ABSTRACT
INTRODUCTION: The Objective was to investigate the incidence of lymphedema after breast cancer treatment and to analyze the risk factors involved in a tertiary level hospital. METHODS: Prospective longitudinal observational study over 3 years post-breast surgery. 232 patients undergoing surgery for breast cancer at our institution between September 2013 and February 2018. Sentinel lymph node biopsy (SLNB) or axillary lymphadenectomy (ALND) were mandatory in this cohort. In total, 201 patients met the inclusion criteria and had a median follow-up of 31 months (range, 1-54 months). Lymphedema was diagnosed by circumferential measurements and truncated cone calculations. Patients and tumor characteristics, shoulder range of motion limitation and local and systemic therapies were analyzed as possible risk factors for lymphedema. RESULTS: Most cases of lymphedema appeared in the first 2 years. 13.9% of patients developed lymphedema: 31% after ALND and 4.6% after SLNB (p < 0.01), and 46.7% after mastectomy and 11.3% after breast-conserving surgery (p < 0.01). The lymphedema rate increased when axillary radiotherapy (RT) was added to radical surgery: 4.3% for SLNB alone, 6.7% for SLNB + RT, 17.6% for ALND alone, and 35.2% for ALND + RT (p < 0.01). In the multivariate analysis, the only risk factors associated with the development of lymphedema were ALND and mastectomy, which had hazard ratios (95% confidence intervals) of 7.28 (2.92-18.16) and 3.9 (1.60-9.49) respectively. CONCLUSIONS: The main risk factors for lymphedema were the more radical surgeries (ALND and mastectomy). The risk associated with these procedures appeared to be worsened by the addition of axillary radiotherapy. A follow-up protocol in patients with ALND lasting at least two years, in which special attention is paid to these risk factors, is necessary to guarantee a comprehensive control of lymphedema that provides early detection and treatment.
Subject(s)
Breast Neoplasms/surgery , Lymphedema/etiology , Mastectomy/adverse effects , Sentinel Lymph Node Biopsy/statistics & numerical data , Aged , Axilla/pathology , Female , Humans , Incidence , Longitudinal Studies , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Risk Factors , Sentinel Lymph Node Biopsy/methods , Tertiary Care Centers/statistics & numerical dataABSTRACT
La cirugía ambulatoria presenta un incremento constante, tanto en los procedimientos que se llevan a cabo como en las unidades capacitadas para su realización. Uno de los aspectos esenciales en su desarrollo es la mejoría permanente de los cuidados prequirúrgicos que reciben los pacientes. Entre ellos, ocupa un lugar destacado la profilaxis antitrombótica y, si bien la incidencia global de la enfermedad tromboembólica venosa en este grupo de pacientes no es muy elevada, se recomienda valorar en todos los pacientes los factores de riesgo trombótico personales y los relacionados con el procedimiento quirúrgico. Según esta valoración, los pacientes se podrán estratificar en bajo o moderado/alto riesgo trombótico, recomendándose aplicar las medidas de tromboprofilaxis adecuadas en cada caso: medidas generales solas o en combinación con tromboprofilaxis farmacológica y/o mecánica. En el presente documento multidisciplinar de consenso, actualización de las recomendaciones de la Asociación Española de Cirugía Mayor Ambulatoria (ASECMA) publicadas en 2011, se establecen las recomendaciones y sugerencias específicas para cada uo de los grupos de riesgo, aplicando los niveles de evidencia hallados en la literatura (AU)
In the past decade, ambulatory surgery has experienced a continuous increase, both in the types of procedures that are performed, as in the number of units qualified for outpatient surgery. One of the essential aspects in this development is the permanent improvement in the perioperative care that patients receive. In this regard, antithrombotic prophylaxis is of outstanding importance. Although the overall incidence of venous thromboembolism in these patients is not very high, the assessment of thrombosis risk factors, both personal and procedure related, is recommended. According to this risk assessment, patients may be stratified into low, moderate or high thrombotic risk categories. Therefore, thromboprophylaxis should be tailored to that risk: general measures alone, or combined with mechanical or pharmacological thromboprophylaxis. This multidisciplinary consensus document the recommendations of the Spanish Association of Major Ambulatory Surgery (ASECMA) published in 2011, and sets out evidence-based recommendations and specific suggestions for the each risk group (AU)
Subject(s)
Humans , Thromboembolism/prevention & control , Anticoagulants/therapeutic use , Ambulatory Surgical Procedures/methods , Premedication/methods , Preoperative Care/methods , Heparin, Low-Molecular-Weight/therapeutic use , Venous Thromboembolism/prevention & control , Practice Patterns, Physicians'ABSTRACT
La estadificación quirúrgica laparoscópica asociada a la histerectomía vaginal constituye un método alternativo de tratamiento del carcinoma de endometrio. El tiempo laparoscópico incluye la práctica de lavados peritoneales, la linfadenectomía y, en mayor o menor grado, la asistencia laparoscópica a la histerectomía vaginal. A causa del seguimiento limitado en muchos casos, todavía no están bien definidos los criterios acerca de las indicaciones y contraindicaciones del procedimiento. El papel de la laparoscopia en el tratamiento del cáncer de endometrio sólo podrá ser determinado cuando se disponga de estudios prospectivos y de resultados a largo plazo. (AU)
