Hand surgery after axillary lymph node clearance for breast cancer: contra-indication to surgery?

Fulford, Dean; Dalal, Sam; Winstanley, John; Hayton, Mike

doi:10.1308/003588410x12699663904475

Cited by 12 publications

(7 citation statements)

References 10 publications

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“…In contrast, 70% of breast surgeons and 90% of breast care-nurses felt that elective hand surgery in these patients was contraindicated. Similarly, when asked about the use of compression tourniquets, 79% of hand surgeons reported that this usage was not contraindicated while only 57% of breast surgeons and 68% of breast care nurses advised against this use 25 . Similar findings were reported in another level 4 survey of Hand surgeons in the American Society of the Hand.…”

Section: Resultsmentioning

confidence: 99%

Preventative Measures for Lymphedema: Separating Fact from Fiction

Cemal

Pusic

Mehrara

2011

Journal of the American College of Surgeons

128

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Section: Resultsmentioning

confidence: 99%

Preventative Measures for Lymphedema: Separating Fact from Fiction

Cemal

Pusic

Mehrara

2011

Journal of the American College of Surgeons

128

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“…Increased risk of post-operative lymphedema or infections is the most cited explanation for avoiding upper limb surgery in this context. Concerning tourniquet use, 79 % of hand surgeons and 57 % of breast surgeons would use it, while 68 % of breast-care nurses did not recommend it [18]. Although lymphedema increased the risk of lymphedema 70-fold compared to no lymphedematous limb [19], no previous study and ours reported any post-surgical infectious complications.…”

Section: Discussionmentioning

confidence: 57%

Impact of carpal tunnel syndrome surgery on women with breast cancer-related lymphedema

Gunnoo¹,

Ebelin²,

Arrault³

et al. 2015

Breast Cancer Res Treat

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Carpal tunnel syndrome may occur in women with ipsilateral lymphedema after breast cancer treatment. Surgery on the lymphedematous arm is classically feared. Thirty-two consecutive women (mean age at cancer treatment 49 years, interquartile range (Q1;Q3) 43;56) with upper limb lymphedema after breast cancer treatment, followed in a single lymphology unit, and symptomatic carpal tunnel syndrome (electromyographically confirmed) requiring surgery were included. Lymphedema volume was calculated using the truncated cone formula, recorded before and after carpal tunnel syndrome surgery, and at each follow-up visit. Median time to lymphedema onset after cancer treatment was 19 (interquartile range (Q1;Q3) 5;73) months. Median lymphedema volume was 497 (Q1;Q3 355;793) mL before (median 4 months) and 582 (Q1;Q3 388;930) mL after carpal tunnel syndrome surgery (median 5 months) (P = 0.004). At the last follow-up post-carpal tunnel syndrome surgery (median 33 months), lymphedema volume was 447 (Q1;Q3 260;733) mL (non-significant, compared to pre-surgery volume). Regular lymphedema treatment included elastic sleeve (n = 31), low-stretch bandage (n = 20), and/or manual lymph drainage (n = 20), with no change before and after carpal tunnel syndrome surgery. All carpal tunnel syndrome clinical manifestations disappeared after surgery and none of the patients experienced local complications. Carpal tunnel syndrome may be treated surgically in women with ipsilateral upper limb lymphedema after breast cancer treatment. Although lymphedema volume increased transiently, it remained stable over long-term follow-up, with no local complications.

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“…6 A 2010 survey found that 41% of hand surgeons, 79% of breast care surgeons, and 89% of breast care nurses thought that ipsilateral hand surgery was contraindicated; the most common reason cited was increased risk of postoperative lymphedema. 7 Nevertheless, the authors also reported that 58% of hand surgeons would still operate on breast cancer patients post-ALND. 7 In the literature, there is no consensus on recommendations about hand surgery for patients post-ALND.…”

mentioning

confidence: 99%

Elective Hand Surgery After Axillary Lymph Node Dissection for Cancer

Lee¹,

LaPorte²,

Brooks³

et al. 2015

Orthopedics

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After axillary lymph node dissection (ALND), patients are cautioned against ipsilateral interventional procedures to avoid the theoretical increased risk of postoperative complications, particularly lymphedema. The authors' goal was to evaluate the complications of elective hand surgery after ALND. The authors reviewed patients presenting to their hand clinic from 1998 to 2011, selecting those with a diagnosis of breast cancer or melanoma and a history of previous ALND; the authors excluded those treated nonoperatively and those treated with elective surgery in the contralateral hand. Average age of the 22 patients meeting the criteria (20 with a history of breast cancer, 6 with preexisting lymphedema) was 53.9 years (range, 26.7 to 73.6 years) at the time of ALND and 63.1 years (range, 31.7 to 83.5 years) at the time of hand surgery. Average interval between surgeries was 9.2 years (range, 8 days to 37.3 years). Follow-up averaged 9.2 months (range, 8 days to 41.7 months). Fifteen patients were surveyed for long-term postoperative results (average surgery-to-survey interval, 4.3 years [range, 1 to 11.9 years]). Fifteen patients had uneventful postoperative recoveries, 4 had peri-incisional erythema requiring oral antibiotics, 1 had incisional pain and scarring, 1 had chronic wound-healing issues, and 1 had a dehiscence requiring a return to the operating room. In the 15 patients who completed the follow-up survey, there was no disease exacerbation in the 3 patients with preexisting lymphedema, and there were no new cases of lymphedema. Routine minor hand surgery did not result in lymphedema and did not increase existing lymphedema in these patients with previous ipsilateral ALND, but almost one-third of them had short-term complications in the postoperative recovery period.

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Hand surgery after axillary lymph node clearance for breast cancer: contra-indication to surgery?

Abstract: A review of the published literature does not support the notion that these patients experience increased complications; therefore, we recommend the advice given to breast cancer patients regarding ipsilateral surgery be re-evaluated.

Cited by 12 publications

References 10 publications

Preventative Measures for Lymphedema: Separating Fact from Fiction

Preventative Measures for Lymphedema: Separating Fact from Fiction

Impact of carpal tunnel syndrome surgery on women with breast cancer-related lymphedema

Elective Hand Surgery After Axillary Lymph Node Dissection for Cancer

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