Feasibility study of combined dynamic imaging and lymphaticovenous anastomosis surgery for breast cancer-related lymphoedema

Abstract

Background Breast cancer‐related lymphoedema (BCRL) presents a significant healthcare burden and adversely affects quality of life of breast cancer survivors. A prospective feasibility study was performed on lymphaticovenous anastomosis (LVA) for the treatment of BCRL. Methods Patients with BCRL underwent near‐infrared spectroscopy with indocyanine green lymphatic mapping to identify suitable lymphatic channels for LVA. End‐to‐end anastomoses to subdermal venules were performed and patients recommenced compression garment therapy (CGT) after surgery. Volumetric assessment of the affected limb was performed at regular intervals using infrared perometry to calculate the excess volume reduction. Results Over a 24‐month interval, 27 patients with BCRL underwent LVA. The mean duration of lymphoedema was 3·5 (range 0·5–18) years, and the mean number of LVAs performed was 3 (range 2–5). Twenty‐four of the 27 patients completed 12‐month follow‐up. Patients exhibited three patterns of volumetric response following LVA: sustained response (16 patients), transient response (5) or no response (6). Sustained responders showed an excess volume reduction of −33·2 per cent at 12 months, and this correlated positively with the number of LVAs performed (r = −0·56, P = 0·034). Overall, ten patients were able to downgrade CGT after surgery, and two patients were CGT‐free at 12 months. Conclusion LVA resulted in a sustained volume reduction in selected patients and may offset the burden of CGT. Further work is required to identify biomarkers that predict a favourable response to LVA surgery.

Lymphedema in survivors of breast cancer (Review)

“…An altered and simplified version of LYMPHA used during the surgery of ALND dramatically decreases the lymphedema rate to 3% compared with ALND alone, which has a higher rate of 13% (114). Two pilot studies proposed a new technique called 'dynamic-lymphaticovenular anastomosis,' which uses preoperative dynamic imaging of the forearm to determine the incision points followed by microsurgery of LVA (115,116). This technique achieves significant reduction of excess limb volume compared with conventional LVA and results in no swelling rebound after postoperative degradation or removal of compression garments in a 12 month follow up period (115,116).…”

Surgical treatment algorithm for breast cancer lymphedema—a systematic review

“…Geographically, the Netherlands (seven articles) ( 20 , 30 , 31 , 36 , 41 , 48 , 50 ) and Japan (six articles) ( 34 , 39 , 42 , 43 , 45 , 47 ) were the most represented regions/areas in the literature. Other contributing regions/areas included Italy (three articles) ( 27 , 29 , 51 ), France (two articles) ( 35 , 38 ), United Kingdom (two articles) ( 32 , 33 ), United States (two articles), Chile (one article) ( 28 ), Peru (one article) ( 44 ), Korea (one article) ( 46 ) and Taiwan (one article) ( 49 ), see Figure 2 .…”

Lymphatic Reconstruction Following Sarcoma Surgery

“…In this regard, ablative surgical procedures such as liposuction [33] or tissue excision have been described [34], but are not an option of first choice, but rather indicated in advanced lymphedema, when fibrotic tissue transformation has occurred and physiological surgical procedures such as lympholymphatic bypass, LVA or vascularized lymph node transfer are not expected to provide any relief [24]. The surgical gold standard in the treatment of lymphedema includes LVA [35,36], vascularized lymph node flap transfers [37,38] and lymphatic vessel transplantation [39]. However, lymphatic vessel transplantation may result in lymphedema of the donor site and thus, LVA and the transfer of vascularized lymph node flaps is generally preferred.…”