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Late Onset Upper Extremity Lymphedema Following Elective Hand Surgery in Breast Cancer Survivors
Heather L. Baltzer, MD; Jamison Harvey, BSc; Paige M. Fox, MD, PhD; Steven L. Moran, MD
Mayo Clinic, Rochester, MN

Purpose: The safety of elective hand surgery in breast cancer survivors is controversial due to concerns of developing de-novo upper extremity lymphedema. The purpose of this study was to evaluate the risk of developing lymphedema following elective hand surgery among patients that underwent ipsilateral axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), and/or radiation therapy (RT).

Method: A retrospective cohort of breast cancer patients treated with ALND, SLNB and/or RT was identified from 1997-2012. Patients with ipsilateral elective hand surgery following their breast cancer treatment were included if there was ?1 year of followup and no pre-existing lymphedema. The primary outcome was the development of medically documented lymphedema following hand surgery. Data pertaining to both hand surgery and breast cancer treatment were compared between patients with and without lymphedema. Dichotomous and continuous variables were compared with Fisher's exact and Student T-tests, respectively.

Results: The analysis included 103 patients, of which four (3.8%) had documented lymphedema following hand surgery. Lymphedema developed early and was self-limited. Patients with and without lymphedema were similar with regard to age and type of hand surgery. Tourniquet time was longer in the non-lymphedema group. The lymphedema group all received adjuvant chemotherapy and RT with either ALND or SLNB. Compared to the non-lymphedema group, the lymphedema group had a shorter interval between hand surgery and completion of breast cancer surgery (2.1 versus 6.2 years; p <0.05) and RT (2.0 versus 3.3 years; p =0.05).

Conclusions: Lymphedema is uncommon following elective hand surgery among breast cancer survivors and does not appear to be influence by tourniquet use. The combination of adjuvant therapies and axillary procedures and a short temporal relationship of these to the hand surgery may put these women at higher risk of developing lymphedema.

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