FREQUENCY AND FACTORS ASSOCIATED WITH INJURY TO THE AXILLARY VEIN IN WOMEN THAT UNDERWENT AXILLARY LYMPHADENECTOMY DURING BREAST CANCER SURGICAL TREATMENT
Keywords:
Breast neoplasms, Surgery, Treatment, Lymphadenectomy, Axillary veinAbstract
Objective: To evaluate which variables are considered risk factors associated with injury to the axillary vein during lymphadenectomy in the surgical treatment of breast cancer patients. Methods: Retrospective study performed through the electronic record analysis of 1,007 patients who underwent axillary lymph node dissection at Hospital Erasto Gaertner, from January 2010 to December 2014. We assessed the following risk factors using a standard questionnaire: age, body mass index (BMI), presence of palpable axillary metastasis in the clinical examination, sentinel lymph node pre-lymphadenectomy, presence of axillary metastasis in the perioperative period, size of metastasis and if it was adhered to axillary vessels, presence of pectoralis muscle invasion, resection of the pectoralis minor muscle, axillary incision separated from breast incision, prior radiotherapy, neoadjuvant chemotherapy, and pre and postoperative staging. For each patient who presented injury to the axillary vein, we paired them with two homogeneous controls (age, BMI, preoperative staging, surgical proposal, and neoadjuvant treatment). Results: Thirteen patients had injury to the axillary vein. In the perioperative evaluation, in most of them, the axilla was positive in the injury group (10 cases = 76.9%) and control group (12 cases = 46.1%), and it was adhered to axillary vessels in 10 cases in the injury group (76.9%) and 7 in the control group (26.9%). Conclusion: In this study, the presence of axillary metastasis in the perioperative evaluation, as well as that adhered to the axillary vessels, is associated with an increased risk of injury to the axillary vein during lymphadenectomy.
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References
World Health Organization. International Agency for Research on Cancer. Globocan. 2015.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology:breast cancer. Version 03. 2013.
American Joint Committee Cancer: Breast. In: Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, eds. AJCC Cancer Staging Manual. 7ªedition. New York: Springer, 2010. p. 347-376.
Fuller MS, Lee CI, Elmore JG. Breast cancer screening: an evidence-based update.Med Clin North Am. 2015;99(3):451-68. doi: 10.1016/j.mcna.2015.01.002
SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). Bethesda:National Cancer Institute; 2009.
Brasil. Ministério da Saúde. Instituto Nacional do Câncer José Alencar Gomes da Silva (INCA). Informativo Vigilância do Câncer n.2. Brasília: Ministério da Saúde; 2012.
Berg JW. The significance of axillary node levels in the study of breast carcinoma. Cancer. 1955;8:776-8.
Zarebczan DB, Neuman HB. Management of the axilla. Surg Clin North Am. 2013;93:429-44.
Warmuth MA, Bowen G, Prosnitz LR, Chu L, Broadwater G, Peterson B, et al. Complications of axillary lymph node dissection for carcinoma of the breast: a report based on a patient survey. Cancer. 1998;83:1362-8.
Salmon RJ, Ansquer Y, Asselain B. Preservation versus section of intercostal-brachial nerve (IBN) in axillary dissection for breast cancer - a prospective randomized trial. Eur J Surg Oncol. 1998;24:158-61.
Schünemann H, Willich N.Lymphödeme nach mammakarzinom. Dtsch Med Wochenschr. 1997;122:536-41.
DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14:500-15.
Herd-Smith A, Russo A, Muraca MG, Del Turco MR, Cardona G. Prognostic factors for lymphedema after primary treatment of breast carcinoma. Cancer. 2001;92:1783-7.
Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer. 2001;92:1368-77.
Kissin MW, Querci della Rovere G, Easton D,Westbury G. Risk of lymphoedema following the treatment of breast cancer. Br J Surg. 1986;73(7):580-4.
Lin PP, Alison DC, Wainstock J, Miller KD, Dooley WC, Friedman N,et al. Impact of axillary lymph node dissection on the therapy of breast cancer patients. J Clin Oncol. 1993;11:1536-44.
Ashikari R, Huvos AG, Snyder RE. Prospective study of noninfiltrating carcinoma of the breast. Cancer. 1977;39:435-9.
Solin LJ, Fowble BL, Schultz DJ, Yet IT, Kowalyshyn MJ, Goodman RL. Definitive irradiation for intraductal carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1990;19:843-50.
Wong JH, Kopald KH, Morton DL. The impact of microinvasion on axillary node metastases and survival in patients with intraductal breast cancer. Arch Surg. 1990;125:1298-302.
Nevin JE, Pinzón G, Morán TJ, Baggerly JT. Minimal breast carcinoma. Am J Surg. 1980;139:357-9.
Schuh ME, Nemoto T, Penetrante RB, Rosner D, Dao TL. Intraductal carcinoma. Analysis of presentation, pathologic findings and outcome of disease. Arch Surg. 1986;121:1303-7.
Kinne DW, Petrek JA, Osborne MP, Fracchia AA, DePalo AA, Rosen PP. Breast carcinoma in situ. Arch Surg. 1989;124:33-6.
Chadha M, Chabon AB, Friedmann P, Vikram B. Predictors of axillary metastases in patients with T1 breast cancer. A multivariate analysis. Cancer. 1994;73:350-3.
Harris J, Ostenn R. Patients with early breast cancer benefit from effective axillary treatment. Breast Cancer Res Treat. 1985;5:17-21. doi: 10.1007/BF01807645
Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227-32. doi: 10.1056/NEJMoa020989
Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008,26:3536-42.
Pain SJ, Vowler S, Purushotham AD. Axillary vein abnormalities contribute to development of lymphoedema after surgery for breast cancer. Br J Surgery. 2005,92:311-5.
Rett MT, Lopes MCA. Fatores de risco relacionados ao linfedema. Rev Bras Mastol. 2002;12:39-42.
Johansson K, Ohlsson K, Ingvar C, Albertsson M, Ekdahl C. Factors associated with the development of arm lymphedema following breast cancer treatment: a match pair case-control study. Lymphology. 2002;35:59-71.
Rett MT, Lopes MCA. Fatores de risco relacionados ao linfedema. Rev Bras Mastol. 2002;12:39-42.
Andac MH. Cardiovascular Injuries, Emergency and Trauma. Ankara: Handbook; 1997. p. 229-250.
Andrikopoulos V, Antoniou I, Panoussis P. Arterial injuries associated with lower-extremity fractures. Cardiovasc Surg. 1995;3(1):15-8.
Carrel A. La téchnique opératoire des anastomoses vasculaires et la transplantation de viscères. Lyon Méd. 1902;98:859-64.
Carrel A. The surgery of blood vessels. Johns Hopkins Med J. 1907;18-28.
Brito CJ, Silva RM. Cirurgia Vascular: Cirurgia Endovascular, Angiologia. São Paulo: Revinter; 2014.
Rutherford RB. Atlas of vascular surgery: basic techniques and exposures. Philadelphia: WB Saunders; 2000.p. 486-93.
Best CH. Heparin and vascular occlusion. Can Med Assoc J. 1936;35:621-2.
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Copyright (c) 2017 Rafaela Miranda Corrêa, Danila Pinheiro Hubie, Reitan Ribeiro, José Clemente Linhares, Sérgio Bruno Bonatto Hatschbach
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