Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection

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• 作者：Roser Belmonte (1) (2) (3)
  Sandra Monleon (1) (2)
  Neus Bofill (1)
  Martha Ligia Alvarado (1)
  Josep Espadaler (4)
  Inmaculada Royo (4)
  
• 关键词：Winged scapula ; Lymph node excision ; Breast neoplasm ; Electromyography ; Long thoracic nerve
• 刊名：Supportive Care in Cancer
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：23
• 期：1
• 页码：169-175
• 全文大小：157 KB
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  4. Mc Lean LH, Vuoto HD, Uriburu JL, Bernabó OL, Santillán FB, Mc Lean IL (1998) Linfadenectomía axilar en cáncer de mama: técnica y resultados. Rev Argent Cir 75:186-91
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  7. Mastrella A, Freitas-Junior R, Paulinelli RR, Soares LR (2013) Incidence and risk factors for winged scapula after surgical treatment for breast cancer. J Clin Nurs. doi:10.1111/jocn.12443
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  14. Oliveira JF, Bezerra T, Ribeiro ACP, Dias RA, Abrah?o F, Silva JG, Bergmann A (2009) Incidence and risk factors of winged scapula after axillary lymph node dissection in breast cancer surgery. Appl Cancer Res 29:69-3
  15. Ameri E, Behtash H, Omidi-Kashani F (2009) Isolated long thoracic nerve paralysis—a rare complication of anterior spinal surgery: a case report. J Med Case Rep 3:7366. doi:10.4076/1752-1947-3-7366 CrossRef
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• 作者单位：Roser Belmonte (1) (2) (3)
  Sandra Monleon (1) (2)
  Neus Bofill (1)
  Martha Ligia Alvarado (1)
  Josep Espadaler (4)
  Inmaculada Royo (4)
  
  1. Servei de Medicina Física i Rehabilitació, Hospital Mar-Esperan?a, C/ Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
  2. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, 08193, Barcelona, Spain
  3. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
  4. Servei de Neurologia i Neurofisiologia Clínica, Hospital del Mar, Passeig Marítim de la Barceloneta, 24, 08003, Barcelona, Spain
  
• ISSN：1433-7339

文摘

Purpose The objectives of this study were to electromyographically (EMG) describe and analyze factors associated with long thoracic nerve injuries in breast cancer patients after axillary lymph node dissection. Methods This was a prospective longitudinal observational study. Two hundred sixty-four women with primary invasive breast cancer were included between 2008 and 2011. All of them were treated by axillary lymph node dissection. Patients were evaluated at 1, 6, and 12?months following surgery. The presence of winged scapula was systematically tested at each follow-up and an EMG performed whenever it was observed. Affected and unaffected groups were compared for demographic, tumour, and treatment variables. Student t test, Mann–Whitney U test, chi-squared or Fisher test were computed as appropriate. Results Among the 36 (13.6?%) winged scapula observed, the EMG confirmed long thoracic nerve injury in 30 (11.3?%) of them, 27 were partial axonotmesis and three were severe axonotmesis. At 12?months, the EMG showed that injury persisted in six (2.27?%) patients. Patients with long thoracic nerve injury had a lower body mass index than unaffected patients (26.2 vs. 28.2, p--.045). Age, tumour stage, type of breast surgery, nodes excised, surgical complications, previous chemotherapy and previous hormonotherapy were not factors associated with winged scapula. Conclusions A lower body mass index was the only factor associated to long thoracic nerve injury. In most of the patients, the EMG showed partial axonotmesis. At 12?months, 2.27?% of studied patients remained with an unsolved long thoracic nerve injury.