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Sympathetic nerve damage as a potential cause of lymphoedema after axillary dissection for breast cancer. BJS 2009; 96: 865-869.

Published: 9th July 2009

Authors: T. M. Bennett Britton, S. M. L. Wallace, I. B. Wilkinson, P. S. Mortimer, A. M. Peters, A. D. Purushotham et al.

Background

The physiological disturbances leading to lymphoedema after breast cancer surgery are poorly understood. Damage to sympathetic nerves during axillary lymph node dissection (ALND), leading to increased capillary fluid filtration, was investigated as a possible contributory factor.

Method

The integrity of the upper limb sympathetic nervous system was tested in 36 patients before, and 3 and 12 months after ALND. Forearm vascular resistance (FVR), calculated from forearm blood flow and mean systemic arterial pressure, was measured before and after exposure to lower‐body negative pressure. Forearm venous compliance was measured using 99mTc‐labelled autologous erythrocytes and radionuclide plethysmography before and after cold water immersion of the feet.

Results

There were clear changes in FVR and venous compliance in response to sympathetic stimulation but no differences attributable to surgery or between the nine patients who developed lymphoedema and the 27 who did not; nor were there differences between the two arms. There was a trend towards lower preoperative FVR in patients who developed lymphoedema.

Conclusion

Lymphoedema is not the result of sympathetic nerve damage sustained during ALND. Preoperative FVR may help predict who will get lymphoedema following this surgery. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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