The breast cancer‐related lymphedema multidisciplinary approach: Algorithm for conservative and multimodal surgical treatment

Ciudad, Pedro; Bolletta, Alberto; Kaciulyte, Juste; Losco, Luigi; Manrique, Oscar J.; Cigna, Emanuele; Mayer, Horacio F.; Escandón, Joseph M.

doi:10.1002/micr.30990

Cited by 25 publications

(46 citation statements)

References 38 publications

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“…Regarding the number and site of anastomoses, one or more can be performed in several levels of the affected extremity ( 19 ). This is usually guided by diagnostic imaging (e.g., indocyanine lymphography) ( 46 ).…”

Section: Discussionmentioning

confidence: 99%

Surgical management of breast cancer-related lymphedema: a narrative review of contemporary practices

Ciudad,

Escandón,

Duarte-Bateman

et al. 2023

Ann Transl Med

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Background and Objective Breast cancer-related lymphedema (BCRL) represents a colossal burden in terms of health and patient-reported outcomes. Surgical management plays a prominent role in the psychological and physical well-being of women suffering from BCRL. Therefore, we performed a narrative review of the current surgical management of BCRL and analyzed the postoperative results. Methods A literature search was conducted across PubMed MEDLINE, Scopus, and Web of Science from database inception through January 2, 2023. We included English-written studies evaluating postoperative outcomes of lymphatic surgery for the management of BCRL. Key Content and Findings The surgical management of lymphedema can be classified into two approaches: (I) physiologic procedures and (II) debulking or ablative procedures. While ablative procedures are intended to lessen the symptomatic burden of lymphedema via the removal of pathological tissues, physiologic procedures are performed to restore the abnormal lymphatic flow by creating bypasses into the venous or lymphatic circulation, or by creating new lymphatic connections by means of lymphangiogenesis. Physiologic procedures generate better outcomes in the early stages of lymphedema as there is some residual physiologic flow and vessels are less fibrotic, while ablative procedures are regarded to be the best alternative in very advanced lymphedema stages. A combination of physiologic and ablative procedures provides more comprehensive surgical management to BCRL. Conclusions Lymphedema is a common complication of breast cancer treatment with an extensive incidence range. Postoperative outcomes of the surgical management of BCRL are heterogeneous despite most studies indicating favorable results after lymphatic surgery.

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Section: Discussionmentioning

confidence: 99%

Surgical management of breast cancer-related lymphedema: a narrative review of contemporary practices

Ciudad,

Escandón,

Duarte-Bateman

et al. 2023

Ann Transl Med

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“…Lymphatics were detected by direct visual identification and confirmed with both correlation to skin markings and intraoperative ICG lymphography using a Leica FL800® microscope. Anastomoses were performed with either 11-0 or 12-0 nylon (Keisei, 50 μ needle, 5R23, 11/12-0N®), by the Intravascular Stenting (IVaS) method with 4/0 nylon as first described by Narushima [27] . After completion of LVA, patency was confirmed with intraoperative ICG lymphography […”

Section: Lymphaticovenular Anastomosismentioning

confidence: 99%

Preoperative ultrasound evaluation for lymphaticovenous anastomosis surgery in advanced breast cancer-related lymphedema

Liang,

Koshima,

Hung

et al. 2023

Plast Aesthet Res

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Aim: Lymphaticovenous anastomosis (LVA) is the mainstay for treating breast cancer-related lymphedema (BCRL). Preoperative ultrasonography is useful to assess the locations and characteristics of lymphatics and veins to improve LVA success remarkably even in cases of advanced BCRL. Aim: The aim of the study was to describe the use of ultrasonography to reliably map suitable lymphatics and veins and successfully perform LVA surgery in cases of advanced BCRL. Method: This retrospective cohort study included 41 cases of BCRL who underwent LVA surgery using preoperative ultrasound to map and characterize lymphatics and veins. Cases were analyzed for the following: (1) whether preoperative ultrasonographic detection of both lymphatics and veins correlate to actual intraoperative findings and (2) improvement in mean limb circumference measurements at 1 and 3 months of follow-up in this patient cohort. Results: For 155 LVA incisions, 212 LVA procedures were performed. Among them, 133 (62.7%) lymphatics and 196 (92.4%) anti-reflux veins were successfully detected and characterized on preoperative sonography. Mean preoperative circumference at the wrist, 10cm below elbow, elbow, and 10cm above elbow were 18.86 cm, 27.79 cm, 29.75 cm, and 33.77 cm, respectively. The mean measurements improved at 1 month correspondingly to 17.14 cm, 24.86 cm, 26.91 cm, and 30.50 cm (9.12%, 10.54%, 9.54%, 9.70% improvement, respectively), and at 3 months to 16.59 cm, 24.28 cm, 26.55 cm, and 30.05 cm (12.02%, 12.63%, 10.73%, 11.02% improvement, respectively). For each individual patient, their four measured circumferences were also added to obtain the Total Circumference (TC). The TC ranged from 89-135 cm (mean 109.46 cm) preoperatively, 83.5-129.5 cm (mean 98.74 cm) 1-month post-op, and 80.5-128 cm (mean 96.55 cm) 3 months post-op. Compared to the preoperative value, each patient had a TC decrease of 2.79%-20.35% (mean 9.80%) at 1-month post-op and 4.39-28.30% (mean 11.80%) at 3 months post-op. These differences were all statistically significant (P < 0.0001). Conclusion: Preoperative ultrasonography is a useful adjunct to detect lymphatic vessels and anti-reflux veins, thereby increasing the chances of successfully performing LVA surgery even in cases of advanced upper limb lymphedema. It can contribute to long-lasting outcomes.

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“…1 On this matter, previous reports have found that when approaching complex microsurgical cases by specialized multidisciplinary teams, outcomes are usually improved. 2,3 To optimize perioperative results, several strategies have been developed. For instance, the use of virtual surgical planning and computed tomography angiography to identify adequate perforators has caused a reduction in surgical time and shorter length of stay.…”

Section: Introductionmentioning

confidence: 99%

“… 1 On this matter, previous reports have found that when approaching complex microsurgical cases by specialized multidisciplinary teams, outcomes are usually improved. 2 , 3 …”

Section: Introductionmentioning

confidence: 99%

The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis

Escandón,

Mascaro-Pankova,

DellaCroce

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Using a co-surgeon model has been suggested to improve perioperative outcomes and reduce the risk of complications. Therefore, we evaluated if a co-surgeon model compared with a single microsurgeon model could decrease the surgical time, length of stay, rate of complications, and healthcare-associated costs in adult patients undergoing microvascular breast reconstruction (MBR). A comprehensive search was performed across PubMed MEDLINE, Embase, and Web of Science. Studies evaluating the perioperative outcomes and complications of MBR using a single-surgeon model and co-surgeon model were included. A random-effects model was fitted to the data. Seven retrospective comparative studies were included. Ultimately, 1411 patients (48.23%) underwent MBR using a single-surgeon model, representing 2339 flaps (48.42%). On the other hand, 1514 patients (51.77%) underwent MBR using a co-surgeon model, representing 2492 flaps (51.58%). The surgical time was significantly reduced using a co-surgeon model in all studies compared with a single-surgeon model. The length of stay was reduced using a co-surgeon model compared with a single-surgeon model in all but one study. The log odds ratio (log-OR) of recipient site infection (log-OR = −0.227; P = 0.6509), wound disruption (log-OR = −0.012; P = 0.9735), hematoma (log-OR = 0.061; P = 0.8683), and seroma (log-OR = −0.742; P = 0.1106) did not significantly decrease with the incorporation of a co-surgeon compared with a single-surgeon model. Incorporating a co-surgeon model for MBR has minimal impact on the rates of surgical site complications compared with a single-surgeon model. However, a co-surgeon optimized efficacy and reduced the surgical time and length of stay.

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The breast cancer‐related lymphedema multidisciplinary approach: Algorithm for conservative and multimodal surgical treatment

Cited by 25 publications

References 38 publications

Surgical management of breast cancer-related lymphedema: a narrative review of contemporary practices

Surgical management of breast cancer-related lymphedema: a narrative review of contemporary practices

Preoperative ultrasound evaluation for lymphaticovenous anastomosis surgery in advanced breast cancer-related lymphedema

The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis

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