K. Vangsness1, A. Sam2,3, M. Silva3, B. Chan3, M. Chu4, M. Agko2, J. Chang2, A.L. Carre2 1Community Memorial Hospital System, Department of Surgery, Ventura, CA, USA 2City of Hope National Medical Center, Division Of Plastic Surgery, Duarte, CA, USA 3UC Riverside School of Medicine, Riverside, CA, USA 4Kaiser Permanente Medical Group, Division Of Plastic & Reconstructive Surgery, Los Angeles, CA, USA
Introduction:
Axillary lymph node dissection (ALND) is a procedure used in the treatment of advanced breast cancer. One of the untoward and difficult complications that patients may experience after ALND is upper extremity lymphedema (LE). One of the tools that reconstructive microsurgeons use to prophylactically combat LE is lymphatic reconstruction (LR), which have been shown in studies to be effective in preventing or delaying the onset of lymphedema after ALND. However, paresthesia, a complication that can occur in patients undergoing LR, is not well reported in the literature. In this study, we hope to highlight the rate of paresthesia among a nationwide cohort of patients undergoing lymphatic reconstruction, as well as other postoperative complications.
Methods:
A review of patients undergoing microsurgical upper extremity lymphatic reconstruction was performed using TrinetX, a database containing deidentified patient information from numerous healthcare groups worldwide. In this study, we focused on healthcare organizations within the USA. A cohort was created using CPT codes for patients undergoing microsurgical upper extremity lymphatic reconstruction and the relevant ICD-10 codes for the postoperative complications of interest. We collected data on outcomes such as paresthesias, lymphedema, hematoma, seroma and surgical site infection (SSI). Basic demographics and length of follow up were noted.
Results:
403 patients undergoing upper extremity lymphatic reconstruction were included for analysis. Mean age of patients at the time of LR was 47.5 years. Most patients undergoing LR were white (231/403, 57.5%), the rest were of minority or unspecified races. Of the cohort, 22/403 patients (5.46%) experienced sensory disturbances, 22/403 patients (5.46%) experienced upper extremity lymphedema, and 10/403 patients (2.48%) experienced postoperative hematoma. In this cohort, no patients were reported to have SSI or postoperative seroma. The mean follow up for patients in our cohort was 246.9 days.
Conclusion:
Upper extremity lymphatic reconstruction is a useful tool for patients undergoing ALND in the treatment of breast cancer. Our results demonstrated low rates of postoperative complications such as lymphedema, hematoma, seroma, and SSI. Despite being underreported in the literature, 5.47% of our cohort experienced postoperative sensory disturbances. We believe that it is crucial to acknowledge this as a noteworthy complication. We anticipate that this may be due to inconsistencies with documentation and lack of standardization of reporting protocols for complications such as sensory disturbances, and we hope to create a framework so surgeons and patients can make informed decisions in their care.