Differences in Transient Fluid Retention and Lymphedema With Breast Cancer Treatment for Lymphatic Microsurgery

Author:

Tokumoto Hideki1,Akita Shinsuke2,Kosaka Kentaro2,Nakamura Rikiya3,Yamamoto Naohito3,Kubota Yoshitaka2,Mitsukawa Nobuyuki2

Affiliation:

1. Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital

2. Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Chiba University

3. Department of Breast Surgery, Chiba Cancer Center Hospital, Chiba, Japan.

Abstract

Background Breast cancer–related lymphedema (BCRL) is a common complication. Repeated taxane-based chemotherapy has been shown to induce endothelial inflammation, leading to fluid retention. Patients with transient fluid retention only have upper limb edema without lymphatic dysfunction. Therefore, indocyanine green lymphography revealed linear findings, and lymphatic microsurgery is not required. This study aimed to investigate the difference between BCRL and fluid retention and present the indication for lymphatic microsurgery for these patients. Methods The study population was divided into BCRL and fluid retention groups. Age, body mass index, laterality, surgery type (lymph node, breast, or no surgery), disease stage, regional lymph node irradiation, hormone therapy, chemotherapy type (taxane- or non–taxane-based group), and treatment with trastuzumab were compared. Results The BCRL and fluid retention groups consisted of 168 and 73 patients, respectively. The BCRL group had significantly higher rates of axillary lymph node dissection (96.4%) and lymph node irradiation (51.8%) than the fluid retention group (53.4% and 24.7%, respectively; P < 0.001 for both). The fluid retention group had a significantly higher rate of taxane-based chemotherapy (100%) than the BCRL group (92.9%; P = 0.02). No significant differences in other characteristics, including treatments with hormone and trastuzumab, were observed. Conclusions Lymphatic microsurgery should be performed after confirming the diagnosis by indocyanine green lymphography, particularly for patients with fluid retention induced by taxane-based chemotherapy. Because the generalized swelling induced by taxane-based chemotherapy is resolved 6 months after chemotherapy, we should wait at least 6 months to perform lymphatic microsurgery.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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1. Update August 2023;Lymphatic Research and Biology;2023-08-01

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