Elective Hand Surgery After Axillary Lymph Node Dissection for Cancer

Lee, R Jay; LaPorte, Dawn M.; Brooks, Jaysson T.; Schubert, Cornelius; Deune, E. Gene

doi:10.3928/01477447-20150504-52

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…Gunnoo et al 22 noted a transient worsening of lymphedema in the affected arm that rapidly disappeared in 32 patients who had carpal tunnel surgery to the ipsilateral arm following mastectomy. In a small study, Lee et al 23 also showed no problems with hand surgery on the ipsilateral arm following prior breast cancer surgery. Baltzer et al 24 performed a retrospective cohort study of 103 patients who underwent elective hand surgery on the arm ipsilateral to prior breast cancer surgery and showed that 3.8% of patients had lymphedema after hand surgery.…”

Section: Discussionmentioning

confidence: 95%

“…In a small study, Lee et al 23 also showed no problems with hand surgery on the ipsilateral arm following prior breast cancer surgery. Baltzer et al 24 performed a retrospective cohort study of 103 patients who underwent elective hand surgery on the arm ipsilateral to prior breast cancer surgery and showed that 3.8% of patients had lymphedema after hand surgery.…”

Section: Discussionmentioning

confidence: 99%

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Ipsilateral Intravenous Catheter Placement in Breast Cancer Surgery Patients

Naranjo¹,

Portner²,

Jakub³

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: There is a continued perception that intravenous line (IV) placement is contraindicated in the arm ipsilateral to prior breast cancer surgery to avoid breast cancer–related lymphedema (BCRL). The aim of this retrospective study was to determine the risk for development of BCRL in ipsilateral arm IV placement compared to contralateral arm IV placement to prior breast cancer surgery. METHODS: We performed a retrospective review, via our Integrated Clinical Systems and Epic Electronic Heath Record of IV placement for anesthesia and surgery in patients with a prior history of breast cancer surgery with or without axillary lymph node dissection. Complication rates were compared for IVs placed in the ipsilateral and contralateral arms. We identified 3724 patients undergoing 7896 IV placements between January 1, 2015, and May 5, 2018, with a prior history of breast cancer surgery via their index anesthesia and surgical procedures. RESULTS: The median time from breast cancer surgery to IV placement was 1.5 years (range, 1 day to 17.8 years). Of 2743 IVs placed in the arm contralateral to prior breast cancer surgery, 2 had a complication, corresponding to an incidence of 7.3 per 10,000 (95% confidence interval [CI], 0.9–26.3 per 10,000). Of 5153 IVs placed in the arm ipsilateral to prior breast cancer surgery, 2 IVs had a complication, for an incidence of 3.9 per 10,000 (95% CI, 0.5–14.0 per 10,000). The frequency of complications was not found to differ significantly between the groups (P = .91), and the 95% CI for the risk difference (ipsilateral minus contralateral) was −23 to +8 complications per 10,000. The complication rate is similar when only the first IV placed following breast cancer surgery is considered (overall 5.4 per 10,000 [95% CI, 0.7–19.4] per 10,000; contralateral 7.0 [95% CI, 0.2–39.0] per 10,000, ipsilateral 4.4 [95% CI, 0.1–24.2] per 10,000; P = 1.00; 95% CI for risk difference [ipsilateral minus contralateral], −41 to +22 per 10,000). CONCLUSIONS: We found very few complications in patients who had an IV placed for surgery following a previous breast cancer surgery and no complications in those patients with IV placement ipsilateral with axillary node dissection. Avoidance of IV placement in the arm ipsilateral to breast cancer surgery is not necessary.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Ipsilateral Intravenous Catheter Placement in Breast Cancer Surgery Patients

Naranjo¹,

Portner²,

Jakub³

et al. 2021

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

show abstract

“…Similar results were seen in further studies. A 2015 study by Lee et al completed a review of patients presenting to their hand clinic between 1998-2011 with previous breast cancer or melanoma with subsequent axillary node dissection [ 22 ]. Of the fifteen patients who were surveyed post-operatively (range 1 to 11.9 years following surgery), no new cases of lymphedema were found with no disease exacerbation in three patients with pre-operative lymphedema [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Elective Hand Surgery in Patients With History of Axillary Node Dissection: Risks and Patient Education

Awan¹,

Schwartz²,

Shifchik³

et al. 2022

Cureus

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Objective: To determine if patients with a prior history of axillary lymph node dissection (ALND) secondary to breast cancer surgery and other procedures are at an increased risk of postoperative complications including lymphedema and infection following elective upper extremity surgery. Furthermore, the study aimed to evaluate the extent of patient education regarding lymphedema as a possible complication of upper extremity surgery.Methods: A review of 312 patients presenting to the clinic with upper extremity pathologies was performed of which 15 patients had a history of surgeries secondary to breast cancer and 297 had no prior history of breast cancer. Nine out of 15 patients with prior breast procedures and 66 out of 297 patients with no such history underwent elective hand surgeries, with 22 out of the 75 patients having a history of ALND. Incidences of postoperative complications including lymphedema and infection were recorded. Afterward, a survey inquiring about patient education was conducted to assess whether the patients were educated regarding lymphedema and if so, when and from whom they received the counseling.Results: No patients with a prior history of ALND secondary to breast cancer or other surgeries developed a postoperative infection or onset of lymphedema, and no patients with preoperative lymphedema had any worsening of lymphedema or infection postoperatively. The survey conducted afterward revealed that 61% of the patients with a prior history of breast cancer-related procedures including lymph node dissection were never counseled regarding lymphedema as a possible complication of hand surgery. Furthermore, 75% of the survey participants wished they were given more information about possible causes and complications of, and ways to prevent or minimize the possibility of lymphedema developing postoperatively.Conclusion: Prior history of ALND did not make patients more susceptible to postoperative complications, thus a history of isolated ALND or breast cancer surgery including ALND should not preclude elective hand surgical procedures from being performed ipsilaterally. Additionally, improvements in the degree of patient counseling regarding postoperative complications following hand surgery are needed as increased patient education is shown to be associated with a lower rate of complications and faster recovery times.

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“…Hand surgery resulted in lymphedema in one case with a history of mastectomy 12 years ago [27]; however, 3 retrospective studies showed no significant change in limb volume following hand surgery in BC patients undergoing ALND or other treatments [11,15,22]. One prospective study reported that arthroplasty worsened BCRL [8].…”

Section: Hand Surgerymentioning

confidence: 99%

Medical Procedures Safety for Breast Cancer Survivors Considering Lymphedema: A Systematic Review

Sheikhi-Mobarakeh

Ramandi

Yarmohammadi

et al. 2021

Multidiscip Cancer Investig

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Introduction: Lymphedema is one of the most disturbing complications of breast cancer treatment and some routine medical procedures such as blood pressure (BP) monitoring or injections have been reported to be the major risk factors for lymphedema. This systematic review aimed to shed light on the safety of some medical procedures among breast cancer survivors with and without lymphedema. Methods: An electronic systematic search in Pubmed and Scopus was undertaken from 1 January 1992 to 12 May 2020 and all relevant studies were summarized in a table based on the PRISMA guideline. Results: Twenty-three articles were included from which 11 and 8 articles were prospective and retrospective original studies, respectively. The remaining 4 articles were case reports. BP measurement, injections, blood draw, and hand surgeries were the medical procedures of interest. Most of the included studies have reported that these medical procedures did not result in lymphedema initiation or worsening in breast cancer survivors; however, case reports of the harmful effects of these procedures were also included in this systematic search. Conclusions: Although recent well-designed prospective studies did not show any significant side effects from medical procedures in breast cancer survivors, concerns exist for both healthcare staff and patients. Additionally, it seems that there are specific aspects that have not been investigated properly in previous studies and should be considered in future studies.

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Elective Hand Surgery After Axillary Lymph Node Dissection for Cancer

Cited by 6 publications

References 12 publications

Ipsilateral Intravenous Catheter Placement in Breast Cancer Surgery Patients

Ipsilateral Intravenous Catheter Placement in Breast Cancer Surgery Patients

Elective Hand Surgery in Patients With History of Axillary Node Dissection: Risks and Patient Education

Medical Procedures Safety for Breast Cancer Survivors Considering Lymphedema: A Systematic Review

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