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Based on literature data, AWS occurs in less than 20% of women who undergo SLNB. As already mentioned, a great number of breast specialists consider this rate overstated, since in their post- surgical visits they rarely find a picture of AWS or Cording. Immediate complications are generally not related to these outcomes, as well as the extent of glandular removal and incisions of the fascia, conditions of the tissues, the fascia, the dynamics of the shoulder, the musculoskeletal and metabolic structure and even less the sensory-motor changes caused by the trauma of diagnosis before surgery.
MATERIALS AND METHODS
Between the beginning of 2012 and the end of 2013, we studied
a sample of 164 patients who had to undergo standard procedures with a single surgical team, in order to underline incidence
of outcomes after quadrantectomy and SLNB (9, 10, 11, 12) in our breast unit.
Before surgery, the patients were examined as for biomechanical, metabolic, structural, postural, dynamic and emotional conditions. After 10, 20, 30 days and then after 2, 3, 6, and 12 months from surgery, they were examined paying particular attention to local outcomes, general clinical data and sensory-motor, relational and mood changes.
In the group of 164 women studied to assess post-operative outcomes, 54 showed AWS of varying degree. AWS degree was classified as follows: G0 - subclinical condition, in which case cording is reflected by the skin sliding from the shoulder towards the elbow, with no feeling of tightness and impairment.
So called stage G1 includes small superficial cords up to the elbow with slightly limited range of motion; G2 refers to one or several thick cords that extend down to the elbow and also impair elbow extension; G3 refers to cords that run down to the wrist with limited range of motion of elbow and wrist.
After assessing the outcome, women with AWS (54 patients) entered a randomized study: one group that did not take any oral medication (control group) and another group that was administered three complementary remedies with lymphokinetic, anti-inflammatory and mood-modulating effect, taken together at the beginning of the first week after surgery and for two months. The hypothesis is that these women show a fibroblast adhesion reactivity with increased reticular and collagen fibers and slower remodeling rate of the connective tissue matrix, as well as a particular fascial and postural structure and an element of stress caused by the disclosure of diagnosis.
The prescribed remedies have a lymphokinetic (Taraxacum, Calendula, Arsenicum album, Chelidonium, Leptandra, Echinacea, Phytolacca, Carduus Mariuanus, Condurango, Hydrastis, Lycopodium, Sanguinaria, drops), anti- inflammatory (Bromelina, Papaina, Tripsina, Chimotripsina, Vitamine C, D, E - tablets), and mood-balancing effect (Passiflora, Valeriana, Melissa, Avena – tablets).
RESUL TS
The randomized study included 54 patients undergoing quadrantectomy and SLNB, selected from a sample of 164 women who had been studied for incidence of post-operative outcomes. They showed subclinical cording or visible thin or thick cords,
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 75 - 2017
differing in paths, both painful and impairing (11 Grade-0 cords, 16 Grade-1 cords, 22 Grade-2 cords and 5 Grade-3 cords). Serosity, infections, age, menopause symptoms, overweight, obesity, hypertension, metabolic diseases and structural bone or tendon restrictions occurring in 54 women with AWS did not differ in frequency from those assessed in the 110 women studied for the incidence of outcomes and not affected by AWS.
These women differed from the other 110 patients without AWS in that they showed a higher incidence of sensory- motor alterations prior to surgery. Involuntary hyperpendularism after diagnosis was assessed in 68.2% of the patients with AWS and in 37.5% of patients without AWS.
Almost all of the patients with AWS, hyperpendularism observed at the time of diagnosis was also associated with haptic hypofunction of the hand (tactile and motor exploration): signs of a lower chance to explore the world around them with the upper limb ipsilateral to the tumor.
The group of 27 women who regularly took the diluted lymphokinetic remedy, the enzymatic anti-inflammatory remedy and the mood-modulating phytotherapic compound (group A), showed an earlier improvement in symptoms compared to women of control group C, who were free to take Nsaids or painkillers (Table 1 and 2).
Table 1
2
Table 2