Marcela Ponzio Pinto e Silva

Movimento do ombro após cirurgia por carcinoma invasor da mama: estudo randomizado prospectivo controlado de exercícios livres versus limitados a 90º no pós-operatório

PURPOSE: to evaluate the efficacy of a physical exercise protocol in the recovery of shoulder movement in women who underwent complete axillary lymph node dissection due to breast carcinoma, comparing free and restricted amplitude movements. METHODS: 59 women who underwent complete axillary lymph node dissection associated with modified mastectomy (46) or quadrantectomy (13) were included in this clinical, prospective and randomized study. On the first day after surgery 30 women were randomized to do the shoulder movement with free amplitude and 29 women had this amplitude restricted to 90o in the first 15 days. Nineteen exercises were done, three sessions per week, for six weeks. Mean (± standard error) deficits of shoulder flexion and abduction were compared, as well as gross and adjusted incidence rates of seroma and dehiscence. RESULTS: 42 days after surgery, flexion and abduction means were similar in the two groups. Both presented a mean flexion deficit (17.2o and 21.6o, respectively), and abduction deficit (19.7o and 26.6o, respectively). The incidence rates of seroma and dehiscence were neither related to exercise nor to the type of surgery, time of drain permanence, number of dissected or compromised lymph nodes, age or obesity. CONCLUSION: early physiotherapy with free movement of the womens shoulder was associated neither with functional capacity nor with postsurgical complications.

Immediate breast reconstruction with transverse latissimus dorsi flap does not affect the short-term recovery of shoulder range of motion after mastectomy.

Immediate breast reconstruction, depending on the surgical strategy, can result in anatomic modifications that may affect the shoulder apparatus. This study compares the recovery of shoulder range of motion (ROM), after mastectomy, in women with and without immediate breast reconstruction with latssimus dorsi flap (LDF). This was a prospective study with 87 women who underwent mastectomy (41 with LDF). Shoulder ROM was assessed with goniometry, with a universal full-circle manual goniometer, prior to surgery, and on a weekly basis during the first 4 weeks postoperatively. Reconstruction with LDF was not associated with a decrease in shoulder ROM (P = 0.84). By the end of the 4-week assessment program, women in both groups still had an average reduction of 30 degrees in their shoulder ROM compared with baseline. Factors significantly associated with a reduction in shoulder ROM during the recovery period were complete dissection of the axilla, current smoking behavior, and presence of painful axillary cords. It is likely that breast reconstruction with LDF has little or no effect on shoulder ROM in the immediate postoperative period. It is also possible that LDF effects (if any) are overridden by the major reduction (over 30% in the immediate postoperative period, subsiding partially during the first weeks postoperatively) in shoulder ROM caused by mastectomy.

Exercícios para membros superiores durante radioterapia para câncer de mama e qualidade de vida

PURPOSE To assess the influence of physiotherapy performed during radiotherapy (RT) on the quality of life (QL) of women under treatment for breast cancer. METHODS This was a randomized clinical trial conducted on 55 women under RT treatment, 28 of whom were assigned to a group submitted to physiotherapy (PG) and 27 to the control group receiving no PG (CG). The physiotherapy technique used for PG was kinesiotherapy for the upper limbs using 19 exercises actively performed, with a series of ten rhythmic repetitions or stretching movements involving flexion, extension, abduction, adduction, internal and external shoulder rotation, separate or combined. QL was evaluated using the Functional Assessment of Cancer Therapy-Breast (FACT-B), at the beginning and at the end of RT and six months after the end of RT. The physiotherapy sessions were started concomitantly with RT, 90 days after surgery, on average. RESULTS There was no difference between subgroups regarding the following subscales: physical well-being (p=0.8), social/family well-being (p=0.3), functional well-being (p=0.2) and breast subscale (p=0.2) at the three time points assessed. A comparison of the emotional subscale applied at the three evaluations demonstrated a better behavior of PG as compared to CG (p=0.01), with both groups presenting improvement on the breast subscale between the beginning and the end of RT (PG p=0.0004 and CG p=0.003). There was improvement in FACT-B scores at the end of RT in both groups (PG p=0.0006 and CG p=0.003). However, at the sixth month after RT, this improvement was maintained only in PG (p=0,005). QL assessed along time by the FACT B (p=0.004) and the Trial Outcome Index (TOI) (sums of the physical and functional well-being subscales and of the breast subscale) was better for PG (p=0.006). There was no evidence of negative effects associated with the exercises. CONCLUSIONS The execution of exercises for the upper limbs was beneficial for QL during and six months after RT.

Manual lymphatic drainage versus exercise in the early postoperative period for breast cancer

Abstract Objective: To compare the effect of active exercise and manual lymphatic drainage (MLD) on postoperative wound healing complications, shoulder range of motion (ROM) and upper limb (UL) perimetry in women undergoing radical mastectomy for breast cancer. Methods: Controlled non-randomized clinical trial with 89 women undergoing breast cancer surgery with axillary lymph node dissection (Brazilian Registry of Clinical Trials: 906). Women were matched for staging, age and body mass index, with 46 women allocated to the exercise group and 43 in the MLD group, receiving 2 weekly sessions during one month. Assessments were performed in the preoperative and 60 d after surgery, including inspection, palpation, goniometry and perimetry. Results: No significant difference existed between groups relative to individual and clinical surgical characteristics. The incidence of seroma, number of punctures performed, dehiscence and infection was similar in both groups. A comparison of shoulder ROM and UL perimetry between groups, obtained in the preoperative and postoperative period, did not show any significant difference. Conclusion: The performance of active exercise or MLD did not demonstrate difference in wound healing complications, shoulder ROM and UL perimetry at 60 d after surgery, suggesting that these techniques may be employed, according to the complaints or symptoms of each woman and physical therapist experience.

Influencia del índice de masa corporal en la frecuencia de linfedema y otras complicaciones después de la cirugía para el cáncer de mama

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. Jose Aristodemo Pinotti Womens Hospital of the Center for Integral Womens 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.Avaliou-se a influencia do indice de massa corporal (IMC) pre-operatoria na ocorrencia de linfedema, aderencia cicatricial, dor e peso no membro superior nos primeiros dois anos apos cirurgia para câncer de mama. O estudo e uma analise retrospectiva, secundaria de 631 prontuarios de mulheres submetidas a cirurgia para câncer de mama e encaminhadas ao Programa de Fisioterapia do Hospital Professor Dr. Jose Aristodemo Pinotti do Centro de Atencao Integral a Saude da Mulher, CAISM /UNICAMP, entre janeiro de 2006 e dezembro de 2007. Eram mulheres com idade media de 56,5 anos (±13,7 anos), a maioria (55%) com sobrepeso ou obesa. Os estadios clinicos 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 apos a cirurgia nao houve associacao significativa entre as categorias do indice de massa corporal e incidencia de aderencia 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 diferenca significativa entre as categorias de indice de massa corporal (p=0,0268). Mulheres obesas tem 3,6 vezes mais chance de desenvolver linfedema no segundo ano apos 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 apos a cirurgia. Nao houve associacao entre IMC e outras complicacoes.

Influência da massa corporal na frequência de linfedema e outras complicações depois de cirurgia para câncer de mama

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. Jose Aristodemo Pinotti Womens Hospital of the Center for Integral Womens 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.Avaliou-se a influencia do indice de massa corporal (IMC) pre-operatoria na ocorrencia de linfedema, aderencia cicatricial, dor e peso no membro superior nos primeiros dois anos apos cirurgia para câncer de mama. O estudo e uma analise retrospectiva, secundaria de 631 prontuarios de mulheres submetidas a cirurgia para câncer de mama e encaminhadas ao Programa de Fisioterapia do Hospital Professor Dr. Jose Aristodemo Pinotti do Centro de Atencao Integral a Saude da Mulher, CAISM /UNICAMP, entre janeiro de 2006 e dezembro de 2007. Eram mulheres com idade media de 56,5 anos (±13,7 anos), a maioria (55%) com sobrepeso ou obesa. Os estadios clinicos 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 apos a cirurgia nao houve associacao significativa entre as categorias do indice de massa corporal e incidencia de aderencia 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 diferenca significativa entre as categorias de indice de massa corporal (p=0,0268). Mulheres obesas tem 3,6 vezes mais chance de desenvolver linfedema no segundo ano apos 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 apos a cirurgia. Nao houve associacao entre IMC e outras complicacoes.

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

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. Jose Aristodemo Pinotti Womens Hospital of the Center for Integral Womens 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.Avaliou-se a influencia do indice de massa corporal (IMC) pre-operatoria na ocorrencia de linfedema, aderencia cicatricial, dor e peso no membro superior nos primeiros dois anos apos cirurgia para câncer de mama. O estudo e uma analise retrospectiva, secundaria de 631 prontuarios de mulheres submetidas a cirurgia para câncer de mama e encaminhadas ao Programa de Fisioterapia do Hospital Professor Dr. Jose Aristodemo Pinotti do Centro de Atencao Integral a Saude da Mulher, CAISM /UNICAMP, entre janeiro de 2006 e dezembro de 2007. Eram mulheres com idade media de 56,5 anos (±13,7 anos), a maioria (55%) com sobrepeso ou obesa. Os estadios clinicos 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 apos a cirurgia nao houve associacao significativa entre as categorias do indice de massa corporal e incidencia de aderencia 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 diferenca significativa entre as categorias de indice de massa corporal (p=0,0268). Mulheres obesas tem 3,6 vezes mais chance de desenvolver linfedema no segundo ano apos 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 apos a cirurgia. Nao houve associacao entre IMC e outras complicacoes.