Sympathetic nerve damage as a potential cause of lymphoedema after axillary dissection for breast cancer.
BACKGROUND
The physiological disturbances leading to lymphoedema after breast cancer surgery are poorly understood. Damage to sympathetic nerves during axillary lymph node dissection (ALND), leading to increased capillary fluid filtration, was investigated as a possible contributory factor.


METHODS
The integrity of the upper limb sympathetic nervous system was tested in 36 patients before, and 3 and 12 months after ALND. Forearm vascular resistance (FVR), calculated from forearm blood flow and mean systemic arterial pressure, was measured before and after exposure to lower-body negative pressure. Forearm venous compliance was measured using (99m)Tc-labelled autologous erythrocytes and radionuclide plethysmography before and after cold water immersion of the feet.


RESULTS
There were clear changes in FVR and venous compliance in response to sympathetic stimulation but no differences attributable to surgery or between the nine patients who developed lymphoedema and the 27 who did not; nor were there differences between the two arms. There was a trend towards lower preoperative FVR in patients who developed lymphoedema.


CONCLUSIONS
Lymphoedema is not the result of sympathetic nerve damage sustained during ALND. Preoperative FVR may help predict who will get lymphoedema following this surgery.
Bennett Britton
T M
TM
Department of Research Oncology, King's College London and Guy's and St Thomas' NHS Foundation Trust, Bermondsey Wing, Guy's Hospital, London, UK.
Wallace
S M L
SM
Wilkinson
I B
IB
Mortimer
P S
PS
Peters
A M
AM
Purushotham
A D
AD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005542:Forearm / Q000098:blood supply; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000209:etiology*; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D013564:Sympathetic Nervous System / Q000293:injuries*; D020196:Trauma, Nervous System / Q000209:etiology*; D014655:Vascular Resistance / Q000502:physiology