Lymphedema after complete axillary node dissection for melanoma: Assessment using a new, objective definition
Identifieur interne : 008D17 ( Main/Exploration ); précédent : 008D16; suivant : 008D18Lymphedema after complete axillary node dissection for melanoma: Assessment using a new, objective definition
Auteurs : Emma C. Starritt [Australie] ; David Joseph [Australie] ; J. Gregory Mckinnon [Australie] ; SING KAI LO [Australie] ; Johannes H. W. De Wilt [Australie] ; John F. Thompson [Australie]Source :
- Annals of surgery [ 0003-4932 ] ; 2004.
Descripteurs français
- KwdFr :
- MESH :
- diagnostic : Lymphoedème.
- effets indésirables : Lymphadénectomie.
- secondaire : Mélanome.
- étiologie : Lymphoedème.
- Pascal (Inist)
- Wicri :
English descriptors
- KwdEn :
- Adult, Aged, Aged, 80 and over, Anthropometry, Arm, Axilla, Axillary ganglion, Complete, Definition, Dissection, Female, Humans, Lymph Node Excision (adverse effects), Lymphedema, Lymphedema (diagnosis), Lymphedema (etiology), Male, Malignant melanoma, Medicine, Melanoma (secondary), Melanoma (surgery), Middle Aged, Surgery, Treatment.
- MESH :
- adverse effects : Lymph Node Excision.
- diagnosis : Lymphedema.
- etiology : Lymphedema.
- secondary : Melanoma.
- surgery : Melanoma.
- Adult, Aged, Aged, 80 and over, Anthropometry, Arm, Axilla, Female, Humans, Male, Middle Aged.
Abstract
Objectives: The objectives of this study were to define appropriate criteria for assessing the presence of lymphedema, and to report the prevalence and risk factors for development of upper limb lymphedema after level I-III axillary dissection for melanoma. Background Data: The lack of a consistent and reliable objective definition for lymphedema remains a significant barrier to appreciating its prevalence after axillary dissection for melanoma (or breast carcinoma). Methods: Lymphedema was assessed in 107 patients (82 male, 25 female) who had previously undergone complete level I-III axillary dissection. Of the 107 patients, 17 had also received postoperative axillary radiotherapy. Arm volume was measured using a water displacement technique. Change in volume of the arm on the side of the dissection was referenced to the volume of the other (control) arm. Volume measurements were corrected for the effect of handedness using corrections derived from a control group. Classification and regression tree (CART) analysis was used to determine a threshold fractional arm volume increase above which volume changes were considered to indicate lymphedema. Results: Based on the CART analysis results, lymphedema was defined as an increase in arm volume greater than 16% of the volume of the control arm. Using this definition, lymphedema prevalence for patients in the present study was 10% after complete level I-III axillary dissection for melanoma and 53% after additional axillary radiotherapy. Radiotherapy and wound complications were independent risk factors for the development of lymphedema. Conclusions: A suggested objective definition for arm lymphedema after axillary dissection is an arm volume increase of greater than 16% of the volume of the control arm.
Url:
Affiliations:
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Starritt</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital</s1><s2>Camperdown</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Camperdown</wicri:noRegion></affiliation></author><author><name sortKey="Joseph, David" sort="Joseph, David" uniqKey="Joseph D" first="David" last="Joseph">David Joseph</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital</s1><s2>Camperdown</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Camperdown</wicri:noRegion></affiliation></author><author><name sortKey="Mckinnon, J Gregory" sort="Mckinnon, J Gregory" uniqKey="Mckinnon J" first="J. Gregory" last="Mckinnon">J. Gregory Mckinnon</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital</s1><s2>Camperdown</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Camperdown</wicri:noRegion></affiliation></author><author><name sortKey="Sing Kai Lo" sort="Sing Kai Lo" uniqKey="Sing Kai Lo" last="Sing Kai Lo">SING KAI LO</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Newtown</s2><s3>AUS</s3><sZ>4 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Newtown</wicri:noRegion></affiliation></author><author><name sortKey="De Wilt, Johannes H W" sort="De Wilt, Johannes H W" uniqKey="De Wilt J" first="Johannes H. W." last="De Wilt">Johannes H. W. De Wilt</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital</s1><s2>Camperdown</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Camperdown</wicri:noRegion></affiliation></author><author><name sortKey="Thompson, John F" sort="Thompson, John F" uniqKey="Thompson J" first="John F." last="Thompson">John F. Thompson</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital</s1><s2>Camperdown</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Camperdown</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>TDepartment of Surgery, University of Sydney</s1><s3>AUS</s3><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>TDepartment of Surgery, University of Sydney</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Annals of surgery</title><title level="j" type="abbreviated">Ann. surg.</title><idno type="ISSN">0003-4932</idno><imprint><date when="2004">2004</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Annals of surgery</title><title level="j" type="abbreviated">Ann. surg.</title><idno type="ISSN">0003-4932</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Anthropometry</term><term>Arm</term><term>Axilla</term><term>Axillary ganglion</term><term>Complete</term><term>Definition</term><term>Dissection</term><term>Female</term><term>Humans</term><term>Lymph Node Excision (adverse effects)</term><term>Lymphedema</term><term>Lymphedema (diagnosis)</term><term>Lymphedema (etiology)</term><term>Male</term><term>Malignant melanoma</term><term>Medicine</term><term>Melanoma (secondary)</term><term>Melanoma (surgery)</term><term>Middle Aged</term><term>Surgery</term><term>Treatment</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Aisselle</term><term>Anthropométrie</term><term>Bras</term><term>Femelle</term><term>Humains</term><term>Lymphadénectomie (effets indésirables)</term><term>Lymphoedème (diagnostic)</term><term>Lymphoedème (étiologie)</term><term>Mâle</term><term>Mélanome ()</term><term>Mélanome (secondaire)</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Lymph Node Excision</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Lymphoedème</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Lymphadénectomie</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="secondaire" xml:lang="fr"><term>Mélanome</term></keywords><keywords scheme="MESH" qualifier="secondary" xml:lang="en"><term>Melanoma</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Melanoma</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Lymphoedème</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Anthropometry</term><term>Arm</term><term>Axilla</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Aisselle</term><term>Anthropométrie</term><term>Bras</term><term>Femelle</term><term>Humains</term><term>Lymphoedème</term><term>Complet</term><term>Ganglion axillaire</term><term>Mâle</term><term>Mélanome</term><term>Mélanome malin</term><term>Dissection</term><term>Définition</term><term>Médecine</term><term>Chirurgie</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Traitement</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Médecine</term><term>Chirurgie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives: The objectives of this study were to define appropriate criteria for assessing the presence of lymphedema, and to report the prevalence and risk factors for development of upper limb lymphedema after level I-III axillary dissection for melanoma. Background Data: The lack of a consistent and reliable objective definition for lymphedema remains a significant barrier to appreciating its prevalence after axillary dissection for melanoma (or breast carcinoma). Methods: Lymphedema was assessed in 107 patients (82 male, 25 female) who had previously undergone complete level I-III axillary dissection. Of the 107 patients, 17 had also received postoperative axillary radiotherapy. Arm volume was measured using a water displacement technique. Change in volume of the arm on the side of the dissection was referenced to the volume of the other (control) arm. Volume measurements were corrected for the effect of handedness using corrections derived from a control group. Classification and regression tree (CART) analysis was used to determine a threshold fractional arm volume increase above which volume changes were considered to indicate lymphedema. Results: Based on the CART analysis results, lymphedema was defined as an increase in arm volume greater than 16% of the volume of the control arm. Using this definition, lymphedema prevalence for patients in the present study was 10% after complete level I-III axillary dissection for melanoma and 53% after additional axillary radiotherapy. Radiotherapy and wound complications were independent risk factors for the development of lymphedema. Conclusions: A suggested objective definition for arm lymphedema after axillary dissection is an arm volume increase of greater than 16% of the volume of the control arm.</div></front></TEI><affiliations><list><country><li>Australie</li></country></list><tree><country name="Australie"><noRegion><name sortKey="Starritt, Emma C" sort="Starritt, Emma C" uniqKey="Starritt E" first="Emma C." last="Starritt">Emma C. Starritt</name></noRegion><name sortKey="De Wilt, Johannes H W" sort="De Wilt, Johannes H W" uniqKey="De Wilt J" first="Johannes H. W." last="De Wilt">Johannes H. W. De Wilt</name><name sortKey="Joseph, David" sort="Joseph, David" uniqKey="Joseph D" first="David" last="Joseph">David Joseph</name><name sortKey="Mckinnon, J Gregory" sort="Mckinnon, J Gregory" uniqKey="Mckinnon J" first="J. Gregory" last="Mckinnon">J. Gregory Mckinnon</name><name sortKey="Sing Kai Lo" sort="Sing Kai Lo" uniqKey="Sing Kai Lo" last="Sing Kai Lo">SING KAI LO</name><name sortKey="Thompson, John F" sort="Thompson, John F" uniqKey="Thompson J" first="John F." last="Thompson">John F. Thompson</name><name sortKey="Thompson, John F" sort="Thompson, John F" uniqKey="Thompson J" first="John F." last="Thompson">John F. Thompson</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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