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THE EUROPEAN JOURNAL OF
lymphology
and related problems
VOLUME 29 • No. 75 • 2017
INDEXED IN EXCERPTA MEDICA
AXILLARY WEB SYNDROME AFTER SENTINEL LYMPH NODE
BIOPSY (SLNB). RANDOMIZED STUDY ON THE EFFICACY OF
A THERAPY PROTOCOL
ANDREOLI C., BRANCHINI L., BASILICO V., CARNAGHI C., MIETTO R., VERONESI A., MARTINO G.*
Istituto Clinico Humanitas Castellanza (VA)
* Metis Oncology Study Centre - Training and Therapy - Milan
ABSTRACT
Obiective: Assess the efficacy of remedies, administered at an early stage in patients with breast cancer diagnose undergoing breast-conservative surgery (quadrantectomy) with sentinel lymph node biopsy (SLNB) and showing AWS or Cording of varying degree and picture.
Materials and methods: 54 women with AWS of varying degree (G0, G1, G2, G3) were randomized in two groups to assess the effectiveness of a therapy protocol consisting in three orally administered remedies with lymphokinetic, anti-inflammatory and mood-modulating effect. Patients were checked 10, 20, 30, 60 days after surgery.
Results: Based on the randomized study, the group that was administered the lymphokinetic, anti-inflammatory and mood- modulating drugs, showed fewer early postoperative outcomes (serosity, infections, limitations), 90% resolution of G0 and G1 outcomes and decreased tightness of cords in G2 and G3 cases.
Conclusions: Therapeutic protocols should be developed for the preventive and early use of medicines with lymphokinetic,
anti- inflammatory and relaxing effect in order to reduce the trauma of diagnosis and surgical incision – albeit limited – as it occurs in quadrantectomy with SLNB, with the aim of improving quality of life and reducing rehabilitation costs.
Key Words: AWS, Iatrogenic outcomes after quadrantectomy and SLNB Complementary therapies, Rehabilitation.
INTRODUCTION
In Breast Unit practices, the patients’ post-operative discomfort is hardly taken into consideration, since breast specialists feels satisfied with the screening for early diagnosis and the good aesthetic results of breast-conservative surgery, compared to the mutilating interventions of some time ago.
Few know that cancer diagnoses makes women’s body vulnerable. This may vary as for posture, structure, constitution, physical
and metabolic condition, as well as specific emotional
and relational reactivity after diagnosis. Breast specialists hardly examine them before surgery in terms of biomechanical and emotional features. (1,2,3,4)
Through their studies on communication, relationship and physicality, Martino and colleagues (1,2,3,4,5) have taught us that cancer diagnosis “blends in” between motion and e-motion and that the scalpel cuts through the skin, fascia, breast and armpit
affecting such vulnerability of the body: these are all intimate and meaningful parts of women.
As breast specialists of a new Breast Unit we therefore took care of: 1. conducting an accurate biomechanical and emotional examination before surgery; 2. broadening the local and systemic clinical gaze on post-conservative surgery outcomes; 3. finding appropriate and preventive therapies for physical and emotional discomfort.
More than half of the women we examined in biomechanical terms before surgery, experienced the sensorimotor alteration described by Martino et al., consisting in hypo-pendularism of the ipsilateral arm with decreased spacial representation, haptic function and therefore relational features.
Incisions in the chest and underarm areas, highly symbolic, are part of a dynamic, postural, metabolic as well as emotional and relational framework, specific to each woman. The different systemic structure can affect the local iatrogenic physical outcome. This work starts with the examination of a local symptom which is scarcely highlighted by breast specialists, i.e. Axillary Web Syndrome, by studying its incidence rate, degree, prevention and treatment in a group of women, homogenous as for surgical operation, while inevitably different in structure, posture and emotions.
Since there are yet no dedicated therapists in our breast facilities who can handle the complex physical and emotional trauma, we had to understand if there were any complementary remedies that might affect the connective and emotional – physical components without interfering with cancer therapies.
AWS O CORDING
Incision of the skin in the chest and underarm region and opening of the clavipectoral fascia with sentinel lymph node biopsy (SLNB) may lead to post-operative development of either one or several smaller or thicker cords, that extend down, from the site of scarring, to the inner arm and forearm and sometimes continue all the way down to the wrist.
These cords lead to motion restrictions, feeling of tightness and pain. The morphology of the cords with their different pathways, tightness and size, makes etiopathogenetic interpretation difficult. Some authors talk of sclerosis of lymphatic vessels and veins with surrounding fibrosis. This manifold picture is defined as retraction, adhesion, lymphatic sclerosis and fibrosclerosis (6). For a decade, this symptom has been generally known as “Axillary Web Syndrome (AWS) or Cording” (7, 8).
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 75 - 2017
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