Axillary Web Syndrome after Lymph Node Dissection: Results Of 1,004 Breast Cancer Patients

Abstract

Axillary web syndrome (AWS) occurs in patients submitted to surgical treatment for breast cancer due to injury of superficial lymphatic vessels during lymph node dissection. Its incidence and risk factors are unknown. The purpose of this study was to evaluate the incidence and risk factors of AWS in breast cancer patients. Methods: Prospective cohort of 1,004 breast cancer patients submitted to axillary clearance at the National Cancer Institute (INCA), between August 2002 and November 2002. Women with prior conditions of the upper arm were excluded. The following variables were collected: age at operation, body mass index (BMI); marital status; years of schooling; neoadjuvant radiotherapy, chemotherapy or tamoxifen; number of lymph nodes removed; number of metastatic lymph nodes; type of axillary surgery; total days with closed suction drainage; TNM stage (pathology); type of surgery; early arm edema (volume > 200 ml). Univariate analysis was performed for describing population profile. Bivariate analysis and logistic regression were performed in order to identify risk factors involved in the development of AWS. This study was approved by the Ethics and Research Committees of INCA and FIOCRUZ. Results: The follow-up period was 24 months. The sample comprised 1,004 women, with a mean age of 55 years, 48% were married, 53% had not completed elementary school and 70% were obese. Mastectomy was performed in 65%, the mean number of lymph nodes removed was 17. As for staging, 47% of the cases were considered in an advanced stage (higher than IIB). The incidence of AWS was 38.2%. The variables that showed significant statistical association with AWS (logistic regression) were: early arm edema (RR=2.27 IC 1.10-4.65) and number (continuous) of lymph nodes removed (RR=1.01 IC 1.00 – 1.03). Conclusion: AWS is a common condition after axillary lymphadenectomy for breast cancer and was statistically associated with the number of lymph nodes removed and with early arm edema.