Surgical Options for Lymphedema Following Breast Cancer Treatment

Ketterer, Claire

doi:10.1097/psn.0000000000000036

Cited by 7 publications

(10 citation statements)

References 14 publications

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“…Lymphedema can be a debilitating condition, causing pain, body image disturbances, frequent infections, restrictions in range of motion, and a great decrease in a person’s quality of life (QoL) [ 1 ]. Axillary lymph node dissection, radiation therapy to the axillary region, postoperative seroma in the axillary region, and obesity are major risk factors for the development of lymph edema [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

The efficacy of lymphaticovenular anastomosis in breast cancer-related lymphedema

Winters

Tielemans

Hameeteman

et al. 2017

Breast Cancer Res Treat

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IntroductionLymphedema can be a debilitating condition, causing a great decrease in a person’s quality of life (QoL). Treatment with lymphaticovenular anastomosis (LVA), in which an anastomosis is created between the lymphatic and venous system, may attenuate lymphedema symptoms and reduce swelling. In this study, we share the results using LVA to treat breast cancer-related lymphedema (BCRL) at our institution.Materials and methodsPatients were eligible for inclusion if they suffered from unilateral BCRL, if functional lymphatics were available, if compression therapy was used for at least 6 months, and if the follow-up was 12 months at minimum. Lymph vessel functionality was assessed preoperatively using indocyanine green (ICG). During surgery, 1–3 anastomoses were created and shunt patency was confirmed using ICG. Arm volumes were measured before surgery and at 6- and 12-month follow-up. QoL was measured before surgery and at 6-month follow-up. Arm volume differences between the healthy arm and affected arm were compared between the time points.ResultsTwenty-nine consecutive female patients with unilateral BCRL were included. The preoperative mean difference in arm volumes was 701 ± 435 ml (36.9%). This was reduced to 496 ± 302 ml (24.7%) at 6-month follow-up (p = 0.00). At 12-month follow-up, the mean difference in arm volume was 467 ± 303 ml (23.5%) (p = 0.02). The overall perceived QoL was increased from 5.8 ± 1.1 to 7.4 ± 0.7 (p = 0.00). The functionality score decreased from 2.2 to 1.8 (p = 0.00), the appearance score decreased from 2.6 to 1.9 (p = 0.00), the symptoms score decreased from 2.8 to 1.8 (p = 0.00), and the mood score decreased from 2.7 to 1.5 (p = 0.00). Fifteen patients (53.6%) were able to discontinue the use of compression garment.ConclusionTreatment with LVAs is effective in reducing arm volume difference in patients suffering from BCRL. Although no complete reduction of the edema was achieved at 12-month follow-up, the procedure significantly increased the patients’ QoL.

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Section: Introductionmentioning

confidence: 99%

The efficacy of lymphaticovenular anastomosis in breast cancer-related lymphedema

Winters

Tielemans

Hameeteman

et al. 2017

Breast Cancer Res Treat

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“…Current representative microsurgical treatments for lymphedema are lymphovenous bypass and LNT. [2][3][4][5][6][7][8][9][10][11][12][13] The former is less invasive and can be performed under local anesthesia, whereas the latter has a better outcome in advanced cases. [23][24][25] For patients with BCRL, when simultaneous breast reconstruction is selected, the esthetic result is also of understandable concern.…”

Section: Discussionmentioning

confidence: 99%

“…1 Recently, the usefulness of lymphaticovenular anastomosis (LVA) and vascularized lymph node transfer (LNT) has been reported, each presenting a series of advantages and disadvantages. [2][3][4][5][6][7][8][9][10][11][12][13] It is possible to perform LNT and breast reconstruction simultaneously by transferring lower abdominal tissue and groin lymph nodes. 2,3 Since the purpose of this surgical treatment is to improve the patients' quality of life, it is reasonable to select simultaneous breast reconstruction, which may increase patients' satisfaction.…”

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confidence: 99%

Contribution of Simultaneous Breast Reconstruction by Deep Inferior Epigastric Artery Perforator Flap to the Efficacy of Vascularized Lymph Node Transfer in Patients with Breast Cancer-Related Lymphedema

Akita

Tokumoto

Yamaji

et al. 2017

J reconstr Microsurg

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Background The contribution of simultaneous breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap to the efficacy of vascularized groin lymph node transfer (LNT) for breast cancer-related lymphedema (BCRL) was investigated. Methods Patients were divided into two groups: the first group underwent groin LNT + DIEP flap surgery for simultaneous breast reconstruction (groin LNT + DIEP flap group) and the second group underwent groin LNT only (groin flap alone group). Patients with BCRL were evaluated based on indocyanine green lymphography findings. LNT was indicated only in advanced-stage BCRL cases, and groin nodes nourished by superficial circumflex iliac artery (SCIA) were used as donors. The side for the vascular pedicle(s) was decided based on our algorithm. In patients with pendulous breast, the flap was vertically transferred on the chest. Lymphatic function was assessed after LNT using imaging tests, and transferred lymph nodes were evaluated using ultrasonography. Results In this study, 27 patients with advanced-stage BCRL underwent LNT. Of them, 13 belonged to the groin LNT + DIEP flap group and 14 belonged to the groin flap alone group. Although reduction volume was not significantly different between the groups, the number of patients in whom lymphatic function was improved and the need for compression therapy could be reduced was significantly higher in the groin LNT + DIEP flap group than in the groin flap alone group. Conclusion When a patient with advanced-stage BCRL undergoes LNT based on SCIA, simultaneous breast reconstruction using DIEP flap may reduce the need for compression therapy.

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“…In some areas of the US, pneumatic compression devices may be covered by insurers, but the patient must first fail using a basic PCT pump before being allowed to try an advanced pump. Lymphaticovenous anastomoses and lymph node transplant surgeries have been performed on selected lymphedema patients, and have demonstrated decreased cellulitis incidence and limb swelling in many cases [9–14]. Compression garment use after the surgeries is still required to maintain limb volume reductions in most cases to prevent further lymph and subcutaneous adipose accumulation.…”

Section: Introductionmentioning

confidence: 99%

“…Compression garment use after the surgeries is still required to maintain limb volume reductions in most cases to prevent further lymph and subcutaneous adipose accumulation. Surgical treatment is indicated for patients who do not improve with conservative measures, or for patients in whom the extremity is so large that it impairs daily activities and prevents successful conservative management [9], but US medical insurers do not routinely cover the surgeries.…”

Section: Introductionmentioning

confidence: 99%

Effect of pneumatic compression therapy on lymph movement in lymphedema-affected extremities, as assessed by near-infrared fluorescence lymphatic imaging

Aldrich

Gross²,

Morrow

et al. 2017

J. Innov. Opt. Health Sci.

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Previous studies have shown cost effectiveness and quality-of-life benefit of pneumatic compression therapy (PCT) for lymphedema. Insurers, such as the Centers for Medicare/Medicaid (CMS), however, desire visual proof that PCT moves lymph. Near-infrared fluorescence lymphatic imaging (NIRFLI) was used to visualize lymphatic anatomy and function in four subjects with primary and cancer treatment-related lymphedema (LE) of the lower extremities before, during, and after pneumatic compression therapy (PCT). Optically transparent and windowed PCT garments allowed visualization of lymph movement during single, one-hour PCT treatment sessions. Visualization revealed significant extravascular and lymphatic vascular movement of intradermally injected dye in all subjects. In one subject with sufficient patent lymphatic vessels to allow quantification of lymph pumping velocities and frequencies, these values were significantly increased during and after PCT as compared to pre-treatment values. Lymphatic contractile activity in patent lymphatic vessels occurred in concert with the sequential cycling of PCT. Direct visualization revealed increased lymphatic function, during and after PCT therapy, in all lymphedema-affected extremities. Further studies are warranted to assess the effects of PCT pressure and sequences on lymph uptake and movement.

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Surgical Options for Lymphedema Following Breast Cancer Treatment

Cited by 7 publications

References 14 publications

The efficacy of lymphaticovenular anastomosis in breast cancer-related lymphedema

The efficacy of lymphaticovenular anastomosis in breast cancer-related lymphedema

Contribution of Simultaneous Breast Reconstruction by Deep Inferior Epigastric Artery Perforator Flap to the Efficacy of Vascularized Lymph Node Transfer in Patients with Breast Cancer-Related Lymphedema

Effect of pneumatic compression therapy on lymph movement in lymphedema-affected extremities, as assessed by near-infrared fluorescence lymphatic imaging

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