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Journal of Cancer Survivorship

, Volume 9, Issue 4, pp 576–598 | Cite as

A systematic review of axillary web syndrome (AWS)

  • W. M. YeungEmail author
  • S. M. McPhail
  • S. S. Kuys
Review

Abstract

Introduction

Axillary web syndrome (AWS) can result in early post-operative and long-term difficulties following lymphadenectomy for cancer and should be recognised by clinicians. This systematic review was conducted to synthesise information on AWS clinical presentation and diagnosis, frequency, natural progression, grading, pathoaetiology, risk factors, symptoms, interventions and outcomes.

Methods

Electronic searches were conducted using Cochrane, Pubmed, MEDLINE, CINAHL, EMBASE, AMED, PEDro and Google Scholar until June 2013. The methodological quality of included studies was determined using the Downs and Black checklist. Narrative synthesis of results was undertaken.

Results

Thirty-seven studies with methodological quality scores ranging from 11 to 26 on a 28-point scale were included. AWS diagnosis relies on inspection and palpation; grading has not been validated. AWS frequency was reported in up to 85.4 % of patients. Biopsies identified venous and lymphatic pathoaetiology with five studies suggesting lymphatic involvement. Twenty-one studies reported AWS occurrence within eight post-operative weeks, but late occurrence of greater than 3 months is possible. Pain was commonly reported with shoulder abduction more restricted than flexion. AWS symptoms usually resolve within 3 months but may persist. Risk factors may include extensiveness of surgery, younger age, lower body mass index, ethnicity and healing complications. Low-quality studies suggest that conservative approaches including analgesics, non-steroidal anti-inflammatory drugs and/or physiotherapy may be safe and effective for early symptom reduction.

Conclusions

AWS appears common. Current evidence for the treatment of AWS is insufficient to provide clear guidance for clinical practice.

Implications for Cancer Survivors

Cancer survivors should be informed about AWS. Further investigation is needed into pathoaetiology, long-term outcomes and to determine effective treatment using standardised outcomes.

Keywords

Axillary web syndrome Axillary lymphadenectomy Breast cancer Melanoma Post-operative morbidity Pain 

Notes

Conflicts of interest

W M Yeung, S M McPhail and S S Kuys declare that they have no conflict of interest.

Supplementary material

11764_2015_435_MOESM1_ESM.docx (17 kb)
Supplementary 1 (DOCX 17 kb)
11764_2015_435_MOESM2_ESM.docx (23 kb)
Supplementary 2 (DOCX 22 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of PhysiotherapyPrincess Alexandra Hospital, Metro South Hospital and Health ServiceBrisbaneAustralia
  2. 2.Principal Research Fellow, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
  3. 3.Centre for Functioning and Health ResearchMetro South Hospital and Health ServiceBrisbaneAustralia
  4. 4.Allied Health Research CollaborativeMetro North Hospital and Health ServiceBrisbaneAustralia
  5. 5.School of Allied Health Sciences, Griffith Health InstituteGriffith UniversityGold CoastAustralia

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