Identification of Potential Factors Associated with Cellulitis Following Lymphovenous Bypass Surgery in Breast Cancer Survivors

Abstract

Background Breast cancer is one of the most common types of cancer, with around 2.3 million cases diagnosed in 2020. One in five cancer patients develops chronic lymphedema caused by multifactorial triggers and treatment-related factors. This can lead to swelling, skin infections, and limb dysfunction, negatively affecting the patient's quality of life. This retrospective cohort study aimed to determine the associations between demographic and breast cancer characteristics and postoperative cellulitis in breast cancer survivors who underwent lymphovenous bypass surgery (LVB) at Mayo Clinic, Florida.

Methods We performed a retrospective chart review. Data were collected retrospectively from 2016 to 2022. Sixty adult breast cancer survivors who underwent LVB were included in the final analysis based on specific inclusion and exclusion criteria. Patients were excluded if they did not meet the inclusion criteria or had incomplete follow-up data. Demographic and surgical data were extracted, including body mass index (BMI), type of anastomosis, number of anastomoses, and preoperative cellulitis status. Lymphedema measurements were performed using tape measurements. Fisher's exact test was used to determine statistically significant associations between variables and postoperative cellulitis.

Results Postoperative cellulitis was more common in patients aged 60 to 69 years (43.2%), whites (75.0%), overweight or obese (90.9%), with one to four anastomoses (81.8%), and nonsmokers (79.5%). The mean International Society of Lymphology (ISL) criteria for both postoperative cellulitis and no postoperative cellulitis was 1.93. Statistically significant associations with postoperative cellulitis were found for the number of anastomoses (p = 0.021), smoking status (p = 0.049), preoperative cellulitis (p = 0.04), and the length of years with lymphedema diagnosis variable (p = 0.004).

Conclusion Our results suggest that a greater number of anastomoses, smoking, preoperative cellulitis, and years with lymphedema are significantly associated with an increased risk of postoperative cellulitis. Awareness of these risk factors is crucial for monitoring and early treatment of infections following surgery.

Keywords

lymphovenous bypass - postoperative complications - breast cancer - breast cancer lymphedema - plastic surgery

Author Contributions

R.A.T. was responsible for conceptualization and methodology and original draft preparation (writing). Validation was done by R.A.T., F.R.A., K.M., C.A.G., S.B., A.S.E., and J.P.G. Investigation was done by R.A.T., F.R.A., S.A.H., S.B., K.M., A.S.E., and J.P.G. Resources were provided by A.J.F., R.A.T., F.R.A., K.M., A.S.E., S.A.H., S.M.P., and J.P.G. Data curation was done by R.A.T., F.R.A., K.M., and J.P.G. Review and editing (writing) were done by R.A.T., F.R.A., S.A.H., S.M.P., K.M., A.S.E., O.A.H., and J.P.G. Visualization was done by R.A.T., C.A.G., S.B., F.R.A., K.M., and J.P.G. A.J.F. and O.A.H. supervised the study. A.J.F. was also responsible for project administration.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of Mayo Clinic (protocol code 18–009486).

Informed Consent Statement

Informed consent was obtained from all the patients involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to patient data protection.

Publication History

Received: 05 January 2024

Accepted: 22 June 2024

Article published online:
22 July 2024

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