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1.
Rev. enferm. UERJ ; 28: e49435, jan.-dez. 2020.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1146262

ABSTRACT

Objetivo: identificar e mapear estratégias preconizadas para prevenção de linfedema em pacientes submetidas a esvaziamento axilar em tratamento do câncer de mama. Método: revisão de escopo realizada em agosto de 2019 considerando oito bases de dados e oito bases da literatura cinzenta. A amostra final foi composta por 13 artigos, selecionados de acordo com critérios de elegibilidade. Resultados: os estudos foram predominantemente randomizados, com nível de evidência 1a, e realizados na América do Norte. Medidas preventivas tradicionalmente utilizadas, como limitar exercícios com carga ou evitar punção venosa e aferição de pressão arterial, não se demonstraram efetivas em nenhum dos estudos encontrados. Foi evidenciado como medida preventiva o controle dos fatores de risco modificáveis associados ao linfedema: IMC elevado (> 25 kg/m2 ) e quimioterapia administrada no braço ipsilateral. Conclusões: não foram apresentadas evidências significativas para medidas cotidianamente preconizadas na prevenção do linfedema, e fatores de risco modificáveis se destacaram entre os riscos para seu desenvolvimento.


Objective: to identify and map strategies recommended for prevention of lymphedema in patients after axillary dissection during breast cancer treatment. Method: this scoping review was conducted in August 2019 across eight databases and eight gray literature data sources. The final sample comprised 13 journal articles that met eligibility criteria. Results: the studies, most of which were randomized, conducted in North America, and offered Level 1a evidence. None of the studies reviewed found traditionally employed preventive measures, such as limiting weight training or avoiding venipuncture and blood pressure measurements, to be effective. Evidence indicated that controlling modifiable lymphedema-related risk factors ­ namely high BMI (> 25 kg/m²) and chemotherapy administration in the ipsilateral arm ­ was a preventive measure. Conclusion: no significant evidence was reported for traditionally recommended preventive measures against lymphedema, and modifiable factors figured prominently among risk factors for lymphedema.


Objetivo: identificar y mapear las estrategias recomendadas para la prevención del linfedema en pacientes después de una disección axilar durante el tratamiento del cáncer de mama. Método: esta revisión de alcance se realizó en agosto de 2019 en ocho bases de datos y ocho fuentes de datos de literatura gris. La muestra final comprendió 13 artículos de revistas que cumplieron con los criterios de elegibilidad. Resultados: los estudios, la mayoría de los cuales fueron aleatorios, se realizaron en Norteamérica y ofrecieron evidencia de Nivel 1a. Ninguno de los estudios revisados encontró que las medidas preventivas empleadas tradicionalmente, como limitar el entrenamiento con pesas o evitar la punción venosa y las mediciones de la presión arterial, sean efectivas. La evidencia indicó que el control de los factores de riesgo relacionados con el linfedema modificables, a saber, un IMC alto (> 25 kg / m²) y la administración de quimioterapia en el brazo ipsilateral, era una medida preventiva. Conclusión: no se informó evidencia significativa de las medidas preventivas recomendadas tradicionalmente contra el linfedema, y los factores modificables figuraron de manera prominente entre los factores de riesgo para el linfedema.


Subject(s)
Humans , Female , Axilla , Breast Neoplasms/therapy , Lymph Node Excision/adverse effects , Lymphedema/prevention & control , Body Mass Index , Risk Factors , Control , Arterial Pressure
3.
Int. braz. j. urol ; 42(3): 431-437, tab
Article in English | LILACS | ID: lil-785717

ABSTRACT

ABSTRACT Introduction and Objective Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery. Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients. Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/pathology , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/pathology , Carcinoma, Transitional Cell/surgery , Carcinoma, Transitional Cell/pathology , Cystectomy/methods , Lymph Node Excision/methods , Pelvis , Postoperative Complications , Prognosis , Time Factors , Biopsy , Urinary Bladder Neoplasms/complications , Brazil , Carcinoma, Squamous Cell/complications , Carcinoma, Transitional Cell/complications , Adenocarcinoma/surgery , Adenocarcinoma/complications , Adenocarcinoma/pathology , Cystectomy/adverse effects , Retrospective Studies , Operative Time , Lymph Node Excision/adverse effects , Lymph Nodes/surgery , Middle Aged
4.
Rev. cuba. cir ; 55(2): 0-0, abr.-jun. 2016. ilus
Article in Spanish | LILACS | ID: lil-791495

ABSTRACT

El cáncer de pulmón es el tumor más frecuente del árbol respiratorio y el que origina mayor número de muertes. Uno de los objetivos más importantes en su manejo es la estadificación, de la cual, el análisis de los ganglios linfáticos del mediastino es de suma importancia para definir los pacientes que pueden recibir cirugía. Para el estudio ganglionar invasivo, la linfadenectomía transcervical ocupa un lugar importante cuando existe evidencia de afectación ganglionar de la zona superior como método diagnóstico y terapéutico inicial en pacientes que después de quimioterapia de inducción y re-estadificación reúnen las condiciones para resección. Se presenta este trabajo con el objetivo de mostrar a la comunidad quirúrgica, la linfadenectomía transcervical utilizada para el diagnóstico y tratamiento del carcinoma pulmonar de células no pequeñas en el Hospital Provincial Universitario Manuel Ascunce Domenech de Camagüey por el grupo de cirugía torácica(AU)


Lung cancer is the most common tumor of the respiratory tract and the one casing more deaths. One of the most important objectives in its treatment is stage characterization, for which analyzing mediastinal lymph nodes is paramount to define patients who can receive surgery. For the nodal invasive study, transcervical lymphadenectomy occupies an important place, when there is evidence of lymph node involvement in the upper area as an initial diagnostic and therapeutic method in patients who, after inducted chemotherapy and stage characterization, are candidates for resection. This work is presented with the aim to present to the surgical community the transcervical lymphadenectomy used by the group of thoracic surgery for diagnosis and treatment of non-small cell lung carcinoma at the Manuel Ascunce Domenech University Provincial Hospital of Camagüey(AU)


Subject(s)
Humans , Male , Female , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/therapy , Lung Neoplasms/mortality , Lymph Node Excision/adverse effects , Neoplasm Staging
5.
Article in English | WPRIM | ID: wpr-213438

ABSTRACT

OBJECTIVE: The aim of this paper was to demonstrate the techiniqes of single-port laparoscopic transperitoneal infrarenal paraaortic lymphadenectomy as part of surgical staging procedure in case of early ovarian cancer and high grade endometrial cancer. METHODS: After left upper traction of rectosigmoid, a peritoneal incision was made caudad to inferior mesenteric artery. Rectosigmoid was mobilized, and then the avascular space of the lateral rectal portion was found by using upward traction of rectosigmoid mesentery. Inframesenteric nodes were removed without injury to the ureter and the left common iliac nodes were easily removed due to the upward traction of the rectosigmoid. The superior hypogastric plexus was found overlying the aorta and sacral promontory, and presacral nodes were removed at subaortic area. Peritoneal traction suture to right abdomen was needed for right para-aortic lymphadenectomy. After right lower para-aortic node dissection, operator was situated between the patient's legs. After upper traction of the small bowel, left upper para-aortic nodes were removed. To prevent chylous ascites, we used hemolock or Ligasure application (ValleyLab Inc.) to upper part of infrarenal and aortocaval nodes. RESULTS: Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy was performed without serious perioperative complications. CONCLUSION: Even though the technique of single-port surgery is still a difficult operation, the quality of single-port laparoscopic transperitoneal infrarenal para-aortic node dissection is excellent, especially mean number of para-aortic nodes. In cases of staging procedures for ovary and endometrial cancer, single-port transperitoneal para-aortic lymphadenectomy is acceptable as an oncologic procedure.


Subject(s)
Endometrial Neoplasms/diagnosis , Female , Humans , Laparoscopy/adverse effects , Lymph Node Excision/adverse effects , Neoplasm Staging/adverse effects , Ovarian Neoplasms/diagnosis
6.
Article in English | WPRIM | ID: wpr-21466

ABSTRACT

OBJECTIVE: Lower extremity lymphedema adversely affects quality of life by causing discomfort, impaired mobility and increased risk of infection. The goal of this study is to investigate factors that influence the likelihood of lymphedema in patients with endometrial cancer who undergo adjuvant radiation with or without chemotherapy. METHODS: A retrospective chart review identified all stage I-III endometrial cancer patients who had a hysterectomy with or without complete staging lymphadenectomy and adjuvant radiation therapy between January 2006 and February 2013. Patients with new-onset lymphedema after treatment were identified. Logistic regression was used to find factors that influenced lymphedema risk. RESULTS: Of 212 patients who met inclusion criteria, 15 patients (7.1%) developed new-onset lymphedema. Lymphedema was associated with lymph-node dissection (odds ratio [OR], 5.6; 95% CI, 1.01 to 105.5; p=0.048) and with the presence of pathologically positive lymph nodes (OR, 4.1; 95% CI, 1.4 to 12.3; p=0.01). Multivariate logistic regression confirmed the association with lymph-node positivity (OR, 3.2; 95% CI, 1.0007 to 10.7; p=0.0499) when controlled for lymph-node dissection. Median time to lymphedema onset was 8 months (range, 1 to 58 months) with resolution or improvement in eight patients (53.3%) after a median of 10 months. CONCLUSION: Lymph-node positivity was associated with an increased risk of lymphedema in endometrial cancer patients who received adjuvant radiation. Future studies are needed to explore whether node-positive patients may benefit from early lymphedema-controlling interventions.


Subject(s)
Adult , Aged , Aged, 80 and over , Endometrial Neoplasms/radiotherapy , Female , Humans , Hysterectomy , Lymph Node Excision/adverse effects , Lymphatic Metastasis , Lymphedema/etiology , Middle Aged , Radiation Injuries/etiology , Radiotherapy, Adjuvant/adverse effects , Retrospective Studies , Risk Factors
7.
Yonsei Medical Journal ; : 1294-1297, 2016.
Article in English | WPRIM | ID: wpr-79759

ABSTRACT

East Asian surgeons generally report lower morbidity and mortality rates for gastrectomy with D2 lymphadenectomy than do surgeons in Western countries; however, the disparity remains unexplained. The aim of this article was to determine the feasibility and safety regarding cases in which East Asian surgeons perform such procedures in Caucasian patients (CPs). Twelve CPs underwent gastrectomy with lymphadenectomy for gastric cancer at Yonsei University Severance Hospital, Seoul, Korea between June 2011 and April 2014. Procedures performed included total gastrectomy (7 of 12, 58%), distal gastrectomy (4 of 12, 33%), and completion total gastrectomy (1 of 12, 8%). Nine patients (75%) underwent D2 lymphadenectomy, and D1+ lymphadenectomy was performed in three others (25%). In four patients (33%), combined resections were carried out. The median values of surgical parameters were as follows: operative time, 266.5 min (range, 120-586 min); estimated blood loss, 90 mL (range, 37-350 mL); retrieved lymph node count, 37.5 (range, 22-63); and postoperative hospital stay, 13.7 days (range, 5-63 days). No mortality was encountered, although two patients (17%) experienced complications (both Clavien-Dindo classification grade IIIa anastomotic leakages), which were successfully managed by conservative treatment. In the hands of East Asian surgeons, mortality and short-term morbidity appears to be acceptably low in CPs subjected to gastrectomy with lymphadenectomy for gastric cancer.


Subject(s)
Adult , Aged , European Continental Ancestry Group , Female , Gastrectomy/adverse effects , Humans , Length of Stay , Lymph Node Excision/adverse effects , Male , Middle Aged , Operative Time , Patients , Pilot Projects , Republic of Korea , Safety , Stomach Neoplasms/pathology , Surgeons
8.
Article in English | WPRIM | ID: wpr-138801

ABSTRACT

OBJECTIVE: To evaluate risk factors for massive lymphatic ascites after laparoscopic retroperitoneal lymphadenectomy in gynecologic cancer and the feasibility of treatments using intranodal lymphangiography (INLAG) with glue embolization. METHODS: A retrospective analysis of 234 patients with gynecologic cancer who received laparoscopic retroperitonal lymphadenectomy between April 2006 and November 2015 was done. In June 2014, INLAG with glue embolization was initiated to manage massive lymphatic ascites. All possible clinicopathologic factors related to massive lymphatic ascites were determined in the pre-INLAG group (n=163). Clinical courses between pre-INLAG group and post-INLAG group (n=71) were compared. RESULTS: In the pre-INLAG group (n=163), four patients (2.5%) developed massive lymphatic ascites postoperatively. Postoperative lymphatic ascites was associated with liver cirrhosis (three cirrhotic patients, p<0.001). In the post-INLAG group, one patient with massive lymphatic ascites had a congestive heart failure and first received INLAG with glue embolization. She had pelvic drain removed within 7 days after INLAG. The mean duration of pelvic drain and hospital stay decreased after the introduction of INLAG (13.2 days vs. 10.9 days, p=0.001; 15.2 days vs. 12.6 days, p=0.001). There was no evidence of recurrence after this procedure. CONCLUSION: Underlying medical conditions related to the reduced effective circulating volume, such as liver cirrhosis and heart failure, may be associated with massive lymphatic ascites after retroperitoneal lymphadenectomy. INLAG with glue embolization can be an alternative treatment options to treat leaking lymphatic channels in patients with massive lymphatic leakage.


Subject(s)
Adult , Aged , Ascites/etiology , Embolization, Therapeutic/methods , Female , Genital Neoplasms, Female/surgery , Humans , Lymph Node Excision/adverse effects , Lymphography , Middle Aged , Postoperative Complications/etiology , Retrospective Studies
9.
Article in English | WPRIM | ID: wpr-138800

ABSTRACT

OBJECTIVE: To evaluate risk factors for massive lymphatic ascites after laparoscopic retroperitoneal lymphadenectomy in gynecologic cancer and the feasibility of treatments using intranodal lymphangiography (INLAG) with glue embolization. METHODS: A retrospective analysis of 234 patients with gynecologic cancer who received laparoscopic retroperitonal lymphadenectomy between April 2006 and November 2015 was done. In June 2014, INLAG with glue embolization was initiated to manage massive lymphatic ascites. All possible clinicopathologic factors related to massive lymphatic ascites were determined in the pre-INLAG group (n=163). Clinical courses between pre-INLAG group and post-INLAG group (n=71) were compared. RESULTS: In the pre-INLAG group (n=163), four patients (2.5%) developed massive lymphatic ascites postoperatively. Postoperative lymphatic ascites was associated with liver cirrhosis (three cirrhotic patients, p<0.001). In the post-INLAG group, one patient with massive lymphatic ascites had a congestive heart failure and first received INLAG with glue embolization. She had pelvic drain removed within 7 days after INLAG. The mean duration of pelvic drain and hospital stay decreased after the introduction of INLAG (13.2 days vs. 10.9 days, p=0.001; 15.2 days vs. 12.6 days, p=0.001). There was no evidence of recurrence after this procedure. CONCLUSION: Underlying medical conditions related to the reduced effective circulating volume, such as liver cirrhosis and heart failure, may be associated with massive lymphatic ascites after retroperitoneal lymphadenectomy. INLAG with glue embolization can be an alternative treatment options to treat leaking lymphatic channels in patients with massive lymphatic leakage.


Subject(s)
Adult , Aged , Ascites/etiology , Embolization, Therapeutic/methods , Female , Genital Neoplasms, Female/surgery , Humans , Lymph Node Excision/adverse effects , Lymphography , Middle Aged , Postoperative Complications/etiology , Retrospective Studies
10.
Int. braz. j. urol ; 41(6): 1209-1219, Nov.-Dec. 2015. tab, graf
Article in English | LILACS | ID: lil-769754

ABSTRACT

Objective: Extended pelvic lymph nodes dissection (EPLND) allows the removal of a higher number of lymph nodes than limited PLND. The aims of this study were to describe our robot-assisted EPLND (RAEPLND) technique with related complications, and to report the number of lymph nodes removed and the rate of lymph nodal metastasis. Materials and Methods: 153 patients underwent RAEPLND prior to robot-assisted radical prostatectomy (RARP). Indications were defined according to Briganti nomogram, to predict risk of lymph-nodal metastasis. Lymphatic packages covering the distal tract of the common iliac artery, the medial portion of the external iliac artery, the external iliac vein and the internal iliac vessels, together with the obturator and the presacral lymphatic packages were removed on both sides. Results: Median preoperative PSA was 7.5 ng/mL (IQR 5.5–11.5). Median operative time was 150 min (135–170). Median RAEPLND alone operative time was 38 min (32.75–41.25); for right and left side, 18 (15–29) and 20 min (15.75–30) (p=0.567). Median number of lymph nodes retrieved per patient was 25 (19.25–30); 13 (11–16) and 11 (8–15) for right and left side. In 19 patients (12.41%) metastasis was found at the level of pelvic lymph nodes. Median number of positive lymph nodes was 1 (1–4.6) per patient. Complications occurred in 11 patients (7.3%). Conclusions: the number of lymph nodes removed was comparable to published data about open series, allowing the increase of detection rate of lymph nodal metastasis for minimally invasive approach without compromising complications' rate if performing the procedure following reported technique.


Subject(s)
Aged , Humans , Male , Middle Aged , Lymph Node Excision/methods , Prostatectomy/methods , Prostatic Neoplasms/surgery , Robotic Surgical Procedures/methods , Iliac Artery/surgery , Lymphatic Metastasis , Lymph Node Excision/adverse effects , Lymph Nodes/pathology , Medical Illustration , Operative Time , Pelvis , Postoperative Complications , Prognosis , Prostate-Specific Antigen/blood , Prostatectomy/adverse effects , Prostatic Neoplasms/pathology , Risk Factors , Robotic Surgical Procedures/adverse effects
11.
Int. braz. j. urol ; 41(3): 486-495, May-June 2015. tab, ilus
Article in English | LILACS | ID: lil-755865

ABSTRACT

ABSTRACTPurpose:

In patients with penile cancer (PeCa) and increased risk of inguinal lymphatic dissemination, inguinal lymphadenectomy offers a direct histological staging as the most reliable tool for assessment of the nodal metastasic status and a definitive oncologic treatment simultaneously. However, peri- and/or postoperative mutilating sequalae often occurn. We report on clinical outcome and complications of a limited inguinal lymph node (LN) dissection.

Materials and Methods:

Clinical and histopathological data of all patients with PeCa who underwent limited inguinal lymphadenectomy (LIL) at our institution between 1986 and 2012 were comprehensively analyzed. Perioperative results were presented in relation to one-sided procedures, if appropriate, which were assessed without cross comparison with contralateral LILs.

Results:

29 consecutive patients with PeCa aged 60±10.3 years were included in the current study with 57 one-sided LIL performed. Mean operative time for one-sided LIL was 89.0±37.3 minutes with 8.1±3.7 LNs removed. A complication rate of 54.4% (n=31), including 16 minor and 15 major complications was found in a total of 57 procedures with leg oedema being the most prevalent morbidity (15.8%). 4 patients with clinically positive LNs developed inguinal lymphatic recurrence within 9 months after surgery.

Conclusions:

Our technique of limited inguinal LN dissection provided an acceptable complication rate without aggravating morbidity. We experienced no recurrences in clinically LN negative patients, so that the approach might be a reasonable option in this scenario. In patients with enlarged LNs, radical inguinal lymphadenectomy still appears to represent the gold standard.

.


Subject(s)
Adult , Aged , Humans , Male , Middle Aged , Carcinoma, Squamous Cell/surgery , Lymph Node Excision/methods , Penile Neoplasms/surgery , Carcinoma, Squamous Cell/pathology , Feasibility Studies , Inguinal Canal/surgery , Lymph Node Excision/adverse effects , Lymphatic Metastasis/pathology , Neoplasm Grading , Operative Time , Perioperative Period , Postoperative Complications , Penile Neoplasms/pathology , Retrospective Studies , Risk Assessment , Time Factors , Treatment Outcome , Tumor Burden
12.
Rio de Janeiro; s.n; 20150000. 88 p. graf, ilus, tab.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1025865

ABSTRACT

Complicações no membro superior encontram-se entre as principais repercussões após a cirurgia do câncer de mama e remoção dos linfonodos axilares, sendo a Síndrome da Rede Axilar (SRA) uma condição comumente observada no pós-operatorio imediato, e que consiste no surgimento de um cordoamento tenso e doloroso, oriundo da região axilar, que gera restrição de movimento no braço homolateral à cirurgia, e é decorrente do processo de cicatrização, que por sua vez é fundamental para o sucesso da cirurgia. A SRA pode causar incapacidade funcional no membro superior, especialmente por estar associada à restrição da amplitude de movimento do ombro e à dor, sendo o comprometimento da função do ombro mais um fator limitante nas atividades da vida diária (AVDs), de higiene pessoal, e na sua autonomia, o que repercute também no estado emocional da mulher. Apesar de ser descrita como uma síndrome autolimitada, com remissão espontânea em até 3 meses de seu surgimento, estudos mostram que, em alguns casos, ela pode estender-se além desse prazo, ou mesmo sofrer recidiva e piorar a incapacidade. Um agravante é o fato de ser uma questão subvalorizada na prática clínica, e por não haver orientação formal às pacientes sobre o risco de surgimento da síndrome, o tratamento costuma ser realizado tardiamente, o que pode prolongar o comprometimento funcional. A intervenção fisioterapêutica tem sido utilizada no pré e pós-operatório das cirurgias de mama para evitar as limitações físico-funcionais decorrentes da cirurgia, porém, o seu uso na SRA não está bem consolidada na literatura, bem como as estratégias educacionais sobre a síndrome ainda não fazem parte da rotina das orientações fisioterapêuticas pós-operatórias, de forma que as pacientes desconhecem os sinais, sintomas e características da SRA. Desta forma, os objetivos do presente trabalho foram: caracterizar o perfil sóciodemográfico e de saúde das mulheres submetidas ao tratamento cirúrgico para câncer de mama em um Hospital Universitário; relatar o efeito da intervenção fisioterapêutica precoce póscirúrgica para câncer de mama devido à SRA a partir do estudo de caso; elaborar um Plano de cuidados fisioterapêuticos de rotina no referido hospital e elaborar material educacional em forma de cartilha informativa para as pacientes em pós-cirúrgico de câncer de mama


Among the main repercussions after surgery for breast cancer and removal of axillary lymph nodes are complications in the arm. The healing process is critical to the success of the surgery, but may result in Axillary Web Syndrome (AWS) a commonly observed condition in the immediate post-operative, and that is the emergence of a tense and painful stranding, arising from the axillary region, generating restriction of movement in the ipsilateral arm surgery. AWS can cause functional impairment in the upper limb, especially to be associated with the restriction of shoulder range of motion and pain, and impairment of shoulder function more a limiting factor in activities of daily living (ADLs), personal hygiene, and their autonomy, which also affects the emotional state of women. Despite being described as a self-limited syndrome with spontaneous remission within 3 months of its inception, studies show that in some cases it may extend beyond that period, or even suffer relapse and worsen disability. An aggravating factor is the fact that it is a matter undervalued in clinical practice, and there is no formal guidance to patients about the risk of developing the syndrome, treatment is usually performed later, which can prolong the functional impairment. The physical therapy intervention has been used before and after surgery of breast surgery to avoid the physical and functional limitations resulting from surgery, however, its use in AWS is not well established in the literature, as well as educational strategies on the syndrome yet not part of the routine of postoperative physical therapy guidelines, so that the patients are unaware of the signs, symptoms and characteristics of AWS. Thus, the objectives of this study were to characterize the socio-demographic and health profiles of women undergoing surgery for breast cancer in a university hospital; report the effect of postoperative early physical therapy intervention for breast cancer due to AWS; develop a routine physical therapy care plan in that hospital and prepare an information booklet to patients in post-surgical breast cancer


Subject(s)
Humans , Female , Postoperative Complications/therapy , Breast Neoplasms/complications , Educational Technology , Lymph Node Excision/adverse effects , Patient Care Planning , Physical Therapy Specialty , Upper Extremity/pathology , Health Communication
13.
Article in English | WPRIM | ID: wpr-55730

ABSTRACT

OBJECTIVE: A number of new techniques have been developed to prevent lymphocele formation after pelvic lymphadenectomy in gynecologic cancers. We assessed whether the electrothermal bipolar vessel sealing device (EBVSD) could decrease the incidence of postoperative lymphocele secondary to pelvic lymphadenectomy. METHODS: A total of 321 patients with gynecologic cancer underwent pelvic lymphadenectomy from 2005 to 2011. Pelvic lymphadenectomy without EBVSD was performed in 134 patients, and pelvic lymphadenectomy with EBVSD was performed in 187 patients. We retrospectively compared the incidence of lymphocele and symptoms between both groups. RESULTS: Four to 8 weeks after operation, 108 cases of lymphocele (34%) were detected by computed tomography scan examination. The incidence of lymphocele after pelvic lymphadenectomy was 56% (75/134) in the tie ligation group, and 18% (33/187) in the EBVSD group. We found a statistically significant difference in the incidence of lymphocele between both groups (p<0.01). To detect the independent risk factor for lymphocele development, we performed multivariate analysis with logistic regression for three variables (device, number of dissected lymph nodes, and operation time). Among these variables, we found a significant difference (p<0.001) for only one device. CONCLUSION: Use of the EBVSD during gynecological cancer operation is useful for preventing the development of lymphocele secondary to pelvic lymphadenectomy.


Subject(s)
Adult , Electrocoagulation/instrumentation , Female , Genital Neoplasms, Female/pathology , Humans , Lymph Node Excision/adverse effects , Lymphatic Metastasis , Lymphocele/etiology , Middle Aged , Neoplasm Staging , Pelvis , Retrospective Studies , Risk Factors
14.
Rev. chil. cir ; 65(5): 409-414, set. 2013. tab
Article in Spanish | LILACS | ID: lil-688446

ABSTRACT

Introduction: axillary lymph node dissection (ALND) is still a usual procedure in the treatment of breast cancer. A drain is normally placed in the surgical bed and maintained several days until obtaining a daily discharge of 30-50 ml, in order to reduce the appearance of seroma. The aim of this study was to analyze possible factors associated with an increased drainage volume. Patients and Methods: a retrospective study of all the patients undergoing ALND for breasts cancer at our institution between 2011 and 2012 was performed. Results: 40 females were included. There were no complications or mortality. Median hospital stay was 2 days. Median day of drainage removal was the 5th postoperative day. Mean total drainage volume was 298.9 +/- 240.1 ml. High blood pressure associated with an increased drainage volume (550 ml vs 217.5 ml; p = 0.001) and a later removal (8th vs 4th day; p = 0.002). Similar happened with age > 65 years (420.8 ml vs 24.6 ml; p = 0.003) and (7th vs 5th day; p = 0.009). The number of metastatic lymph nodes showed a direct correlation with total drainage volume (Pearson 0.503; p = 0.017) and removal day (Spearman 0.563; p = 0.006), similar to the primary tumour size: total drainage volume (Pearson 0.447; p = 0.042) and removal day (Spearman 0.556; p = 0.009). Conclusion: age over 65 years, high blood pressure, number of metastatic lymph nodes and primary tumour size associated with a higher drainage volume and time to remove the drain.


Introducción: la linfadenectomía axilar (LA) sigue siendo un procedimiento frecuente en el tratamiento del cáncer de mama. Habitualmente se coloca un drenaje en el hueco axilar, que se mantiene varios días, hasta que tiene un débito diario de 30-50 ml, con el fin de reducir la aparición de seroma. El objetivo del presente estudio es analizar posibles factores asociados a un mayor volumen de drenaje. Pacientes y Métodos: realizamos un estudio retrospectivo de todas las pacientes intervenidas de LA por cáncer de mama en nuestro centro durante los años 2011 y 2012. Resultados: incluimos 40 mujeres en el estudio. No hubo complicaciones ni mortalidad. La mediana de estancia hospitalaria fue de 2 días. El día mediano de retirada de drenaje fue el 5° postoperatorio. El volumen medio total del drenaje fue 298,9 +/- 240,1 ml. La hipertensión arterial se asocia a un mayor volumen de drenaje (550 ml vs 217,5 ml; p = 0,001) y a una retirada más tardía del mismo (8° día vs 4° día; p = 0,002). Al igual ocurre con la edad > 65 años (420,8 ml vs 24,6 ml; p = 0,003) y (7° vs 5° día; p = 0,009). El número de ganglios metastásicos también se correlaciona con el volumen total de drenaje (coeficiente de correlación de Pearson 0,503; p = 0,017) y con el día de retirada (Spearman 0,563; p = 0,006), lo mismo que el tamaño del tumor primario: volumen total de drenaje (Pearson 0,447; p = 0,042) y día de retirada (Spearman 0,556; p = 0,009). Conclusión: la edad mayor de 65 años, la hipertensión arterial, el número de ganglios metastásicos y el tamaño del tumor primario se asocian con mayor volumen por el drenaje axilar y días necesarios hasta la retirada.


Subject(s)
Humans , Female , Adult , Middle Aged , Drainage , Lymph Node Excision/adverse effects , Lymph Node Excision/methods , Breast Neoplasms/surgery , Axilla , Postoperative Complications/prevention & control , Hypertension/complications , Mastectomy , Multivariate Analysis , Retrospective Studies , Risk Factors , Seroma/etiology , Seroma/prevention & control
15.
Rev. bras. ginecol. obstet ; 35(4): 171-177, abr. 2013. tab
Article in Portuguese | LILACS | ID: lil-676299

ABSTRACT

OBJETIVO: Avaliar as alterações do sistema venoso axilo-subclávio e do sistema linfático em mulheres com linfedema após linfadenectomia axilar para o tratamento do câncer de mama. MÉTODOS: Trata-se de um estudo de série de casos, envolvendo 11 mulheres com linfedema unilateral de membro superior após linfadenectomia axilar para o tratamento do câncer de mama. O estudo foi realizado em hospital universitário do Brasil Central no período compreendido entre os meses de março de 2010 e março de 2011. Avaliou-se a presença de alterações venosas nas veias subclávia e axilar, por meio do exame de ultrassonografia com dopplervelocimetria, e de alterações linfáticas, pela linfocintilografia, em ambos os membros superiores. O teste Exato de Fisher foi utilizado na comparação entre os membros. RESULTADOS: No membro superior com linfedema, detectou-se diferença significativa na veia subclávia, em relação ao membro contralateral, quanto ao volume do fluxo (p<0,001), sendo que 54,6% das mulheres apresentaram fluxo aumentado. Já, na veia axilar, 45,4% apresentaram fluxo aumentado e 45,4% reduzido, com diferença significante (p<0,01) na comparação entre os membros. Também foram observadas alterações linfáticas significativas (p<0,05), em relação ao membro contralateral, representadas pelo trajeto do vaso (não visibilizado), número de vasos linfáticos (nenhum), linfonodos axilares (ausentes) e refluxo dérmico (presente). No membro superior contralateral sem linfedema, não foram encontradas alterações venosas ou linfáticas. CONCLUSÃO: As mulheres submetidas à linfadenectomia axilar para o tratamento do câncer de mama apresentam tanto alterações venosas quanto linfáticas no membro superior com linfedema.


PURPOSE: To evaluate changes in the venous axillary-subclavian and lymphatic systems of women with lymphedema after axillary lymphadenectomy for breast cancer treatment. METHODS: This was a case series involving 11 women with unilateral upper limb lymphedema after axillary lymphedenectomy for the treatment of breast cancer. The study was carried out in the Mastology Program of the Clinical Hospital of the Federal University of Goiás, Goiânia, GO, during the period between March 2010 and March 2011. Doppler velocimetry ultrasonography was used to detect the presence of venous changes in the subclavian and axillary veins. Lymphatic changes were evaluated by lymphoscintigraphy in both upper limbs. Fisher's exact test was used for the comparison between limbs. RESULTS: Subclavian vein flow volume in the upper limb with lymphedema was significantly different from that in the contralateral limb (p<0.001), 54.6% of the women had increased flow. In the axillary vein, 45.4% had increased flow and 45.4% had decreased flow, with a statistically significant difference (p<0.01) between limbs. Compared to the contralateral limb, significant lymphatic changes (p<0.05) were also found in the vessel route (not visualized), number of lymphatic vessels (none), axillary lymph nodes (absent) and dermal reflux (present). In the contralateral upper limb without lymphedema, no venous or lymphatic alterations were encountered. CONCLUSION: The women subjected to axillary lymphadenectomy for the treatment of breast cancer presented both venous and lymphatic changes in the upper limb with lymphedema.


Subject(s)
Adult , Female , Humans , Middle Aged , Axillary Vein/pathology , Breast Neoplasms/surgery , Lymph Node Excision/adverse effects , Lymphedema/etiology , Lymphoid Tissue/pathology , Subclavian Vein/pathology , Axilla , Lymph Node Excision/methods
16.
Rev. bras. ginecol. obstet ; 31(7): 361-366, jul. 2009. tab
Article in Portuguese | LILACS | ID: lil-528524

ABSTRACT

OBJETIVO: identificar a alteração de sensibilidade no trajeto do nervo intercostobraquial utilizando um estesiômetro e observar a repetição das medições efetuadas com esse aparelho. MÉTODOS: foi aplicado o estesiômetro de Semmes-Weinstein para a avaliação da sensibilidade no trajeto do nervo intercostobraquial. Participaram desse estudo 94 mulheres divididas em dois grupos: Grupo CA, composto por 47 mulheres submetidas à linfonodenectomia axilar por câncer de mama, e grupo comparativo, composto por 47 mulheres sem câncer de mama e que não foram submetidas a qualquer tipo de cirurgia nas axilas. Em cada participante, foram realizadas anamnese e aplicação do estesiômetro duas vezes consecutivas. As respostas ao teste com estesiômetro do Grupo Controle foram utilizadas como valores de referência de normalidade. RESULTADOS: a prevalência de alteração de sensibilidade, no Grupo CA, foi de 85,1 por cento, com base nas repostas do Grupo Controle. Foi confirmada a repetição na aplicação do estesiômetro no Grupo CA por meio do teste de Kappa (p=0,8). CONCLUSÕES: na amostra desse estudo, as alterações de sensibilidade tiveram alta prevalência; as avaliações efetuadas com o uso do estesiômetro apresentaram repetição e, por isto, considerou-se o equipamento confiável para avaliação da sensibilidade no trajeto do nervo intercostobraquial.


PURPOSE: to identify sensitivity alteration in the intercostal brachial nerve pathway using an extensiometer, and to observe the measurement reproducibility of the apparatus. METHODS: the Semmes-Weinstein extensiometer was used to evaluate the sensitivity along the intercostal brachial nerve pathway. Ninety-four women have participated in the study, divided into two groups: a CA Group composed of 47 women submitted to breast cancer axillary lymphadenectomy, and a comparative group composed of 47 women without breast cancer, who had not been submitted to any kind of axillary surgery. Each participant underwent anamnesis and two consecutive applications of the extensiometer. The Control Group responses to the extensiometer test were used as normality reference values. RESULTS: based on Control Group responses, the prevalence of sensitivity changes was 85.1 percent in the CA Group. Reproducibility of the extensiometer application was confirmed in the CA Group through the Kappa's test (p=0.8). CONCLUSIONS: in this studied sample, sensitivity alterations had high prevalence; evaluations made with the extensiometer were reproducible, and thus we consider the equipment reliable to evaluate sensitivity along the intercostal brachial nerve pathway.


Subject(s)
Female , Humans , Middle Aged , Arm/innervation , Breast Neoplasms/surgery , Lymph Node Excision/adverse effects , Mononeuropathies/diagnosis , Touch , Axilla , Case-Control Studies , Cross-Sectional Studies
17.
Rev. bras. cancerol ; 55(2): 115-120, abr.-jun. 2009. ilus
Article in Portuguese | LILACS | ID: lil-646691

ABSTRACT

A escápula alada é uma entre as várias complicações decorrentes do tratamento cirúrgico, com excisão total ou parcial da mama associada ao esvaziamento axilar (linfadenectomia axilar). Esse esvaziamento quase sempre está presente, já que consiste em ser uma área de importante propagação metastática. Durante o ato cirúrgico, podem ocorrer lesões parciais (neuropraxia) ou lesões totais (neurotmese) do nervo torácico longo, levando ao quadro de escápula alada. Apesar de ser pouco descrita na literatura, variando de 1,5 por cento a 12,6 por cento, é bastante frequente na prática diária do serviço de fisioterapia. Danos nesse nervo resultam numa desestabilização de toda estrutura escapuloumeral, podendo trazer como consequências: alterações posturais, diminuição da amplitude de movimento no ombro ipsilateral e quadros álgicos na articulação, assim como na região periescapular. Este trabalho visa a fazer uma revisão na literatura, a fim de propor um protocolo de atendimento fisioterápico precoce para as portadoras de escápula alada, no intuito de minimizar ou prevenir complicações, fornecendo, dessa forma, melhor qualidade de vida para as pacientes.


Subject(s)
Humans , Female , Adult , Middle Aged , Clinical Protocols , Lymph Node Excision/adverse effects , Muscular Atrophy , Breast Neoplasms/surgery , Breast Neoplasms/complications , Physical Therapy Modalities , Quality of Life , Scapula
18.
Int. braz. j. urol ; 35(2): 164-170, Mar.-Apr. 2009. tab
Article in English | LILACS | ID: lil-516958

ABSTRACT

PURPOSE: To evaluate the treatment of symptomatic pelvic lymphoceles (SPL) after performing radical retropubic prostatectomy (RRP) and pelvic lymphadenectomy (PLA) simultaneously. MATERIAL AND METHODS:We analyzed, in a retrospective study, 250 patients who underwent RRP with PLA simultaneously. Only patients with SPL were treated using different non- and invasive procedures such as percutaneous aspiration, percutaneous catheter drainage (PCD) with or without sclerotherapy, laparoscopic lymphocelectomy (LL) and open marsupialization (OM). RESULTS: Fifty-two patients (21 percent) had postoperative subclinical pelvic lymphoceles. Thirty patients (12 percent) developed SPL. Fifteen patients with noninfected uniloculated lymphocele (NUL) healed spontaneously after performing PCD. The remaining seven patients required sclerotherapy with additional doxycycline. After performing PCD, NUL healed better and faster than noninfected multiloculated lymphocele (NML) (success rate: 80 percent vs. 16 percent, respectively). Twenty-seven percent of patients treated initially with PCD, with or without sclerotherapy had persistent lymphocele. All patients were successfully treated with LL. Only one patient had an abscess as a major complication of a persistent SPL after PCD and sclerotherapy and was treated via an open laparotomy. CONCLUSIONS: Symptomatic NUL can be treated using PCD with or without sclerotherapy. If this therapy fails as first-line treatment, laparoscopic lymphocelectomy should be considered within a short period of time in order to achieve successful treatment. NML should be treated using a laparoscopic approach in centers where this type of expertise is available. Infected lymphoceles are drained externally. In these cases, percutaneous or open external drainage with adequate antibiotic coverage is preferable.


Subject(s)
Humans , Male , Drainage/methods , Lymph Node Excision/adverse effects , Lymphocele/therapy , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Sclerotherapy , Follow-Up Studies , Laparoscopy , Lymphocele/etiology , Lymphocele/pathology , Pelvis , Postoperative Period , Prostatectomy/methods , Retrospective Studies
19.
Rev. Assoc. Med. Bras. (1992) ; 54(6): 517-521, nov.-dez. 2008. tab
Article in Portuguese | LILACS | ID: lil-504648

ABSTRACT

OBJETIVO: O objetivo deste estudo foi avaliar a morbidade cirúrgica pós-biópsia de linfonodo sentinela (BLS) ou dissecção axilar com (DA-NP) e sem preservação do nervo intercostobraquial (DA-NS). MÉTODOS: Fez-se estudo coorte prospectivo com 108 pacientes divididas em três grupos: BLS (n=35), DA-NP (n=36) e DA-NS (n=37). Foram avaliadas ocorrência de déficit sensorial, dor, linfedema, seroma e infecção no membro superior homolateral à cirurgia. Monofilamentos de Semmes-Weinstein foram usados para avaliar o déficit sensorial, perimetria braquial foi feita para avaliação da presença de linfedema e aplicado questionário de dor. Para análise estatística foram utilizados os testes ANOVA e Kruskal-Wallis. Foi feita análise bivariada e multivariada. RESULTADOS: Pelo menos uma complicação pós-cirúrgica, imediata ou tardia, ocorreu em 45/108 (41,7 por cento) pacientes avaliadas. A complicação mais comum foi dor. Houve diferença estatisticamente significante entre os três grupos somente quanto ao déficit sensorial (p=0,04). Dor, linfedema e déficit sensorial ocorreram com maior freqüência no grupo DA-NS. As pacientes dos grupos BLS e DA-NP não apresentaram diferenças estatisticamente significantes para nenhuma das variáveis analisadas. A pesquisa com os monofilamentos mostrou sensibilidade cutânea preservada em 28/35 pacientes do grupo BLS, em 25/36 pacientes do grupo DA-NP e em 10/37 pacientes do grupo DA-NS (p<0,001). CONCLUSÃO: A secção do nervo está relacionada a maior déficit sensorial havendo diferença estatisticamente significante entre os três grupos, o que não demonstrou ser significante com os demais critérios avaliados dentre os grupos analisados.


BACKGROUND: The aim of this study was to evaluate the morbidity after sentinel node biopsy (SNB) and axillary dissection with (AD-NS) or without sparing the intercostobrachial nerve (AD-NOS). Methods: A prospective cohort study was performed on 108 patients divided into three groups: SNB (n=35), AD-NS (n=36) and AD-NOS (n=37). We evaluated the incidence of sensory loss, pain, lymphedema, seroma formation and infection in the arm homolateral to the breast surgery. Semmes-Weinstein monofilaments were used to assess the sensory loss; brachial perimetry was used to evaluate presence of lymphedema and a pain questionnaire was administered. ANOVA and Kruskal-Wallis statistical tests were used. Bivariate and Multivariate analyses were performed. RESULTS: After surgery at least one complication was reported by 45/108 (41.7 percent) patients. Pain was the outcome more often reported by patients. In the three groups a significant difference was observed only regarding sensory loss (p=0.04). Pain, lymphedema, and sensory loss were more frequently found in the AD-NOS group. No significant difference was observed between SNB and AD-NS groups. Semmes-Weinstein monofilaments showed preservation of cutaneous sensitivity in 28/35 patients from the SNB group, in 25/36 patients from AD-NS group but in only 10/37 patients from AD-NOS group (p<0.001). CONCLUSION: The ICB section is associated with higher sensory loss, with statistically significant difference between the groups that were not shown to be significant with the others complications.


Subject(s)
Female , Humans , Breast Neoplasms/pathology , Lymph Node Excision/adverse effects , Mastectomy/adverse effects , Analysis of Variance , Axilla/surgery , Brachial Plexus/surgery , Breast Neoplasms/surgery , Lymphedema , Lymph Node Excision/standards , Multivariate Analysis , Mastectomy/standards , Prospective Studies , Pain/etiology , Statistics, Nonparametric
20.
Article in English | IMSEAR | ID: sea-37724

ABSTRACT

This study was undertaken to evaluate the incidence and independent predictors for febrile morbidity after radical hysterectomy and pelvic lymphadenectomy. Patients with FIGO stage IB-IIA cervical cancers who had undergone RHPL at Chiang Mai University Hospital between January 2003 and December 2005, were reviewed. The clinical variables including the age at diagnosis, menopausal status, body mass index, previous cervical conization, tumor size, preoperative chemotherapy, preoperative anemia, operative time, and estimated blood loss were analyzed for prediction of postoperative febrile morbidity. During the study period, 357 women were reviewed. The mean age was 44.7 years. Sixty-five (18.2%) women were postmenopausal. The majority of women (77.3%) were in FIGO stage IB1. The most common histology was squamous cell carcinoma (69.2%). Febrile morbidity was noted in 94 women (26.3%, 95% CI= 21.8-31.2) in whom 25 (7.0%) had urinary tract infection (19), abdominal wound infection (4), and vaginal cuff infection (2), respectively. Only massive blood loss (>1,500 ml) was noted as the significantly independent predictor for febrile morbidity (aOR= 2.7, 95% CI=1.1-6.6, P=0.028). In conclusion, approximately one-fourth of the women undergoing RHPL at our institute had postoperative febrile morbidity. Only massive blood loss is a significant predictor for this complication.


Subject(s)
Adenocarcinoma/pathology , Adult , Aged , Blood Loss, Surgical , Carcinoma, Squamous Cell/pathology , Female , Fever/epidemiology , Humans , Hysterectomy/adverse effects , Incidence , Lymph Node Excision/adverse effects , Middle Aged , Postoperative Complications , Risk Factors , Surgical Wound Infection/epidemiology , Treatment Outcome , Urinary Tract Infections/epidemiology , Uterine Cervical Neoplasms/pathology
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