ARM LYMPHEDEMA RATES IN BREAST CANCER PATIENTS WITH NEOADJUVANT CHEMOTHERAPY AFTER AXILLARY LYMPH NODE DISSECTION VERSUS TARGETED AXILLARY DISSECTION: A PROSPECTIVE COHORT STUDY ghlimsg@yahoo.com.sg

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ARM LYMPHEDEMA RATES IN BREAST CANCER PATIENTS WITH NEOADJUVANT CHEMOTHERAPY AFTER AXILLARY LYMPH NODE DISSECTION VERSUS TARGETED AXILLARY DISSECTION: A PROSPECTIVE COHORT STUDY

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Singapore

Oral or Poster

Axillary lymph node dissection (ALND) is associated with a high risk of arm lymphedema. Targeted axillary dissection (TAD) could be performed after neoadjuvant chemotherapy to avoid ALND, if there was nodal pathological complete response. However, as TAD is an emerging technique, little data exists on its lymphedema rates. We aimed to compare the arm lymphedema rates between breast cancer patients with neoadjuvant chemotherapy who had undergone ALND versus TAD alone.

Patients who underwent TAD at a tertiary centre were recruited prospectively. Clinical, radiological, pathological data and arm lymphedema rates were compared to a similar cohort who had ALND after neoadjuvant chemotherapy.

123 patients were included, of which 18 and 105 underwent TAD alone and ALND respectively. Both groups had similar demographic, radiological and pathological features except that the TAD alone group had a statistically higher rate of PR negativity (p=0.0198), ypTpcr (p=0.0346), ypN0 (p=0.0012) and breast conservation (p=0.0001). On median follow-up of 23.3 months (range: 3.7-44.7) and 13 months (range: 2-51), arm lymphedema was reported in 10.5% and 0% of patients who underwent ALND and TAD alone respectively. Of the patients who underwent ALND, 8 (7.6%) patients had Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) and none of these patients developed arm lymphedema.

ALND is associated with a higher rate of arm lymphedema compared to TAD alone. However, arm lymphedema in the ALND group may be negated by LYMPHA. Our findings require validation with larger studies with longer follow-up.