Hand

Risk of New Lymphedema After Hand Surgery in Patients With Prior Breast Cancer

A small systematic review provides some reassurance, but is it reliable?

What’s the Claim?

A small systematic review tackled a question that matters to one in eight women who have hand surgery: Will surgery with a tourniquet cause or worsen lymphedema among patients who previously had breast surgery and axillary lymph node dissection? Among patients with no lymphedema before the hand surgery, the risk was slightly less than 3% (and the risk of postoperative infection was 0.7%); in patients who had some lymphedema before hand surgery, it worsened in 11%, and nearly 17% developed hand infection. The authors reported that all patients with new or worsening lymphedema experienced resolution of that symptom within 3 months.

How’s It Stack Up?

It’s a systematic review, and so it comports with the main published findings. The art here is in the interpretation. The authors felt that the risk of infection in patients with no history of lymphedema was comparable to that of patients without prior breast cancer, but the risk of infection among patients who started out with lymphedema might have been higher. The findings apply to patients having elective hand surgery only (not emergencies), and nearly all of the procedures were performed with a tourniquet.

What’s Our Take?

This would be good news, if we could count on it. Concerns about the four source studies summarized in this small systematic review cause us to recommend interpreting it with caution. CORRelations examined the source studies and found that they generally did not report the proportion of patients who were lost to follow-up, and the follow-up duration was quite short in some of them (as short as 8 days in one study). As we’ve emphasized before, the missing are more likely to have complications than the accounted for, and longer surveillance matters.

While it seems likely that if lymphedema after hand surgery were a frequent problem we’d know about it by now, it’s probably more frequent than estimated in this systematic review. A paper too new to have been included in this systematic review had the same problem — the minimum follow-up to be eligible for inclusion was only 1 month, but the patients who developed lymphedema did so at an average of 30 months later, and none experienced the problem before 4 months. The missing are probably having a very different experience, so take care in interpreting studies like this. Finally, it’s possible that avoiding a tourniquet would make things safer in terms of lymphedema risk, but this wasn’t studied.