Work

Predictors of early arm lymphoedema in breast cancer patients treated with modified radical mastectomy -a prospective observational study

Year: 2025

Type: article

Abstract: BACKGROUND: Breast cancer is the most common malignancy among women globally, with 2.3 million new cases in 2022. Advances in early detection and treatment have improved survival, but long-term complications like breast cancer-related lymphoedema (BCRL) remain underrecognized. Affecting 6-40% of patients following axillary lymph node dissection, BCRL leads to chronic swelling, pain, and reduced quality of life. The risk is heightened in low- and middle-income countries (LMICs), where delayed diagnosis and limited awareness necessitate more aggressive interventions. Despite its profound physical, psychosocial, and economic impact, BCRL remains understudied in LMICs, highlighting the need for region-specific data and preventive strategies. METHODS: This prospective observational study, which was conducted in a tertiary care centre over 18 months (July 2022-December 2023), aimed to identify clinicopathological predictors of the development of early ipsilateral arm lymphoedema in patients undergoing Modified radical mastectomy (MRM). We diagnosed lymphoedema via circumferential measurements (≥ 10% increase in ipsilateral arm) at 1 day pre-surgery and followed up the patients at 1-, 3-, and 6-months post-surgery. Variables included patient demographics, tumour characteristics, and treatment factors. RESULTS: , p = 0.008), Left-sided tumours (40% vs. 18% for right-sided, p = 0.03), number of lymph nodes removed (mean 21.14 vs. 13.49, p = 0.003), and positive lymph nodes (mean 3.81 vs. 1.15, p = 0.009), Axillary radiation (55% vs. 16.7%, p < 0.001). Multivariate analysis confirmed BMI (aOR = 1.19, 95%CI:1.00-1.42; p = 0.045), total lymph nodes removed (aOR = 1.08, 95%CI:1.01-1.15; p = 0.027), and axillary radiation (aOR = 4.57, 95%CI:1.37-15.26; p = 0.013) as independent predictors, while positive lymph nodes lost significance when adjusted for confounders (aOR = 1.04, p = 0.718). Age, hormone receptor status, and chemotherapy type showed no significant associations. CONCLUSION: The study highlights the critical role of pre-operative risk stratification. These findings underscore the need for personalized surgical and adjuvant strategies to mitigate Lymphoedema risk, enhancing long-term survivorship care in breast cancer patients. TRIAL REGISTRATION: Clinical Trials Registry India-CTRI/2023/08/056411 (Registered prospectively on 11/08/2023).

Source: BMC Surgery

DOI: 10.1186/s12893-025-03255-3