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International Angiology 1999 December;18(4):294-8


lingua: Inglese

Postmastectomy lymphoedema. Treatment and a five-year follow-up study

Berlin E., Gjöres J. E., Ivarsson C., Palmqvist I., Thagg G., Thulesius O.

From the Departments of Clinical Physiology and Surgery, Central Hospital, Växjö, Sweden


Background. Lymphoedema of the arm is a com­mon prob­lem after mas­tec­to­my and radio­ther­a­py of mam­mary can­cer. In a pros­pec­tive 5-year fol­low-up study we inves­ti­gat­ed the devel­op­ment of arm oede­ma and the ­effect of con­ser­va­tive com­pres­sion treat­ment.
Methods. Two hun­dred and twen­ty-six ­patients who had under­gone mas­tec­to­my were inves­ti­gat­ed. Oedema for­ma­tion was esti­mat­ed by record­ing dis­placed water vol­ume of both arms pre­op­er­a­tive­ly and six times post­op­er­a­tive­ly. One hun­dred fifty-seven ­patients (70%) could be fol­lowed for five years. An inter-arm dif­fer­ence of 100 ml or more was ­defined as oede­ma. Three types of treat­ment were given: (1) Compression with stock­ings in 28 ­patients, (2) inter­mit­tent com­pres­sion (Flowtron) in 8 and (3) inter­mit­tent com­pres­sion (Lympha-Press) and com­pres­sion ­sleeves in 19 ­patients.
Results. A total of 46 ­patients (20%) devel­oped post­op­er­a­tive oede­ma, 17 with­in six ­months and 29 one year post­op­er­a­tive­ly. The aver­age oede­ma vol­ume was 418 ml. Most ­patients with a mod­er­ate or ­severe oedema had irra­di­a­tion ther­a­py. Severe lym­phoe­de­ma (750 ml or more) ­occurred in ­patients with irra­di­a­tion post­op­er­a­tive­ly and lymph node engage­ment. There was no cor­re­la­tion ­between ­patient age and oede­ma for­ma­tion. Compression ther­a­py with stock­ings ­reduced oede­ma in 15 out of 28 ­patients (54%) and pre­vent­ed fur­ther swell­ing. Therapy with stock­ings and Lympha Press ­reduced the arm vol­ume in 13 out of 19 ­patients (68%). Four out of eight ­patients treat­ed with Flowtron ­showed oede­ma reduc­tion. In most ­patients ces­sa­tion of treat­ment result­ed in ­relapse of swell­ing to the same ­degree as ­before.
Conclusions. Compression ther­a­py is ben­e­fi­cial to con­trol postmas­tec­to­my arm swell­ing. This ­applies to dif­fer­ent modal­ities and pro­longed peri­ods of treat­ment are ­required to check pro­gres­sion. Application of stock­ings is the sim­plest way to treat post­op­er­a­tive oede­ma. In most cases post­op­er­a­tive oede­ma ­appeared dur­ing the first year after sur­gery and the most ­severe cases ­occurred after irra­di­a­tion.

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