Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: Over 4 years follow-up

Abstract

Breast cancer-related lymphedema (LE) represents an important morbidity that jeopardizes breast cancer patients' quality of life. Different attempts to prevent LE brought about improvements in the incidence of the pathology but LE still represents a frequent occurrence in breast cancer survivors. Over 4 years ago, Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) was proposed and long-term results are reported in this study. From July 2008 to December 2012, 74 patients underwent axillary nodal dissection for breast cancer treatment together with LYMPHA procedure. Volumetry was performed preoperatively in all patients and after 1, 3, 6, 12 months, and once a year. Lymphoscintigraphy was performed in 45 patients preoperatively and in 30 also postoperatively after at least over 1 year. Seventy one patients had no sign of LE, and volumetry was coincident to preoperative condition. In three patients, LE occurred after 8-12 months postoperatively. Lymphoscintigraphy showed the patency of lymphatic-venous anastomoses at 1-4 years after operation. LYMPHA technique represents a successful surgical procedure for primary prevention of arm LE in breast cancer patients.

Prevention of Postsurgical Lymphedema by 9-cis Retinoic Acid

“…For example, lymphatico-venous microsurgical anastamosis to maintain lymphatic outflow at the time of mastectomy and lymphadenectomy has shown promising results in preventing primary breast cancer-related lymphedema. 26 Pharmacologic agents that stimulate lymphangiogenesis, such as VEGF-C, may also have a role in the management of postsurgical lymphedema. 11 To assess novel surgical techniques and pharmacological therapies for lymphedema, it is imperative to develop clinically relevant and physiologically accurate animal models where controlled studies can be performed.…”

LYMPHA Technique to Prevent Secondary Lower Limb Lymphedema

“…Despite the numerous efforts to reduce complication rates after ilioinguinal lymphadenectomy, the treatment and prevention of lymphedema remains a true challenge. 1,2 In our study, multiple lymphatic-venous anastomoses (MLVA) was performed immediately after groin dissection (lymphatic microsurgical preventive healing approach [LYMPHA] 3,4 ). This report describes the LYMPHA procedure in the groin and its implications for morbidity and lymphedema prevention.…”

The changing role of axillary treatment in breast cancer: Who will remain at risk for developing arm morbidity in the future?

“…In cases where crossover of SLNB/ALND and ARM-nodes are present in the axillary dissection plain, lymphatic venous anastomosis are made after dissection in order to restore the upper-extremity lymphatic drainage system. After a 4-year follow-up, the Boccardo group reported a lymphedema incidence rate of 4% (3/74) [36]. Although it concerns only a small study, these results are quite promising, when compared with the incidence of BCRL after ALND and SLNB, 20% and 6% respectively [4].…”