Risk factors of lymphedema on affected side of upper limb after breast cancer surgery --- report from a single center of China

Objective: Lymphedema on affected side of upper limb is one of the most common complications after breast cancer surgery. This paper intends to discuss the morbidity of limb lymphedema and analyzes related risk factors, in hope of providing some guidance for early prevention of such complication. Method: 2,597 female patients with breast cancer who received operations in our hospital from December 2011 to December 2015 were sampled. According to patients’ subjective feelings and Objective measurements, the morbidity of lymphedema on affected side of upper limb was evaluated. patients were asked if they discovered swelling on affected upper limb and whether they felt heavy or numb on the affected side of upper limb. If the answer was definite, it meant the existence of upper limb lymphedema. Objective measurements were made in combination with patients’ subjective feelings. Patients’ metacarpophalangeal joints, wrist joints and elbow joints were measured in about 20 cm, 15 cm, 10 cm and 5 cm above or below respectively. Then, all numerical values were added to determine the sum. Concerning patients’ subjective feelings, patients were asked to answer following questions in the form of questionnaire. They were asked if they discovered swelling on affected upper limb and whether they felt heavy or numb on the affected side of upper limb. If the answer was definite, it meant the existence of upper limb lymphedema. If the sum of the numerical values of the affected side was 5 cm higher than the opposite side, or any measured part was 2 cm longer than the opposite side, it would be defined as true lymphedema. Results: After operation, the morbidity of lymphedema on affected side of upper limb was 10.7%. It was significantly and positively correlated to surgical approaches, postoperative infection, degree of lymph node metastasis and extent of lymph node dissection, but irrelated to age of patients, BMI, tumor size, breast reconstruction and neoadjuvant chemotherapy. The degree of lymph node metastasis (OR=1.301, P=0.011), extent of lymph node dissection (OR=2.149, P=0.000) and postoperative upper limb infection (OR=52.475, P=0.000) were discovered to be independent risk factors of lymphedema on affected upper limb. Conclusions: For patients with breast cancer who were detected with metastasis of many lymph nodes, wide extent of lymph node dissection and postoperative infection on upper limb, the morbidity of postoperative upper limb lymphedema was higher, and surgical approaches significantly impacted the morbidity of such lymphedema.