Frequency and associated factors of axillary web syndrome in women who had undergone breast cancer surgery: a transversal and retrospective study

Abstract

BackgroundBreast cancer is the most common malignancy among women. Surgical treatment is an essential part of therapy, which still includes chemotherapy, radiotherapy and hormone therapy. The increase in early cancer detection and less aggressive treatment has made longer survival rates possible for women with this neoplasia. Morbidities after treatment have subsequently aroused particular interest in the scientific community in order to minimize their effects and provide increased quality-of-life for these patients. The present study aimed at investigating one of these morbidities: axillary web syndrome, which occurs after axillary surgical management.MethodsFrom December 2011 to September 2012, according to the inclusion and exclusion criteria, 97 patients, who had been surgically treated for breast cancer, were enrolled, interviewed, and submitted to a specific physical exam. An investigation of the axillary cords, characteristic of this syndrome, was performed in all patients.ResultsThe axillary web syndrome was diagnosed in 28.86% of the women. Higher risk of triggering the syndrome has been associated with younger age (21.7%), longer time between first treatment and data collection (29.3%), greater number of resected lymph nodes (149.7%) and surgical management medical teams (113.2%).ConclusionsOne can conclude that axillary web syndrome was associated with younger age, greater time elapsed since surgery, surgical management of medical staff and number of resected lymph nodes.Further studies are needed to review prior-to-surgery and post-operative follow-up, to properly assess the effects of surgery in the axilla on homeostatic balance, not only in the ipsilateral upper limb, but also assess their compensatory consequences throughout the body.

Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication

“…A third but smaller (n = 36) prospective cohort study showed a significant relationship between lower BMI and AWS in univariate analysis [6]. In contrast, a retrospective, descriptive design showed no significant association between AWS and BMI although the women with AWS had a lower mean BMI than those without (27.29 vs. 28.15); the authors commented that their failure to find a difference may have been due to the fact that the vast majority of women in their sample were overweight or obese [10].…”

“…Younger age has been shown also to be a risk factor for developing AWS (or cording) in 4 prospective cohort studies [6][7][8]10]. In that younger women with breast cancer typically have a lower BMI, it has been speculated that age and BMI are related in their risk contributions [7].…”

“…1) [13]. These fibrous bands can extend down through the antecubital fossa and further into the volar surface of the forearm and wrist [4,10]. Typically, AWS occurs within the first 8 weeks after axillary surgery with symptoms resolving within the first 12 weeks postoperatively [12].…”

Effect of physical activity levels on oncological breast surgery recovery: a prospective cohort study

“…In this study, we found an association between vigorous PA performance and risk of developing AWS. The authors who previously examined risk factors for developing AWS found no relationship between training level and increased risk of AWS 47 , 48 , with the exception of a case report that described AWS development after physical effort 49 . Moreover, among the risk factors for the development of AWS should be considered younger age, greater time elapsed since surgery and number of resected lymph nodes 50 , but PA was not considered.…”

Appropriateness of a physiotherapic treatment protocol for the axillary web syndrome, applied in a territorial rehabilitation service

“…Currently in Italy over 37,000 new cases are diagnosed per year (1), (2) 25% of which women below 50 years of age (3). Axillary surgical procedures have reported, along with post-operative morbidity of bleeding, infections, presence of lymphedema and shoulder pain, also the axillary fibrous banding syndrome, better known as axillary web syndrome (AWS), that normally appears between the first and the fifth week after surgery (5),(6) diagnosed on 28.86% of women (7), (8), its manifestation is mainly at the level of ipsilateral axillary region at surgical dissection, but it can also extend towards the elbow, throughout the antecubital space and, in the most serious cases, up to the column of the thumb ( 9),(10), causing upper limb functional deficits (11). The purpose of the description of this clinical case is to create an appropriate physiotherapic protocol to deal with patients having AWS in a rehabilitation ser-vice, through an active and passive manual therapy of the upper limb and cervico-dorsal segment (MAP) together with self-mobilization exercises to do at home (EA), both established the MAPEA protocol.…”