Evaluation of simplified lymphatic microsurgical preventing healing approach (SLYMPHA) for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 563-563
Author(s):  
Tolga Ozmen ◽  
Mesa Lazaro ◽  
Yan Zhou ◽  
Alicia Vinyard ◽  
Eli Avisar
Keyword(s):  
Multivariate Analysis ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Complication Rates ◽  
Node Dissection

563 Background: Lymphedema (LE) is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 16%. Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) has been proposed as an effective adjunct to ALND for the prevention of LE. This procedure however requires microsurgical techniques. The aim of this study was to assess the efficiency of Simplified-LYMPHA (SLYMPHA) in preventing LE in a prospective cohort of patients. Methods: All patients, undergoing ALND with or without SLYMPHA between January 2014 and December 2016 were included in the study. SLYMPHA is a slightly modified and simplified version of LYMPHA. It is performed by the operating surgeon performing the ALND. One or more lymphatic channels identified by reverse arm mapping are inserted using a sleeve technique into the cut end of a neighboring vein. During follow-up visits, tape-measuring limb circumference method was used to detect clinical LE. Demographic, clinical, surgical and pathologic factors were recorded. The incidence of clinical LE was compared between ALND with and without SLYMPHA. Univariate and multivariate analysis were used to assess the role of other factors in the appearance of clinical LE. Results: 406 patients were included in the study. SLYMPHA procedure was attempted in 81 patients and was completed successfully in 90% of patients. Early complication rates were similar between patients who underwent SLYMPHA and who did not (4% vs. 4.13%; p = 0.948). Median follow-up time was 15±13.73 [1-32] months. Patients, who underwent SLYMPHA, had a significantly lower rate of clinical LE both in univariate and multivariate analysis (3% vs 19%; p = 0.001; OR 0.12 [0.03-0.5]). Excising > 22 lymph nodes and a co-diagnosis of diabetes were also correlated with higher clinical LE rates on univariate analysis, but only excising > 22 lymph nodes remained to be significant on multivariate analysis. Conclusions: SLYMPHA is a safe and relatively simple method, which decreases incidence of clinical LE dramatically. It should be considered as an adjunct procedure to ALND for all patients during initial surgery.

Long-term results of simplified lymphatic microsurgical preventing healing approach (SLYMPHA) for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 514-514
Author(s):  
Tolga Ozmen ◽  
Christina Layton ◽  
Orli Friedman-Eldar ◽  
Siarhei Melnikau ◽  
Susan Kesmodel ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Long Term Results ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Simple Method

514 Background: Lymphedema (LE) is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 16%. SLYMPHA is a safe and relatively simple method, which decreases incidence of LE dramatically. Our initial study showed an 88% decrease in clinical LE rate after a median follow up of 15 months. The aim of this study was to confirm these results after a longer follow up period. Methods: All patients, undergoing ALND between January 2014 and November 2020 were included in the study. During follow-up visits, tape-measuring limb circumference method was used to detect clinical LE. The incidence of clinical LE was compared between patients with and without SLYMPHA. Univariate and multivariate analysis were used to assess the role of other factors in the appearance of clinical LE. Results: 580 patients were included in the study. 35% of cohort underwent SLYMPHA. Mean follow-up time was 44 ±31.9 months. Patients, who underwent SLYMPHA, had a significantly lower LE rate (10% vs 26%; p=0.002; OR 0.4 [0.31-0.77]). Diabetes and removing ³22 lymph nodes also correlated with increased LE however this effect disappeared on multivariate analysis. Conclusions: SLYMPHA is a safe and relatively simple method, which continued its efficacy after 4-years follow up. It should be considered as an adjunct procedure to ALND for all patients during initial surgery.[Table: see text]

scholarly journals 17-Year Follow-Up of Comparing Mastoscopic and Conventional Axillary Dissection in Breast Cancer: A Multicentres, Randomized Controlled Trial

2021 ◽  
Author(s):  
Chengyu Luo， ◽  
Guang Cao ◽  
Wenbin Guo ◽  
Jie Yang ◽  
Qiuru Sun ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Axillary Lymph ◽  
Node Dissection

Abstract Background: Longer follow-up was necessary to testify the exact value of mastoscopic axillary lymph node dissection (MALND).Methods：From January 1, 2003 to December 31, 2005, 1027 patients with breast cancer were randomly assigned to two groups: MALND and CALND (conventional axillary lymph node dissection). 996 eligible patients were enrolled.Results：The final cohort of 996 patients was followed for an average of 198 months. The events other than death differed significantly between the two cohorts（p=0.0311） (46.3% in MALND and 53.2% in CALND, respectively). The sum of the events other than death and deaths from other causes was much more in CALND （59.6%）than in MALND (53.4%）（p=0.0494）. The 17-year DFS rates were 36.7 percent for MALND group and 33.6 percent for CALND group，respectively. There was a significant difference between the groups (p=.0306). The OS rates were 53.2 percent after MALND and 46.0 percent after CALND ( p= .0119). The MALND patients had much less axillary pain (p =. 0000), numbness or paresthesia (p = .0000) ，arm mobility (p =. 0000), and arm swelling on operated side (p = .0000). The aesthetic appearance of axilla in MALND group was much better than that in CALND group (p =. 0000) at an average follow-up of 17-year.Conclusions：The use of MALND in breast cancer surgery not only decreases the relapse and arm complications but also improves long-term survival of patients. Therefore, MALND should be one of the preferred approaches for breast cancer surgery when ALND is needed.

Sentinel lymph node status and axillary lymph node dissection in the surgical treatment of breast cancer

2014 ◽  
Vol 155 (6) ◽  
pp. 203-215 ◽  
Author(s):  
Gábor Cserni
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Sentinel Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Axillary Clearance

Axillary lymph node dissection has been traditionally perceived as a therapeutic and a staging procedure and unselectively removes all axillary lymph nodes. There still remains some controversy as concerns the survival benefit associated with axillary clearance. Sentinel lymph node biopsy removes the most likely sites of regional metastases, the lymph nodes directly connected with the primary tumour. It allows a more accurate staging and a selective indication for clearing the axilla, restricting this to patients who may benefit of it. Axillary dissection was performed in all patients during the learning phase of sentinel lymphadenectomy, but later only patients with metastasis to a sentinel node underwent this operation. Currently, even some patients with minimal sentinel node involvement, including some with macrometastasis may skip axillary clearance. This review summarizes the changes that have occurred in the surgical management of the axilla, the evidences and controversies behind these changes, along with current recommendations. Orv. Hetil., 2014, 155(6), 203–215.

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