Evaluating Upper Extremity Lymphedema Following Hand Surgery in Patients with Previous Ipsilateral Lymph Node Surgery Michael J. Fitzgerald, MD¹² Jesse Galina BS¹², Peter Olivares BS¹², Ariel Henig BA¹, Emily Kolodka BA¹, Cesar Iturriaga BS,¹² Susan Maltser MD¹³, Lewis B. Lane MD¹², and Kate W. Nellans MD, MPH¹² 1Donald and Barbara Zucker
School of Medicine at Hofstra/Northwell 2Northwell Health Orthopedics 3Northwell Health Physical Medicine & Rehabilitation
Background • • •
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Lymph node surgery is common practice in patients with breast cancer Hand surgery and injections occur frequently amongst patients of an older age group Patients who have had lymph node removal surgery are advised against hand surgery due to the supposed risk of developing upper extremity lymphedema To date, there is a paucity of evidence supporting this claim, yet advising against hand procedures following lymph node surgery continues to be common practice
Hypothesis • Patients who have undergone lymph node surgery are unlikely to develop upper extremity lymphedema following ipsilateral hand surgery
Methods • Retrospective chart review of patients using electronic medical records from the Northwell Health System • Inclusion criteria: history of breast cancer surgery followed by ipsilateral hand intervention by Northwell Hand/Physical Medicine & Rehabilitation physicians, as well as follow up examination after the procedure
Preliminary Results Results
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21 patients (26 interventions) ○ Steroid Injection: 17 ○ Surgery: 6 ○ Mass Aspiration/NSAIDs/Splint: 3
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Median Follow-Up: 10.9 months (range 0.3-90)
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Breast Procedure: Lumpectomy: 11; Mastectomy: 5; Bilateral Mastectomy: 8; Excisional Biopsy: 2
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Lymph Node Dissection: Sentinel: 4; 2-5 Nodes: 10; > 5 Nodes: 2; All Nodes: 2; Unknown: 4; None: 4
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Pre-existing lymphedema: 8 ○ Exacerbation after intervention: None
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New Onset Lymphedema: 1 ○ Unclear if this presentation truly was lymphedema or a symptom of patient’s uncontrolled Rheumatoid Arthritis
Figure 7: Independent CRISPR knockout of CDK4 or CDK6 does not cause dropout in most breast cancer cell lines studied.
http://www.healioswoundsolutions.com/lymphedema/
Conclusions • Many patients who have had breast cancer can develop upper extremity problems later on in life that require injections and/or surgery • Hand surgery/injections following ipsilateral lymph node surgery was not found to correlate with increased ipsilateral lymphedema • Therefore, treatment for the hand conditions of these patients should not be withheld due to fear of lymphedema development
Future Direction • Currently conducting analysis of the complete data set of 311 patients • Re-reviewing the charts of patients whose hand procedure was relatively recent
Resources Fulford, Dean, et al. “Hand Surgery after Axillary Lymph Node Clearance for Breast Cancer: Contra-Indication to Surgery?” The Annals of The Royal College of Surgeons of England, vol. 92, no. 7, 2010, pp. 573–576., doi:10.1308/003588410x12699663904475.