>
<p id="P5">Of 891 mastectomies, 65% (580/891) had immediate implant, 11% (101/891) immediate autologous, and 24% (210/891) no reconstruction. The two-year cumulative incidence of lymphedema was: 4.08% (95% CI: 2.59–6.41%) implant, 9.89% (95% CI: 4.98–19.1%) autologous, and 26.7% (95% CI: 20.4–34.4%) no reconstruction. By multivariate analysis, immediate implant (HR: 0.352, p<0.0001) but not autologous (HR: 0.706, p=0.2151) reconstruction was associated with a significantly reduced risk of lymphedema compared to no reconstruction. Axillary lymph node dissection (p<0.0001), higher Body Mass Index (p<0.0001), and greater number of nodes dissected (p=0.0324) were associated with increased lymphedema risk.</p>
</sec>
<sec id="S5"><title>Conclusion</title>
<p id="P6">This prospective study suggests that in patients for whom implant-based reconstruction is available, immediate implant reconstruction does not increase the risk of lymphedema compared to mastectomy alone.</p>
</sec>
</div>
</front>
</TEI>
<affiliations><list></list>
<tree><noCountry><name sortKey="Colwell, Amy S" sort="Colwell, Amy S" uniqKey="Colwell A" first="Amy S." last="Colwell">Amy S. Colwell</name>
<name sortKey="Ferguson, Chantal M" sort="Ferguson, Chantal M" uniqKey="Ferguson C" first="Chantal M." last="Ferguson">Chantal M. Ferguson</name>
<name sortKey="Horick, Nora" sort="Horick, Nora" uniqKey="Horick N" first="Nora" last="Horick">Nora Horick</name>
<name sortKey="Jammallo, Lauren S" sort="Jammallo, Lauren S" uniqKey="Jammallo L" first="Lauren S." last="Jammallo">Lauren S. Jammallo</name>
<name sortKey="Miller, Cynthia L" sort="Miller, Cynthia L" uniqKey="Miller C" first="Cynthia L." last="Miller">Cynthia L. Miller</name>
<name sortKey="O Oole, Jean A" sort="O Oole, Jean A" uniqKey="O Oole J" first="Jean A." last="O Oole">Jean A. O Oole</name>
<name sortKey="Sadek, Betro T" sort="Sadek, Betro T" uniqKey="Sadek B" first="Betro T." last="Sadek">Betro T. Sadek</name>
<name sortKey="Shenouda, Mina N" sort="Shenouda, Mina N" uniqKey="Shenouda M" first="Mina N." last="Shenouda">Mina N. Shenouda</name>
<name sortKey="Skolny, Melissa N" sort="Skolny, Melissa N" uniqKey="Skolny M" first="Melissa N." last="Skolny">Melissa N. Skolny</name>
<name sortKey="Smith, Barbara L" sort="Smith, Barbara L" uniqKey="Smith B" first="Barbara L." last="Smith">Barbara L. Smith</name>
<name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C." last="Specht">Michelle C. Specht</name>
<name sortKey="Swaroop, Meyha N" sort="Swaroop, Meyha N" uniqKey="Swaroop M" first="Meyha N." last="Swaroop">Meyha N. Swaroop</name>
<name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G." last="Taghian">Alphonse G. Taghian</name>
</noCountry>
</tree>
</affiliations>
</record>

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EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/LymphedemaV1/Data/Main/Exploration

HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000F90 | SxmlIndent | more

HfdSelect -h $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd -nk 000F90 | SxmlIndent | more

Pour mettre un lien sur cette page dans le réseau Wicri

{{Explor lien
   |wiki=    Wicri/Sante
   |area=    LymphedemaV1
   |flux=    Main
   |étape=   Exploration
   |type=    RBID
   |clé=     PMC:4508247
   |texte=   Immediate implant reconstruction is associated with a reduced risk of lymphedema compared to mastectomy alone: a prospective cohort study
}}

Pour générer des pages wiki

HfdIndexSelect -h $EXPLOR_AREA/Data/Main/Exploration/RBID.i   -Sk "pubmed:25607768" \
       | HfdSelect -Kh $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd   \
       | NlmPubMed2Wicri -a LymphedemaV1

This area was generated with Dilib version V0.6.31.
Data generation: Sat Nov 4 17:40:35 2017. Site generation: Tue Feb 13 16:42:16 2024

Serveur d'exploration sur le lymphœdème

Immediate implant reconstruction is associated with a reduced risk of lymphedema compared to mastectomy alone: a prospective cohort study

Immediate implant reconstruction is associated with a reduced risk of lymphedema compared to mastectomy alone: a prospective cohort study

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English descriptors

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Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri

Pour générer des pages wiki

	Serveur d'exploration sur le lymphœdème
	Attention, ce site est en cours de développement ! Attention, site généré par des moyens informatiques à partir de corpus bruts. Les informations ne sont donc pas validées.