Lymphedema Incidence After Axillary Lymph Node Dissection Quantifying the Impact of Radiation and the Lymphatic Microsurgical Preventive Healing Approach
Lymphedema Incidence After Axillary Lymph Node Dissection Quantifying the Impact of Radiation and the Lymphatic Microsurgical Preventive Healing Approach
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DOI：
10.1097/sap.0000000000001864
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发表时间：
2019-04-01
影响因子：
1.5
通讯作者：
Singhal, Dhruv
中科院分区：
文献类型：
--
作者：
Johnson, Anna Rose;Kimball, Sarah;Singhal, Dhruv
背景：腋窝手术和放射治疗是乳腺癌治疗的重要方面，与水肿的发展有关。研究表明，淋巴管显微外科预防性愈合方法（LYMPHA）可以大大降低高危人群中水肿的发生率。本研究的目的是总结相关的证据，水肿发病率腋窝淋巴结清扫术（ALND），区域淋巴结放射治疗（RLNR），和LYMPHA.Methods：我们进行了文献检索，以确定研究涉及乳腺癌患者接受ALND或不RLNR。我们的主要结果是水肿的发展。我们分析了LYMPHA对水肿发生率的影响。我们选择了DerSimonian和Laird随机效应荟萃分析模型，由于临床，方法学和统计学异质性的研究。结果：我们的搜索策略产生了1476篇文章。筛选后，纳入了19项研究。从3035例患者中提取数据，其中711例患有水肿。RLNR联合ALND治疗组的水肿发生率明显高于单用ALND组（P < 0.001）。接受ALND的患者中水肿的汇总累积发生率为14.1%，而接受LYMPHA和ALND的患者中为2.1%（P = 0.029）。合并累积发生率为33.4%，在那些接受ALND，RLNR，和LYMPHA（P = 0.004）ALND，RLNR，和10.3%。结论：腋窝淋巴结清扫和RLNR是重要的干预措施，以获得区域控制许多患者，但被发现构成了一个增加的风险发展的水肿。我们的研究结果支持LYMPHA，一种预防性手术技术，可以降低高危患者乳腺癌相关性水肿的风险。
Background: Axillary surgery and radiotherapy are important aspects of breast cancer treatment associated with development of lymphedema. Studies demonstrate that Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) may greatly reduce the incidence of lymphedema in high-risk groups. The objective of this study is to summarize the evidence relating lymphedema incidence to axillary lymph node dissection (ALND), regional lymph node radiation (RLNR) therapy, and LYMPHA.Methods: We performed a literature search to identify studies involving breast cancer patients undergoing ALND with or without RLNR. Our primary outcome was the development of lymphedema. We analyzed the effect of LYMPHA on lymphedema incidence. We chose the DerSimonian and Laird random-effects meta-analytic model owing to the clinical, methodological, and statistical heterogeneity of studies.Results: Our search strategy yielded 1476 articles. After screening, 19 studies were included. Data were extracted from 3035 patients, 711 of whom had lymphedema. The lymphedema rate was significantly higher when RLNR was administered with ALND compared with ALND alone (P < 0.001). The pooled cumulative incidence of lymphedema was 14.1% in patients undergoing ALND versus 2.1% in those undergoing LYMPHA and ALND (P = 0.029). The pooled cumulative incidence of lymphedema was 33.4% in those undergoing ALND and RLNR versus 10.3% in those undergoing ALND, RLNR, and LYMPHA (P = 0.004).Conclusion: Axillary lymph node dissection and RLNR are important interventions to obtain regional control for many patients but were found to constitute an increased risk of development of lymphedema. Our findings support that LYMPHA, a preventive surgical technique, may reduce the risk of breast cancer-related lymphedema in high-risk patients.