title: De Novo Upper Extremity Lymphedema After Elective Hand Surgery in Breast Cancer Survivors.
abstract: BACKGROUND
  The safety of elective hand surgery in breast cancer (BC) survivors is controversial because of concerns of developing upper extremity lymphedema. This study aimed to evaluate the risk of developing lymphedema after elective hand surgery among patients that underwent ipsilateral axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), and/or radiation therapy (RT).
  
  
  METHODS
  A retrospective cohort of BC patients treated with ALND, SLNB, and/or RT was identified (1997-2012). Patients with subsequent ipsilateral elective hand surgery were included if greater than 1 year of follow-up and no preexisting lymphedema. The primary outcome was lymphedema after hand surgery. Comparisons between patients with and without lymphedema were made to identify potential lymphedema risk factors. Dichotomous and continuous variables were compared with Fisher exact and Student t tests, respectively.
  
  
  RESULTS
  The analysis included 103 patients, of which 4 (3.8%) had documented lymphedema after hand surgery. Lymphedema developed early and was self-limited. Lymphedema was not related to age and type of hand surgery. Tourniquet time was longer in the nonlymphedema group. The lymphedema group all received adjuvant chemotherapy and RT with either ALND or SLNB. Patients with lymphedema had a shorter interval between hand surgery and completion of BC surgery (2.1 vs 6.2 years) and RT (2.0 vs 3.3 years).
  
  
  CONCLUSIONS
  Lymphedema is uncommon after elective hand surgery among survivors and was not associated with tourniquet use. The combination of adjuvant therapies and axillary procedures and a short temporal relationship of these to hand surgery may increase lymphedema risk.
authors.affiliation: From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Baltzer
authors.forename: Jamison
authors.initials: J
authors.lastname: Harvey
authors.forename: Paige M
authors.initials: PM
authors.lastname: Fox
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moran
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001132:Arm / Q000503:physiopathology; D001365:Axilla / Q000503:physiopathology / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D000073116:Cancer Survivors; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008209:Lymphedema / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome