Prevalência de linfedema após mastectomia em portadoras de câncer de mama: uma revisão sistemática acerca da influência da reconstrução imediata

RIBEIRO, RAFAEL VILELA EIRAS

doi:10.5935/2177-1235.2019RBCP0017

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Cirurgia Plástica

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Artigo de Revisão • Rev. Bras. Cir. Plást. 34 (01) • 2019 • https://doi.org/10.5935/2177-1235.2019RBCP0017 copiar

Prevalência de linfedema após mastectomia em portadoras de câncer de mama: uma revisão sistemática acerca da influência da reconstrução imediata

Autoria SCIMAGO INSTITUTIONS RANKINGS

▪ RESUMO

Este estudo objetivou analisar, por meio de uma revisão sistemática da literatura, a influência da reconstrução imediata na prevalência de linfedema após mastectomia em pacientes portadoras de câncer de mama. Foram analisados os mais relevantes estudos publicados originalmente em qualquer idioma até agosto de 2018, indexados às bases de dados US National Library of Medicine, Cochrane Central Register of Controlled Trials, Web of Science e Scientific Electronic Library Online. A amostra foi composta por 10 publicações que se adequaram aos critérios de inclusão e exclusão estabelecidos, incluindo 2.425 pacientes submetidas a apenas mastectomia e 2.772 pacientes submetidas à mastectomia associada à reconstrução imediata da mama. A prevalência de linfedema foi 20,95% nas pacientes submetidas a apenas mastectomia (n = 508) e de 5,23% nas pacientes submetidas à mastectomia associada à reconstrução imediata (n = 145), havendo diferença estatisticamente significativa (p < 0,001). Concluiu-se que a mastectomia associada à reconstrução imediata influencia positivamente o prognóstico das pacientes portadoras de câncer de mama, proporcionando um índice significativamente menor de linfedema, quando comparada à realização de apenas mastectomia.

Descritores:
Mastectomia; Linfedema relacionado a câncer de mama; Mamoplastia; Neoplasias da mama; Excisão de linfonodo.

Estudo	Cirurgias (n)	Média de idade (anos)	IMC médio (kg/m²)	Follow-up
Freitas Júnior et al.¹⁷17. Freitas Júnior R, Ribeiro LFJ, Taia L, Kajita D, Fernandes MV, Queiroz GS. Linfedema em pacientes submetidas à mastectomia radical modificada. Rev Bras Ginecol Obstetr. 2001;23(4):205-8. DOI: https://doi.org/10.1590/S0100-72032001000400002 https://doi.org/10.1590/S0100-7203200100...	109	42,0	-	48 meses
Petrek et al.²⁰20. Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer. 2001;92(6):1368-77. DOI: https://doi.org/10.1002/1097-0142(20010915)92:6<1368::AID-CNCR1459>3.0.CO;2-9 https://doi.org/10.1002/1097-0142(200109...	263	52,3	-	20 anos
Nesvold et al.¹⁸18. Nesvold IL, Dahl AA, Løkkevik E, Marit Mengshoel A, Fosså SD. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy. Acta Oncol. 2008;47(5):835-42. DOI: https://doi.org/10.1080/02841860801961257 https://doi.org/10.1080/0284186080196125...	263	55,0	26	Média de 48 meses
Park et al.¹⁹19. Park JH, Lee WH, Chung HS. Incidence and risk factors of breast cancer lymphoedema. J Clin Nurs. 2008;17(11):1450-9. DOI: https://doi.org/10.1111/j.1365-2702.2007.02187.x https://doi.org/10.1111/j.1365-2702.2007...	450	50,0	-	24 meses
Avraham et al.²²22. Avraham T, Daluvoy SV, Riedel ER, Cordeiro PG, Van Zee KJ, Mehrara BJ. Tissue expander breast reconstruction is not associated with an increased risk of lymphedema. Ann Surg Oncol. 2010;17(11):2926-32. PMID: 20499284 DOI: https://doi.org/10.1245/s10434-010-1112-2 https://doi.org/10.1245/s10434-010-1112-...	130	61	26	-
Card et al.²³23. Card A, Crosby MA, Liu J, Lindstrom WA, Lucci A, Chang DW. Reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone. Plast Reconstr Surg. 2012;130(6):1169-78. PMID: 22878475 DOI: https://doi.org/10.1097/PRS.0b013e31826d0faa https://doi.org/10.1097/PRS.0b013e31826d...	549	-	28,6	Média de 59 meses
Lee et al.²⁴24. Lee KT, Mun GH, Lim SY, Pyon JK, Oh KS, Bang SI. The impact of immediate breast reconstruction on postmastectomy lymphedema in patients undergoing modified radical mastectomy. Breast. 2013;22(1):53-7. DOI: https://doi.org/10.1016/j.breast.2012.04.009 https://doi.org/10.1016/j.breast.2012.04...	595	46,0	23,3	Média de 53 meses
Pandey & Shrestha¹⁰10. Pandey RA, Shrestha S. Prevalence of arm lymphedema among patients with breast cancer surgery. JCMS-Nepal. 2016;12(3):111-7.	66	-	-	12 meses
TOTAL	2425	-	-	-
MEDIA	-	51,05	25,975	-

Estudo	Cirurgias (n)	Média de idade (anos)	IMC médio (kg/m²)	Follow-up médio
Avraham et al²²22. Avraham T, Daluvoy SV, Riedel ER, Cordeiro PG, Van Zee KJ, Mehrara BJ. Tissue expander breast reconstruction is not associated with an increased risk of lymphedema. Ann Surg Oncol. 2010;17(11):2926-32. PMID: 20499284 DOI: https://doi.org/10.1245/s10434-010-1112-2 https://doi.org/10.1245/s10434-010-1112-...	186	45	24	-
Card et al.²³23. Card A, Crosby MA, Liu J, Lindstrom WA, Lucci A, Chang DW. Reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone. Plast Reconstr Surg. 2012;130(6):1169-78. PMID: 22878475 DOI: https://doi.org/10.1097/PRS.0b013e31826d0faa https://doi.org/10.1097/PRS.0b013e31826d...	541	-	25,7	59 meses
Crosby et al.²¹21. Crosby MA, Card A, Liu J, Lindstrom WA, Chang DW. Immediate breast reconstruction and lymphedema incidence. Plast Reconstr Surg. 2012;129(5):789e-95e. PMID: 22544109	1499	50	25,7	56 meses
Lee et al.²⁴24. Lee KT, Mun GH, Lim SY, Pyon JK, Oh KS, Bang SI. The impact of immediate breast reconstruction on postmastectomy lymphedema in patients undergoing modified radical mastectomy. Breast. 2013;22(1):53-7. DOI: https://doi.org/10.1016/j.breast.2012.04.009 https://doi.org/10.1016/j.breast.2012.04...	117	45,0	21,9	53 meses
Lee et al.⁶6. Lee KT, Bang SI, Pyon JK, Hwang JH, Mun GH. Method of breast reconstruction and the development of lymphoedema. Br J Surg. 2017;104(3):230-7. DOI: https://doi.org/10.1002/bjs.10397 https://doi.org/10.1002/bjs.10397...	429	43,0	22,0	45.3 meses
TOTAL	2772	-	-	-
MEDIA	-	45,75	23,86	53,3 meses

Estudo	Total	Cirurgias (n)					Média de idade (anos)	Total
		MS	MS+ALND	MRM	MS(n)	MS+ALND(n)	MRM(n)	n	%
Freitas Júnior et al.¹⁷17. Freitas Júnior R, Ribeiro LFJ, Taia L, Kajita D, Fernandes MV, Queiroz GS. Linfedema em pacientes submetidas à mastectomia radical modificada. Rev Bras Ginecol Obstetr. 2001;23(4):205-8. DOI: https://doi.org/10.1590/S0100-72032001000400002 https://doi.org/10.1590/S0100-7203200100...	109	-	-	-	-	-	-	15	13,76
Petrek et al.²⁰20. Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer. 2001;92(6):1368-77. DOI: https://doi.org/10.1002/1097-0142(20010915)92:6<1368::AID-CNCR1459>3.0.CO;2-9 https://doi.org/10.1002/1097-0142(200109...	263	-	-	-	-	-	-	128	48,67
Nesvold et al.¹⁸18. Nesvold IL, Dahl AA, Løkkevik E, Marit Mengshoel A, Fosså SD. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy. Acta Oncol. 2008;47(5):835-42. DOI: https://doi.org/10.1080/02841860801961257 https://doi.org/10.1080/0284186080196125...	263	77	-	186	6	-	37	43	16,35
Park et al.¹⁹19. Park JH, Lee WH, Chung HS. Incidence and risk factors of breast cancer lymphoedema. J Clin Nurs. 2008;17(11):1450-9. DOI: https://doi.org/10.1111/j.1365-2702.2007.02187.x https://doi.org/10.1111/j.1365-2702.2007...	450	54	145	251	3	32	77	112	24,89
Avraham et al.²²22. Avraham T, Daluvoy SV, Riedel ER, Cordeiro PG, Van Zee KJ, Mehrara BJ. Tissue expander breast reconstruction is not associated with an increased risk of lymphedema. Ann Surg Oncol. 2010;17(11):2926-32. PMID: 20499284 DOI: https://doi.org/10.1245/s10434-010-1112-2 https://doi.org/10.1245/s10434-010-1112-...	130	59	71	-	8	28	-	36	27,69
Card et al.²³23. Card A, Crosby MA, Liu J, Lindstrom WA, Lucci A, Chang DW. Reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone. Plast Reconstr Surg. 2012;130(6):1169-78. PMID: 22878475 DOI: https://doi.org/10.1097/PRS.0b013e31826d0faa https://doi.org/10.1097/PRS.0b013e31826d...	549	474	100	-	-	-	-	57	10,61
Lee et al.²⁴24. Lee KT, Mun GH, Lim SY, Pyon JK, Oh KS, Bang SI. The impact of immediate breast reconstruction on postmastectomy lymphedema in patients undergoing modified radical mastectomy. Breast. 2013;22(1):53-7. DOI: https://doi.org/10.1016/j.breast.2012.04.009 https://doi.org/10.1016/j.breast.2012.04...	595	-	-	595	-	-	110	110	18,49
Pandey & Shrestha¹⁰10. Pandey RA, Shrestha S. Prevalence of arm lymphedema among patients with breast cancer surgery. JCMS-Nepal. 2016;12(3):111-7.	66	12	-	54	2	-	5	7	10,61
TOTAL	2425	676	316	1086	19	60	229	508	20,95

Estudo	Total	Cirurgias (n)				Linfedema		Total
		MS	MS+ALND	MRM	MS(n)	MS+ALND(n)	MRM(n)	n	%
Avraham et al²²22. Avraham T, Daluvoy SV, Riedel ER, Cordeiro PG, Van Zee KJ, Mehrara BJ. Tissue expander breast reconstruction is not associated with an increased risk of lymphedema. Ann Surg Oncol. 2010;17(11):2926-32. PMID: 20499284 DOI: https://doi.org/10.1245/s10434-010-1112-2 https://doi.org/10.1245/s10434-010-1112-...	186	676	316	1086	19	60	229	508	20,95
Card et al.²³23. Card A, Crosby MA, Liu J, Lindstrom WA, Lucci A, Chang DW. Reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone. Plast Reconstr Surg. 2012;130(6):1169-78. PMID: 22878475 DOI: https://doi.org/10.1097/PRS.0b013e31826d0faa https://doi.org/10.1097/PRS.0b013e31826d...	541	474	100	-	-	-	-	21	3,88
Crosby et al.²¹21. Crosby MA, Card A, Liu J, Lindstrom WA, Chang DW. Immediate breast reconstruction and lymphedema incidence. Plast Reconstr Surg. 2012;129(5):789e-95e. PMID: 22544109	1499	1067	432	-	7	43	-	50	3,34
Lee et al.²⁴24. Lee KT, Mun GH, Lim SY, Pyon JK, Oh KS, Bang SI. The impact of immediate breast reconstruction on postmastectomy lymphedema in patients undergoing modified radical mastectomy. Breast. 2013;22(1):53-7. DOI: https://doi.org/10.1016/j.breast.2012.04.009 https://doi.org/10.1016/j.breast.2012.04...	117	-	-	117	-	-	11	11	9,40
Lee et al.⁶6. Lee KT, Bang SI, Pyon JK, Hwang JH, Mun GH. Method of breast reconstruction and the development of lymphoedema. Br J Surg. 2017;104(3):230-7. DOI: https://doi.org/10.1002/bjs.10397 https://doi.org/10.1002/bjs.10397...	429	280	149	-	-	-	-	34	7,93
TOTAL	2772	10914	774	114	13	66	11	145	5,23

Sociedade Brasileira de Cirurgia Plástica Rua Funchal, 129 - 2º Andar / cep: 04551-060, São Paulo - SP / Brasil, Tel: +55 (11) 3044-0000 - São Paulo - SP - Brazil
E-mail: rbcp@cirurgiaplastica.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Instituição: Santa Casa de Montes Claros, Montes Claros, MG, Brasil

Critérios de Inclusão
Delineamento	•	ECCR
•	Meta-análise
•	Série de casos
Amostra	•	Humanos
Intervenção	•	Apenas mastectomia
•	Mastectomia associada à reconstrução imediata
•	Comparativo entre as referidas abordagens
Período de publicação	•	Não especificado
Idioma	•	Não definido
Critérios de Exclusão
Delineamento	•	Metodologia mal explicitada e/ou incompreensível
•	Relato de caso
•	Revisão da literature
Intervenção	•	Mastectomia associada à reconstrução tardia
•	Tratamento não cirúrgico ou não especificado
Forma de publicação	•	Apenas resumo