Influence of body mass index on the frequency of lymphedema and other complications after surgery for breast cancer

Avaliou-se a influência do índice de massa corporal (IMC) pré-operatória na ocorrência de linfedema, aderência cicatricial, dor e peso no membro superior nos primeiros dois anos após cirurgia para câncer de mama. O estudo é uma análise retrospectiva, secundária de 631 prontuários de mulheres submetidas à cirurgia para câncer de mama e encaminhadas ao Programa de Fisioterapia do Hospital Professor Dr. José Aristodemo Pinotti do Centro de Atenção Integral à Saúde da Mulher, CAISM /UNICAMP, entre janeiro de 2006 e dezembro de 2007. Eram mulheres com idade média de 56,5 anos (±13,7 anos), a maioria (55%) com sobrepeso ou obesa. Os estádios clínicos II e III foram encontrados em 63% das mulheres. Mastectomia radical foi a cirurgia mais frequente (54,4%), seguida por quadrantectomia (32,1%). No primeiro ano após a cirurgia não houve associação significativa entre as categorias do índice de massa corporal e incidência de aderência cicatricial, dor, peso e linfedema. No segundo ano, mulheres com sobrepeso e obesidade apresentaram maiores taxas de peso no membro superior e linfedema. Para linfedema houve diferença significativa entre as categorias de índice de massa corporal (p=0,0268). Mulheres obesas têm 3,6 vezes mais chance de desenvolver linfedema no segundo ano após a cirurgia (odds ratio 3,61 95% IC 1,36-9,41). Concluiu-se que IMC ≥25kg/m2 anterior ao tratamento para câncer de mama pode ser considerado fator de risco para desenvolvimento do linfedema dois anos após a cirurgia. Não houve associação entre IMC e outras complicações.Objective: this study assessed the influence of pre-operative body mass index (BMI) has upon lymphedema, scar tissue adhesion, pain, and heaviness in the upper limb at two years after surgery for breast cancer. Methods: retrospective analysis of 631 medical records of women who underwent surgery for breast cancer and were referred to the Physiotherapy Program at Prof. Dr. José Aristodemo Pinotti Women's Hospital of the Center for Integral Women's Health Care, CAISM/UNICAMP between January 2006 and December 2007. Results: mean age of women was 56.5 years (±13.7 years) and the most part (55%) were overweight or obese, surgical stages II and III were present in 63% of women studied. Radical mastectomy was the most frequent surgery (54.4%), followed by quadrantectomy (32.1%). In the first year after surgery, there was no significant association between BMI categories and incidence of scar tissue adhesion, pain, heaviness and lymphedema. In the second year, overweight and obese women had higher rates of heaviness in the upper limb and lymphedema. For lymphedema, there was a significant difference among BMI categories (p=0.0268). Obese women are 3.6 times more likely to develop lymphedema in the second year after surgery (odds ratio 3.61 95% CI 1.36 to 9.41). Conclusion: BMI ≥25kg/m2 prior to treatment for breast cancer can be considered a risk factor for developing lymphedema in the two years after surgery. There was no association between BMI and the development of other complications.Evaluación la influencia del índice de masa corporal preoperatorio, la aparición de linfedema, la adhesión de tejido cicatrizal, dolor y pesadez en los dos primeros años después de la cirugía para el cáncer de mama. Método: análisis retrospectivo de 631 historias clínicas de mujeres sometidas a cirugía para el cáncer de mama y encaminadas al Programa de Fisioterapia do Centro de Atención Integral de la Salud de la Mujer - Professor Dr. José Aristodemo Pinotti - CAISM /UNICAMP entre enero de 2006 y diciembre de 2007. Resultados: mujeres de mediana edad 56,5 años (±13,7 años), 55% tenían sobrepeso u obesidad. Etapas II y III del cáncer se encontraron en el 63% de las mujeres. Cirugía de mastectomía radical fue la más frecuente (54,4%), seguido de cuadrantectomía (32,1%). En el primer año después de la cirugía no hubo asociación significativa entre categorías de índice de masa corporal y incidencia de la adhesión del tejido de cicatriz, dolor, peso y linfedema. En el segundo año, sobrepeso y obesidad tenían mayores tasas de peso y linfedema. Para linfedema hubo diferencias significativas entre categorías de índice de masa corporal (p=0,0268). Las mujeres obesas tienen 3,6 veces más probabilidades de desarrollar linfedema en el segundo año después de la cirugía (odds ratio 3,61 IC del 95%: 1,36 a 9,41). La conclusión és índice de masa corporal ≥25kg/m2 antes del tratamiento para el cáncer de mama puede ser considerado un factor de riesgo para desarrollo de linfedema, dos años después de la cirugía. No hubo asociación entre el índice de masa corporal y otras complicaciones

Interleukin-17A negatively regulates lymphangiogenesis in T helper 17 cell-mediated inflammation

During inflammation lymphatic vessels (LVs) are enlarged and their density is increased to facilitate the migration of activated immune cells and antigens. However, after antigen clearance, the expanded LVs shrink to maintain homeostasis. Here we show that interleukin (IL)-17A, secreted fromT helper type 17 (T(H)17) cells, is a negative regulator of lymphangiogenesis during the resolution phase of T(H)17-mediated immune responses. Moreover, IL-17A suppresses the expression of major lymphatic markers in lymphatic endothelial cells and decreases in vitro LV formation. To investigate the role of IL-17A in vivo, we utilized a cholera toxin-mediated inflammation model and identified inflammation and resolution phases based on the numbers of recruited immune cells. IL-17A, markedly produced by T(H)17 cells even after the peak of inflammation, was found to participate in the negative regulation of LV formation. Moreover, blockade of IL-17A resulted in not only increased density of LVs in tissues but also their enhanced function. Taken together, these findings improve the current understanding of the relationship between LVs and inflammatory cytokines in pathologic conditions.

Inguinal hernia after radical retropubic prostatectomy: risk factors and prevention

The two most frequently occurring and well-described complications of radical retropubic prostatectomy (RRP) for prostate cancer are incontinence and impotence. Inguinal hernia (IH) has, over the last decade, emerged as an additional complication, with an estimated incidence of 15-20% after RRP. IH is a common lesion in men aged between 50 and 70 years with or without prostate cancer, and the literature indicates that annual incidence is somewhere between 0.5% and 1% in the general male population. Important risk factors for the development of post-RRP IH are previous IH surgery, increasing age, and low BMI. However, subclinical IH at the time of RRP and a lower midline incision seem to be the most important causative factors. Prophylactic procedures and, in the case of clinically detectable IH lesions, concurrent repair during RRP are advocated. Reports on alternative approaches to RRP, such as minilaparotomy RRP, laparoscopic radical prostatectomy (including robot-assisted procedures) and radical perineal prostatectomy have indicated low rates of postoperative IH. The risk of developing IH after prostatectomy should be part of the preoperative risk assessment when making treatment decisions for patients with prostate cancer