Influence of body mass index on the frequency of lymphedema and other complications after surgery for breast cancer

ABSTRACT Objective: this study assessed the influence of pre-operative body mass index (BMI) has upon lymphedema, scar tissue adhesion, pain, and heaviness in the upper limb at two years after surgery for breast cancer. Methods: retrospective analysis of 631 medical records of women who underwent surgery for breast cancer and were referred to the Physiotherapy Program at Prof. Dr. José Aristodemo Pinotti Women's Hospital of the Center for Integral Women's Health Care, CAISM/UNICAMP between January 2006 and December 2007. Results: mean age of women was 56.5 years (±13.7 years) and the most part (55%) were overweight or obese, surgical stages II and III were present in 63% of women studied. Radical mastectomy was the most frequent surgery (54.4%), followed by quadrantectomy (32.1%). In the first year after surgery, there was no significant association between BMI categories and incidence of scar tissue adhesion, pain, heaviness and lymphedema. In the second year, overweight and obese women had higher rates of heaviness in the upper limb and lymphedema. For lymphedema, there was a significant difference among BMI categories (p=0.0268). Obese women are 3.6 times more likely to develop lymphedema in the second year after surgery (odds ratio 3.61 95% CI 1.36 to 9.41). Conclusion: BMI ≥25kg/m2 prior to treatment for breast cancer can be considered a risk factor for developing lymphedema in the two years after surgery. There was no association between BMI and the development of other complications.

摘要：本项研究旨在评估术前体重指数（BMI）对乳腺癌手术两年后上肢淋巴水肿、瘢痕组织粘连、疼痛及沉重感的影响。方法：对2006年1月至2007年12月期间于巴西圣保罗CAISM/UNICAMP综合女性健康中心José Aristodemo Pinotti教授妇科医院接受乳腺癌手术并被转诊至物理治疗项目的631位女性的医疗记录进行回顾性分析。结果：女性的平均年龄为56.5岁（±13.7岁），其中大部分（55%）女性体重超重或肥胖，研究中63%的女性患有II期或III期乳腺癌。根治性乳腺切除术是最常见的手术方式（54.4%），其次是象限切除术（32.1%）。在手术后的第一年内，BMI类别与瘢痕组织粘连、疼痛、沉重感和淋巴水肿的发生率之间无显著关联。在手术后的第二年，体重超重和肥胖的女性上肢沉重感和淋巴水肿的发生率更高。对于淋巴水肿，BMI类别之间存在显著差异（p=0.0268）。肥胖女性在手术两年后发生淋巴水肿的风险是正常体重女性的3.6倍（优势比3.61，95%置信区间1.36至9.41）。结论：对于乳腺癌治疗前的BMI≥25kg/m2可以被视为乳腺癌手术两年后发生淋巴水肿的风险因素。BMI与术后其他并发症的发生无显著关联。