Risk Factors for Lymphedema After Breast Cancer Surgery: A Prospective Cohort Study Evaluating Axillary Surgical Approaches

AIM: Breast cancer-related lymphedema remains a major complication that follows axillary surgery. This prospective study evaluated the effects of axillary surgical techniques and treatment-related factors on the development of lymphedema in patients undergoing breast cancer surgery.METHODS: This prospective observational cohort study included 119 patients who underwent breast and axillary surgery for invasive breast cancer between June 2020 and April 2022. Arm volume measurements were recorded preoperatively and during follow-up at 10–15 days, 1–3 months, 6 months, and 1 year postoperatively using a standardized circumferential method. Lymphedema was defined as a ≥10% increase in the volume difference between the operated and contralateral arm relative to the individual baseline inter-arm difference. Demographic, clinical, and treatment-related variables, including the axillary surgical procedure, radiotherapy, chemotherapy, body mass index, and number of removed lymph nodes, were analyzed. Univariate and multivariable logistic regression analyses were performed to identify potential risk factors associated with lymphedema development.RESULTS: Lymphedema developed in 18 (15.1%) of 119 patients. The incidence of lymphedema was significantly higher in patients who underwent axillary lymph node dissection (ALND; 24.4%) than in those who underwent sentinel lymph node biopsy (SLNB; 10.3%, p = 0.040). No significant association was observed between axillary radiotherapy and lymphedema development (p = 0.809). No variables remained statistically significant after multivariable adjustment. However, ALND showed a trend toward an increased risk of lymphedema (odds ratio [OR] 6.14, 95% confidence interval [CI] 0.91–41.49, p = 0.063), whereas neoadjuvant chemotherapy (NACT) showed a trend toward a reduced risk (OR 0.34, 95% CI 0.10–1.19, p = 0.091).CONCLUSIONS: In univariable analyses, ALND was associated with a higher occurrence of lymphedema following breast cancer surgery. However, no variable remained statistically significant after multivariable adjustment, likely reflecting the limited number of lymphedema events and the resulting limited statistical power. In this cohort, NACT was not associated with an increased risk of lymphedema. Although exploratory subgroup analyses suggested a lower incidence of lymphedema among patients undergoing SLNB following NACT, these findings should be interpreted cautiously given the limited subgroup size and require confirmation in larger prospective studies. These findings support ongoing efforts to minimize unnecessary axillary dissection whenever oncologically appropriate.