Efficacy of octreotide in preventing lymphedema after radical, modified radical, and partial mastectomy with axillary lymphadenectomy

Postoperative octreotide is known to reduce lymphorrhea after axillary node dissection in breast cancer and other gynecological malignancies with varying efficacy. However, the effect of octreotide on the development of lymphedema after axillary node dissection has not been explored. We sought to evaluate the role of octreotide in preventing lymphedema in patients who underwent axillary lymphadenectomy.

This retrospective review of the TriNetX Analytics Network queried the Global Collaborative Network with over 170 million patients to identify patients undergoing complete axillary lymphadenectomy or radical, modified radical, or partial mastectomy with axillary node dissection. Then, the patients who received octreotide after surgery were identified. Patients with a history of octreotide use prior to surgery or hereditary lymphedema were excluded. Patients were identified using diagnosis and procedure codes. Occurrence of postoperative lymphedema was compared between 1:1 propensity score matched cohorts. Patients were matched for age, body mass index (BMI), gender, race, radiation therapy, and smoking among others. Risk ratios, t-tests, and Z-tests were used to compare outcomes.

A total of 222 patients who underwent axillary lymphadenectomy and received octreotide postoperatively were matched to 222 patients who did not receive octreotide from an original pool of 69,955 patients. Prior to matching, the standardized mean difference between the two groups was greater than 0.1 for age, BMI, and several race categories. After matching, all standardized mean differences were less than 0.1. Patients who received octreotide were at significantly lesser risk of developing lymphedema (p<0.0001) when compared to patients who did not receive octreotide. Patients who received octreotide required fewer manual therapy techniques including lymphatic massage/drainage (p<0.05). Additionally, patients who received octreotide were less likely to undergo plastic surgical consultation or surgical correction of their lymphedema (p<0.05). Patients who received octreotide were not at increased risk of bradycardia (p>0.05) or hypothyroidism (p>0.05).

Patients who underwent axillary lymphadenectomy and received octreotide postoperatively were associated with significantly less risk of developing lymphedema and undergoing surgical lymphedema correction without increased risk of hypothyroidism or bradycardia. This study establishes the potential role of octreotide for lymphedema prevention in patients undergoing axillary lymphadenectomy.