AXILLARY WEB SYNDROME AND RISK FACTORS: PROSPECTIVE EVALUATION OF PATIENTS AFTER BREAST CANCER TREATMENT.

Patricia Vieira Guedes Figueira, Cinira Assad Simão Haddad, Roberta Pitta Costa Luz, Samanta Karlla Lopes de Almeida Rizzi, Thaís Lúcia Pinheiro, Simone Elias Martinelli, Gil Facina, Afonso Celso Pinto Nazário

Institution: Universidade Federal de Sao Paulo

“Objective: The objective of this study is to describe risk factors related to Axillary Web Syndrome (AWS).

Methods: Prospective cohort study of 173 women followed at Mastology outpatient unit of Universidade Federal de São Paulo between July 2014 and September 2015. Patients had undergone a comprehensive evaluation that included anthropometrics datas, related morbidities, tumor and surgery characteristics and the presence of cord, before surgery and 7, 15, 30, 60, 90 and 180 days postoperatively.

Results: The main risk factor founded in this study was the lymphadenectomy (p=0,029), women had risk to developing AWS 28% higher. Other variables related showed a tendency to develop cord as the mastectomy (p= 0.098) with higher lymph node involvement (N=2) (p=0,130). However, patients with hypertension had risk of developing AWS 42% higher (p=0,003) and on the on the other hand patients with Diabetes Melitus presented risk 30% lower to present AWS (p=0,022). There was no correlation between Body Mass Index (BMI) and increased prevalence of cords (p=0.453).

Conclusion: The main risk factor for developing AWS in women after breast cancer surgery in this study was axillary lymphadenectomy. The manipulation of the armpit during surgery with removal of lymph nodes could cause increase inflammation that eventually stimulates the proliferation of fibroblasts and could cause fibrosis in vessels and the formation of the cords. Hypertension and diabetes mellitus were not described in previous studies about AWS, but their presence or drugs for their control could influence the lymphatic and venous flow and somehow increase or decrease the appearance of cords, but further studies are needed for this association.

Key words: axillary web syndrome, breast cancer, lymphadenectomy, morbidities.