Interdisciplinary approach to the treatment of postmastectomy lymphedema

Abstract

A prospective randomized controlled clinical study included 80 women aged 54.9 ± 8 years, who underwent radical surgery for breast cancer and had late postmastectomy lymphedema (II -IV degree). No evidence of erysipelas was observed for the last 3 months. Material and Methods.The severity of lymphedema and treatment outcomes were assessed using water plethysmography in relative units (in %). Changes in the subcutaneous adipose tissue thickness were measured by ultrasound. To assess the severity of liposuction complications, the Clavien-Dindo classification was used. Three homogeneous groups of patients were treated. In Group 1 (n=30), conservative methods (intermittent pneumatic compression of the arm, electrostimulation of skeletal muscles, magnetic therapy, massage, therapeutic exercises, compression bandaging) were performed in the preoperative period; in group 2 (n=30) - in the late postoperative period of liposuction; in group 3 (n=20) liposuction was followed by compression bandaging. Results. The average volume excess in the edematous upper extremity significantly decreased, being 84.2 ± 10.0 % in group1 patients, 87.8 ± 9.3 % in group 2 and 72.2 ± 9.6 % in group 3 (p<0.001). The regression rate of grade 2 lymphedema was 94.8 ± 1.2 % in group 1 patients, 96.1 ± 0.7 % in group 2 patients and 82.1 ± 2.5 % in group 3 patients. The regression rate of grades 3 lymphedema was 81.7 ± 2.2 % in group 1, 86.9 ± 2.2% in group 2 and 65.2 ± 0.8 % in group 3. The regression rate of grades 4 lymphedema was 71.0 ± 2.8% in group 1, 73.4 ± 2.2% in group 2 and 62.6 ± 4.2% in group 3 (p<0.001). Early complications of grade 1 liposuction occurred in 5% patients. Favorable immediate treatment outcome (reduction in lymphedema by 50100 % and reduction in the thickness of subcutaneous fat by 50 %) was noted in 100% of patients of groups 1 and 2 and in 90 % patients of group 3. A good long-term result (after 12-18 months) was observed in 93.3 % of group 1 patients, in 100 % of group 2 patients and in 55 % of group 3 patients. Conclusions. The results obtained show that the elimination of excess adipose component without improving the drainage function of the lymphatic system does not lead to good long-term treatment outcomes for late lymphedema.