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Elective hand surgery after axillary lymph node dissection for cancer.

R Jay Lee, Dawn M LaPorte, Jaysson T Brooks

    Orthopedics
    |May 14, 2015
    PubMed
    Summary

    Elective hand surgery after axillary lymph node dissection (ALND) did not cause new lymphedema or worsen existing cases. However, nearly one-third of patients experienced short-term postoperative complications, highlighting potential risks for cancer survivors undergoing ipsilateral procedures.

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    Area of Science:

    • Oncology
    • Plastic Surgery
    • Lymphedema Management

    Background:

    • Patients undergoing axillary lymph node dissection (ALND) are often advised against ipsilateral procedures due to theoretical risks of complications, especially lymphedema.
    • This caution impacts cancer survivors who may require subsequent interventions, such as hand surgery.

    Purpose of the Study:

    • To evaluate the safety and complication rates of elective hand surgery performed on the same side as previous ALND.
    • To determine if such procedures increase the risk of developing or exacerbating lymphedema.

    Main Methods:

    • Retrospective review of 22 patients (breast cancer or melanoma history) who underwent elective hand surgery after ipsilateral ALND between 1998 and 2011.
    • Exclusion of nonoperatively treated patients and those with contralateral hand surgery.
    • Follow-up included clinical assessment and a survey for long-term outcomes, averaging 9.2 months and 4.3 years, respectively.

    Main Results:

    • Fifteen of 22 patients experienced uneventful recoveries.
    • Short-term complications included peri-incisional erythema (4 patients), incisional pain/scarring (1), chronic wound issues (1), and wound dehiscence requiring reoperation (1).
    • No new cases of lymphedema occurred, and existing lymphedema was not exacerbated in patients with pre-existing conditions.

    Conclusions:

    • Routine elective hand surgery on the ipsilateral side of ALND appears safe regarding lymphedema development or worsening.
    • A significant proportion of patients may experience minor short-term postoperative complications.
    • Further research may be warranted to optimize management and minimize short-term adverse events in this patient population.