Surgical Prevention of Arm Lymphedema After Breast Cancer Treatment

Abstract

LYMPHA represents a valid technique for primary prevention of secondary arm lymphedema with no risk of leaving undetected malignant disease in the axilla.

Complicated breast cancer–related lymphedema: evaluating health care resource utilization and associated costs of management

“…37 Others have advocated for prophylactic lymphovenous shunt or vascularized lymph node transfer at the time of axillary dissection as another opportunity to prevent or reduce lymphedema severity. 38,39 Improving provider awareness of the substantial health care burden of lymphedema is quickly becoming a priority today, as evidenced by the passing of a federal bill specifically targeting lymphedema in January 2014. 40,41 The Lymphedema Diagnosis and Treatment Cost Saving Act expands insurance coverage for conservative lymphedema treatment in light of evidence suggesting the benefits of halting lymphedema disease progression.…”

Surgical Treatment Modalities for Lymphedema

“…In a group of 14 patients with subclinical lower extremity lymphedema from resection of a variety of gynecologic cancers, LVA effectively prevented symptomatic lymphedema [9]. Moreover, LVA successfully prevented lymphedema in a group of 23 women who underwent axillary lymph node dissection for breast cancer treatment [10]. The reported complication profile for this procedure also favors its use, as was seen in the meta-analysis aforementioned, showing a 3.9% incidence of infection, 4.1% incidence of lymphorrhea, and 10% requiring a subsequent operation [7].…”

“…In animal models, several groups have demonstrated that exogenous treatment with VEGF-C/D stimulates post-natal lymphangiogenesis to improve lymphedema (4-7). However, reports that link VEGF-C expression with tumor metastasis [8][9][10] make VEGF-based therapy risky in patients with a history of cancer.…”

Surgical Prevention of Arm Lymphedema in Breast Cancer Treatment

“…During lymph nodal dissection also one or two collateral branches of the axillary vein are prepared with a length suitable for reaching the lymphatic vessels. The microsurgical technique of lymphatic venous anastomosis has already been described (11). The vein was averagely 2 mm in diameter and lymphatics about half mm.…”