{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T06:14:57Z","timestamp":1773296097204,"version":"3.50.1"},"reference-count":33,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Background\u2003Postmastectomy secondary lymphedema can cause substantial morbidity. However, few studies have investigated longitudinal quality of life (QoL) outcomes in patients with postmastectomy lymphedema, especially with regard to surgical versus nonoperative management. This study prospectively investigated QoL in surgically versus nonsurgically managed patients with postmastectomy upper extremity lymphedema.<\/jats:p><jats:p>Methods\u2003This was a longitudinal cohort study of breast cancer-related lymphedema patients at a single institution, between February 2017 and January 2020. Lymphedema Quality of Life Instrument (LyQLI) and RAND-36 QoL instrument were used. Mann\u2013Whitney U and Fisher's exact tests were used for descriptive statistics. Wilcoxon's signed-rank testing and linear modeling were used to analyze longitudinal changes in QoL.<\/jats:p><jats:p>Results\u2003Thirty-two lymphedema patients were recruited to the study (20 surgical and 12 nonsurgical). Surgical and nonsurgical cohorts did not significantly differ in clinical\/demographic characteristics or baseline QoL scores, but at the 12-month time point surgical patients had significantly greater LyQLI overall health scores than nonsurgical patients (79.3 vs. 58.3, p\u2009=\u20090.02), as well as higher composite RAND-36 physical (68.5 vs. 38.3, p\u2009=\u20090.04), and mental (77.0 vs. 52.7, p\u2009=\u20090.02) scores. Furthermore, LyQLI overall health scores significantly improved over time in surgical patients (60.0 at baseline vs. 79.3 at 12 months, p\u2009=\u20090.04). Besides surgical treatment, race, and age were also found to significantly impact QoL on multivariable analysis.<\/jats:p><jats:p>Conclusion\u2003Our results suggest that when compared with nonoperative management, surgery improved QoL for chronic, secondary upper extremity lymphedema patients within 12-month postoperatively. Our results also suggested that insurance status may have influenced decisions to undergo lymphedema surgery. Further study is needed to investigate the various sociodemographic factors that were also found to impact QoL outcomes in these lymphedema patients.<\/jats:p>","DOI":"10.1055\/s-0040-1713667","type":"journal-article","created":{"date-parts":[[2020,7,5]],"date-time":"2020-07-05T22:40:22Z","timestamp":1593988822000},"page":"606-615","source":"Crossref","is-referenced-by-count":9,"title":["Surgical versus Nonsurgical Management of Postmastectomy Lymphedema: A Prospective Quality of Life Investigation"],"prefix":"10.1055","volume":"36","author":[{"given":"Halley","family":"Darrach","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6643-0909","authenticated-orcid":false,"given":"Pooja S.","family":"Yesantharao","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Persing","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Kokosis","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah M.","family":"Carl","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Bridgham","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Seu","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"Stifler","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin M.","family":"Sacks","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,7,5]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1196\/annals.1413.014","article-title":"Estimating the population burden of lymphedema","volume":"1131","author":"S G Rockson","year":"2008","journal-title":"Ann N Y Acad Sci"},{"issue":"02","key":"ref2","first-page":"324","article-title":"Lower extremity lymphedema update: pathophysiology, diagnosis, and treatment guidelines","volume":"59","author":"K Kerchner","year":"2008","journal-title":"J Am Acad Dermatol"},{"issue":"22","key":"ref3","doi-asserted-by":"crossref","first-page":"5138","DOI":"10.1002\/cncr.25458","article-title":"Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema","volume":"116","author":"J N Cormier","year":"2010","journal-title":"Cancer"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"8","DOI":"10.3322\/caac.20001","article-title":"Lymphedema: a primer on the identification and management of a chronic condition in oncologic treatment","volume":"59","author":"B D Lawenda","year":"2009","journal-title":"CA Cancer J Clin"},{"issue":"04","key":"ref5","first-page":"170","article-title":"The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the international society of lymphology","volume":"49","author":"Executive Committee","year":"2016","journal-title":"Lymphology"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1055\/s-0037-1599100","article-title":"Systematic review of the surgical treatment of extremity lymphedema","volume":"33","author":"H M Carl","year":"2017","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"209S","DOI":"10.1097\/PRS.0000000000002683","article-title":"Lymphedema","volume":"138","author":"D W Chang","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/j.1742-4801.2005.00066.x","article-title":"Health-related quality of life with lymphoedema: a review of the literature","volume":"2","author":"P A Morgan","year":"2005","journal-title":"Int Wound J"},{"issue":"12","key":"ref9","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1200\/JCO.2008.18.3517","article-title":"Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study","volume":"27","author":"Y-CT Shih","year":"2009","journal-title":"J Clin Oncol"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1089\/lrb.2009.0004","article-title":"The psycho-social impact of lymphedema","volume":"7","author":"S H Ridner","year":"2009","journal-title":"Lymphat Res Biol"},{"key":"ref11","volume-title":"Lymphedema","author":"B C Sleigh","year":"2019"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"80e","DOI":"10.1097\/PRS.0000000000003912","article-title":"Vectra 3D Imaging for quantitative volumetric analysis of the upper limb: a feasibility study for tracking outcomes of lymphedema treatment","volume":"141","author":"M J Landau","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1016\/j.bjps.2019.01.029","article-title":"Postmastectomy upper limb lymphedema: Combined vascularized lymph node transfer and scar release with fat graft expedites surgical and patients' related outcomes. A retrospective comparative study","volume":"72","author":"M Maruccia","year":"2019","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"350","DOI":"10.3109\/07853890109002089","article-title":"The RAND-36 measure of health-related quality of life","volume":"33","author":"R D Hays","year":"2001","journal-title":"Ann Med"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s11136-014-0783-8","article-title":"Lymphedema Quality of Life Inventory (LyQLI)-development and investigation of validity and reliability","volume":"24","author":"P Klern\u00e4s","year":"2015","journal-title":"Qual Life Res"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1089\/lrb.2017.0048","article-title":"Test of responsiveness and sensitivity of the questionnaire \u201clymphedema quality of life inventory\u201d","volume":"16","author":"P Klern\u00e4s","year":"2018","journal-title":"Lymphat Res Biol"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/j.amjsurg.2016.08.016","article-title":"Reliable prediction of postmastectomy lymphedema: the risk assessment tool evaluating lymphedema","volume":"213","author":"M N Basta","year":"2017","journal-title":"Am J Surg"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.4081\/hpr.2013.932","article-title":"Quality of life in chronic disease patients","volume":"1","author":"K Megari","year":"2013","journal-title":"Health Psychol Res"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/jso.25523","article-title":"Factors associated with professional healthcare advice seeking in breast cancer-related lymphedema","volume":"121","author":"C-Y Lin","year":"2020","journal-title":"J Surg Oncol"},{"issue":"09","key":"ref20","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1631\/jzus.2005.B0936","article-title":"A systematic review: how to choose appropriate health-related quality of life (HRQOL) measures in routine general practice?","volume":"6","author":"T-H Chen","year":"2005","journal-title":"J Zhejiang Univ Sci B"},{"issue":"02","key":"ref21","first-page":"115","article-title":"The use of MRI in the diagnosis of chronic lymphedema of the lower extremity","volume":"13","author":"R Haaverstad","year":"1994","journal-title":"Int Angiol"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1080\/028418501127346909","article-title":"MR imaging of primary, secondary, and mixed forms of lymphedema","volume":"42","author":"K G Astr\u00f6m","year":"2001","journal-title":"Acta Radiol"},{"issue":"02","key":"ref23","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.ejrad.2008.10.041","article-title":"Chronic lower extremity lymphedema: a comparative study of high-resolution interstitial MR lymphangiography and heavily T2-weighted MRI","volume":"73","author":"Q Lu","year":"2010","journal-title":"Eur J Radiol"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1089\/lrb.2017.0086","article-title":"Complex decongestive therapy in breast cancer-related lymphedema: does obesity affect the outcome negatively?","volume":"17","author":"B Duyur Cak\u0131t","year":"2019","journal-title":"Lymphat Res Biol"},{"issue":"03","key":"ref26","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1097\/SAP.0000000000001228","article-title":"A cross-sectional study of variations in reimbursement for breast reconstruction: is a healthcare disparity on the horizon?","volume":"80","author":"E B Odom","year":"2018","journal-title":"Ann Plast Surg"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s10585-018-9897-7","article-title":"Lymphedema surgery: the current state of the art","volume":"35","author":"J W Granzow","year":"2018","journal-title":"Clin Exp Metastasis"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s10549-016-3913-x","article-title":"Race\/ethnicity, genetic ancestry, and breast cancer-related lymphedema in the Pathways Study","volume":"159","author":"M L Kwan","year":"2016","journal-title":"Breast Cancer Res Treat"},{"issue":"08","key":"ref30","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1001\/jamasurg.2014.23","article-title":"Racial disparities in adoption of axillary sentinel lymph node biopsy and lymphedema risk in women with breast cancer","volume":"149","author":"D M Black","year":"2014","journal-title":"JAMA Surg"},{"issue":"06","key":"ref31","doi-asserted-by":"crossref","first-page":"e0218462","DOI":"10.1371\/journal.pone.0218462","article-title":"Racial\/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults","volume":"14","author":"A R Qui\u00f1ones","year":"2019","journal-title":"PLoS One"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"E76","DOI":"10.5888\/pcd14.160613","article-title":"Differences between younger and older US adults with multiple chronic conditions","volume":"14","author":"M L Adams","year":"2017","journal-title":"Prev Chronic Dis"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1002\/micr.30079","article-title":"Comprehensive review of vascularized lymph node transfers for lymphedema: outcomes and complications","volume":"38","author":"M F Scaglioni","year":"2018","journal-title":"Microsurgery"},{"issue":"08","key":"ref34","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1002\/micr.30246","article-title":"Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema","volume":"37","author":"M F Scaglioni","year":"2017","journal-title":"Microsurgery"},{"issue":"07","key":"ref35","doi-asserted-by":"crossref","first-page":"2424","DOI":"10.1245\/s10434-014-4276-3","article-title":"A prospective evaluation of lymphedema-specific quality-of-life outcomes following vascularized lymph node transfer","volume":"22","author":"K M Patel","year":"2015","journal-title":"Ann Surg Oncol"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1713667.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T12:34:23Z","timestamp":1696336463000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1713667"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,5]]},"references-count":33,"journal-issue":{"issue":"08","published-online":{"date-parts":[[2020,9,1]]},"published-print":{"date-parts":[[2020,10]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1713667","relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,5]]}}}