Seroma indicates increased risk of lymphedema following breast cancer treatment: A retrospective cohort study

Navid Mohamadpour Toyserkani a, Mads Gustaf Jørgensen a, Karen Haugaard b, Jens Ahm Sørensen, Breast. 2017 Apr; 32:102-104.

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Seroma indicates increased risk of lymphedema following breast cancer treatment: A retrospective cohort study

Navid Mohamadpour Toyserkani a, Mads Gustaf Jørgensen a, Karen Haugaard b, Jens Ahm Sørensen, Breast. 2017 Apr; 32:102-104.

INTRODUCTION:

Lymphedema is one of the most serious complications following breast cancer treatment. While many risk factors are well described the role of seroma formation has recently produced mixed results. Therefore, we aimed to evaluate if seroma is a risk factor for development of lymphedema in one of the largest retrospective cohort studies.

MATERIAL AND METHODS:

We included all patients with unilateral breast cancer treated in the period of 2008-2014. Data regarding treatment and breast cancer characteristics were retrieved from the national breast cancer registry. Data regarding lymphedema treatment and seroma aspirations were retrieved from local treatment codes.

RESULTS:

In total 1822 patients were included of which 291 developed lymphedema. Multivariate cox regression analysis showed that seroma was an independent risk factor (HR 1.92 CI 1.30-2.85, p= 0.001). Other independent risk factors were lymphadenectomy, radiation therapy, chemotherapy, BMI above 30, total lymph nodes removed above 15 and higher number of metastatic lymph nodes.

CONCLUSIONS:

Postoperative seroma doubles the risk of developing lymphedema. Future studies should examine if seroma reducing measures will lead to lower risk of lymphedema.

Main findings

  • The study was conducted as a retrospective cohort study. All patients diagnosed and treated for breast cancer at Odense University Hospital in the period 2008-2014 were evaluated for inclusion via the medical records.
  • Postoperative seroma doubles the risk of developing lymphoedema. In total 1822 patients were included of which 291 developed lymphedema. Seroma was seen to be a risk factor and also BMI above 30, higher number of metastatic lymph nodes, more than 15 nodes removed in total, radiation and chemotherapy.
  • The study suggests future studies should examine if reduction in seroma formation leads to lower risk of developing lymphoedema.
  • The diagnosis of lymphoedema is a concern as it was defined as all patients that received physiotherapeutic lymphedema treatment. It is unclear how a diagnosis of lymphoedema was established.