Do medical procedures in the arm increase the risk of lymphoedema after axillary surgery? A review

Abstract

Lymphoedema of the arm is a potentially serious consequence of any axillary procedure performed during the management of breast cancer. In an attempt to reduce its incidence and severity, patients are instructed to avoid venepunctures and blood pressure measurements on the treated arm. These precautions are not possible in some patients and attempts to adhere to them can cause discomfort, anxiety and stress for both patients and their health-care workers. The strength with which these recommendations are made is in contrast to the level of evidence underpinning them. This paper reviews this evidence regarding the safety, or lack thereof, of blood pressure monitoring and intravenous puncture in women who have had axillary surgery. With this evidence generally being anecdotal in nature, there appears to be no rigorous evidence-based support for the risk-reduction behaviours of avoiding blood pressure monitoring and venepuncture in the affected arm in the prevention of lymphoedema after axillary procedure. A clinical trial was proposed to investigate whether such avoidance measures were valuable, but failed during its inception. There remains a need for research from prospective trials on this controversial topic to determine the most appropriate patient recommendations that should be provided after axillary procedure regarding the risks for development of lymphoedema.

Near-Infrared Fluorescence Lymphatic Imaging to Reconsider Occlusion Pressure of Superficial Lymphatic Collectors in Upper Extremities of Healthy Volunteers

“…Modi et al’s study also included a group of lymphedematous patients; we have deliberately focused our study on healthy subjects. On the one hand, patients with an history of oncological surgery are at risk of developing secondary lymphedema (guidelines and literature mention that a latent lymphedema may be triggered by a blood pressure cuff procedure on the limb at risk 40 ); on the other hand, the impairment of the superficial lymphatic collectors makes them poorly visible, not visible or absent.…”

Effectiveness and Safety of Acupuncture Moxibustion Therapy Used in Breast Cancer‐Related Lymphedema: A Systematic Review and Meta‐Analysis

“…Study [3] shows that the 10-year cumulative incidence of BCRL is 41.1% in women that underwent ALND as part of the surgical treatment for breast cancer. Patients with BCRL suffer from weight gain, skin thickening, arm swelling, and reduced shoulder range of motion, resulting in restrictions on daily activities, as well as pain, anxiety, and depression [4]. BCRL is caused by the accumulation of lymph fluid in tissues due to surgery, radiotherapy, or other reasons that disturb the transport ability of the lymphatic system [5].…”

Restricted venous access after lymph node dissection: no evidence (voodoo)

“…Clark et al ., in 2005, produced the only prospective study to suggest an association between venepuncture and lymphoedema . Although this study suggested a relative risk of 2.4 with skin puncture, it has been widely criticized for not specifying the timing of the development of lymphoedema in relation to the skin puncture, thereby creating substantial uncertainty around the association . Further, they only recorded in‐hospital venepuncture in the days after surgery, which inaccurately reflects the real exposure.…”

“…Lymphoedema affects 21% of patients undergoing axillary lymphadenectomy and 5.6% of patients following sentinel lymph node biopsy, most commonly for breast cancer or melanoma. Sufferers are estimated to cost US$10 000 more per year in healthcare expenditure than patients without lymphoedema .…”

“…reviewed nine and both concluded that there is no robust evidence to support an increased risk of lymphoedema following ‘risky' behaviour. Likewise, Cheng et al ., in their review state ‘evidence from various sources suggests that neither blood pressure measurement nor skin puncture in the ipsilateral limb causes lymphoedema' . In 2008, the National Breast and Ovarian Cancer Centre analysed 39 studies which failed to find a causal relationship between BP measurements or skin puncture and the development of lymphoedema .…”