An audit of the incidence of arm lymphoedema after prophylactic level I/II axillary dissection without division of the pectoralis minor muscle.
Identifieur interne : 004235 ( PubMed/Corpus ); précédent : 004234; suivant : 004236An audit of the incidence of arm lymphoedema after prophylactic level I/II axillary dissection without division of the pectoralis minor muscle.
Auteurs : G. Querci Della Rovere ; I. Ahmad ; P. Singh ; S. Ashley ; I R Daniels ; P. MortimerSource :
- Annals of the Royal College of Surgeons of England [ 0035-8843 ] ; 2003.
English descriptors
- KwdEn :
- Adult, Aged, Aged, 80 and over, Axilla, Breast Neoplasms (surgery), Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Lymph Node Excision (methods), Lymphatic Metastasis, Lymphedema (etiology), Medical Audit, Middle Aged, Muscle, Skeletal, Postoperative Complications (etiology), Retrospective Studies, Risk Factors.
- MESH :
- etiology : Lymphedema, Postoperative Complications.
- methods : Lymph Node Excision.
- surgery : Breast Neoplasms.
- Adult, Aged, Aged, 80 and over, Axilla, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Lymphatic Metastasis, Medical Audit, Middle Aged, Muscle, Skeletal, Retrospective Studies, Risk Factors.
Abstract
Lymphoedema is reported to occur in approximately one in four women following curative treatment for breast cancer. Reported rates are almost exclusively for level 1,2,3 axillary clearance with few data for the current practice of level 1,2 dissections. Swelling can affect the whole upper limb but frequently will remain restricted to hand, forearm or upper arm. The aims of this study were to determine incidence after level 1,2 dissection, degree and site of swelling and risk factors which might determine such incidences. Results were available on 198 patients. The cumulative prevalence of lymphoedema after level 1,2 dissections was 14% in the arm, 12% in the forearm and 16% in the hand, assuming a circumference difference of more than 5% indicated lymphoedema. Moderate lymphoedema representing more than 10% circumference difference was found in 1% (arm), 3.5% (forearm) and 0.5% in the hand. Risk factors for lymphoedema were experience of the surgeon (upper arm only), dominant limb (forearm only) and right-sided cancer treatment (for hand only). When lymphoedema in any site was considered, right-sided treatment and nodal status were independently significant.
DOI: 10.1308/003588403321661299
PubMed: 12831486
Links to Exploration step
pubmed:12831486Le document en format XML
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<author><name sortKey="Querci Della Rovere, G" sort="Querci Della Rovere, G" uniqKey="Querci Della Rovere G" first="G" last="Querci Della Rovere">G. Querci Della Rovere</name>
<affiliation><nlm:affiliation>Breast Unit, Royal Marsden NHS Trust, Sutton, Surrey, UK. gquercidellarovere@doctors.org.uk</nlm:affiliation>
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<author><name sortKey="Ahmad, I" sort="Ahmad, I" uniqKey="Ahmad I" first="I" last="Ahmad">I. Ahmad</name>
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<author><name sortKey="Singh, P" sort="Singh, P" uniqKey="Singh P" first="P" last="Singh">P. Singh</name>
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<author><name sortKey="Ashley, S" sort="Ashley, S" uniqKey="Ashley S" first="S" last="Ashley">S. Ashley</name>
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<author><name sortKey="Daniels, I R" sort="Daniels, I R" uniqKey="Daniels I" first="I R" last="Daniels">I R Daniels</name>
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<author><name sortKey="Mortimer, P" sort="Mortimer, P" uniqKey="Mortimer P" first="P" last="Mortimer">P. Mortimer</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">An audit of the incidence of arm lymphoedema after prophylactic level I/II axillary dissection without division of the pectoralis minor muscle.</title>
<author><name sortKey="Querci Della Rovere, G" sort="Querci Della Rovere, G" uniqKey="Querci Della Rovere G" first="G" last="Querci Della Rovere">G. Querci Della Rovere</name>
<affiliation><nlm:affiliation>Breast Unit, Royal Marsden NHS Trust, Sutton, Surrey, UK. gquercidellarovere@doctors.org.uk</nlm:affiliation>
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<author><name sortKey="Singh, P" sort="Singh, P" uniqKey="Singh P" first="P" last="Singh">P. Singh</name>
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<author><name sortKey="Ashley, S" sort="Ashley, S" uniqKey="Ashley S" first="S" last="Ashley">S. Ashley</name>
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<author><name sortKey="Daniels, I R" sort="Daniels, I R" uniqKey="Daniels I" first="I R" last="Daniels">I R Daniels</name>
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<series><title level="j">Annals of the Royal College of Surgeons of England</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Axilla</term>
<term>Breast Neoplasms (surgery)</term>
<term>Cross-Sectional Studies</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Lymph Node Excision (methods)</term>
<term>Lymphatic Metastasis</term>
<term>Lymphedema (etiology)</term>
<term>Medical Audit</term>
<term>Middle Aged</term>
<term>Muscle, Skeletal</term>
<term>Postoperative Complications (etiology)</term>
<term>Retrospective Studies</term>
<term>Risk Factors</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lymphedema</term>
<term>Postoperative Complications</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Lymph Node Excision</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Breast Neoplasms</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Axilla</term>
<term>Cross-Sectional Studies</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Lymphatic Metastasis</term>
<term>Medical Audit</term>
<term>Middle Aged</term>
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<front><div type="abstract" xml:lang="en">Lymphoedema is reported to occur in approximately one in four women following curative treatment for breast cancer. Reported rates are almost exclusively for level 1,2,3 axillary clearance with few data for the current practice of level 1,2 dissections. Swelling can affect the whole upper limb but frequently will remain restricted to hand, forearm or upper arm. The aims of this study were to determine incidence after level 1,2 dissection, degree and site of swelling and risk factors which might determine such incidences. Results were available on 198 patients. The cumulative prevalence of lymphoedema after level 1,2 dissections was 14% in the arm, 12% in the forearm and 16% in the hand, assuming a circumference difference of more than 5% indicated lymphoedema. Moderate lymphoedema representing more than 10% circumference difference was found in 1% (arm), 3.5% (forearm) and 0.5% in the hand. Risk factors for lymphoedema were experience of the surgeon (upper arm only), dominant limb (forearm only) and right-sided cancer treatment (for hand only). When lymphoedema in any site was considered, right-sided treatment and nodal status were independently significant.</div>
</front>
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<Title>Annals of the Royal College of Surgeons of England</Title>
<ISOAbbreviation>Ann R Coll Surg Engl</ISOAbbreviation>
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<ArticleTitle>An audit of the incidence of arm lymphoedema after prophylactic level I/II axillary dissection without division of the pectoralis minor muscle.</ArticleTitle>
<Pagination><MedlinePgn>158-61</MedlinePgn>
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<Abstract><AbstractText Label="UNLABELLED">Lymphoedema is reported to occur in approximately one in four women following curative treatment for breast cancer. Reported rates are almost exclusively for level 1,2,3 axillary clearance with few data for the current practice of level 1,2 dissections. Swelling can affect the whole upper limb but frequently will remain restricted to hand, forearm or upper arm. The aims of this study were to determine incidence after level 1,2 dissection, degree and site of swelling and risk factors which might determine such incidences. Results were available on 198 patients. The cumulative prevalence of lymphoedema after level 1,2 dissections was 14% in the arm, 12% in the forearm and 16% in the hand, assuming a circumference difference of more than 5% indicated lymphoedema. Moderate lymphoedema representing more than 10% circumference difference was found in 1% (arm), 3.5% (forearm) and 0.5% in the hand. Risk factors for lymphoedema were experience of the surgeon (upper arm only), dominant limb (forearm only) and right-sided cancer treatment (for hand only). When lymphoedema in any site was considered, right-sided treatment and nodal status were independently significant.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">This study demonstrates that lymphoedema is a common complication following level 1,2 dissection. Whole limb volume is often considered the main outcome measure for detecting lymphoedema and determining success of treatment, yet swelling may be restricted to regions of the limb and site specific circumference measurements are therefore recommended. Pre- and postoperative circumference measurements are likely to be the most sensitive way of determining presence of lymphoedema following surgery for breast cancer.</AbstractText>
</Abstract>
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<AffiliationInfo><Affiliation>Breast Unit, Royal Marsden NHS Trust, Sutton, Surrey, UK. gquercidellarovere@doctors.org.uk</Affiliation>
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