scholarly journals Surgical Prevention of Breast Cancer-Related Lymphedema: Delayed Distal Lymphaticovenicular Anastomosis– An Alternative to the Classic LYMPHA Technique

2021 ◽  
pp. 277-283
Author(s):  
Lynn M Orfahli ◽  
Tony CT Huang ◽  
Wei F Chen
Keyword(s):  
Breast Cancer ◽  
Lymph Vessel ◽  
Radical Excision ◽  
The Novel ◽  
Axillary Lymphadenectomy ◽  
Treatment Measures ◽  
Breast Cancer Related Lymphedema ◽  
Distally Based ◽  
Prevention Of Breast Cancer

Breast cancer-related lymphedema (BCRL) is a devastating potential complication of axillary lymphadenectomy and radiotherapy. Several effective surgical treatment measures now exist, including lymphaticovenicular anastomosis (LVA), vascularized lymph node transplant (VLNT), and vascularized lymph vessel transplant (VLVT) for fluid-predominant disease, and liposuction and radical excision for solid-predominant disease. Super-microsurgical LVA is of particular interest, owing to its minimally invasive nature and highly favorable outcomes in the hands of experienced supermicrosurgeons. As LVA techniques are refined and improved, interest is rising in utilizing it to prevent the manifestation of disease in the first place. Lymphatic microsurgical preventive healing approach (LYMPHA), also known as immediate lymphatic reconstruction (ILR), is the most widely used approach. It involves performing axillary LVA immediately following axillary lymphadenectomy. While preliminary results are favorable, the high-pressure proximal axillary venous branches used in ILR and the site’s vulnerability to damage from radiotherapy endanger the long-term patency of these anastomoses. Moreover, a theoretical oncologic concern exists regarding creating a direct conduit for the remaining malignant cells in the axilla into the circulation. Finally, coordinating ILR with axillary lymphadenectomy creates significant logistical challenges. Delayed, distally-based LVA (DD-LVA) has emerged as an alternative method that avoids these issues. This article presents an overview of the development of preemptive lymphatic reconstruction, and the senior author’s approach to the novel technique of DD-LVA.

scholarly journals Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer-Related Lymphedema in Long-Term Breast Cancer Survivors

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1303
Author(s):  
Khairunnisa’ Md Yusof ◽  
Kelly A. Avery-Kiejda ◽  
Shafinah Ahmad Suhaimi ◽  
Najwa Ahmad Zamri ◽  
Muhammad Ehsan Fitri Rusli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Survivors ◽  
Potential Risk ◽  
Breast Cancer Survivors ◽  
Ultrasound Examination ◽  
Arm Circumference ◽  
Potential Risk Factors ◽  
Breast Cancer Related Lymphedema

Breast cancer has been reported to have the highest survival rate among various cancers. However, breast cancer survivors face several challenges following breast cancer treatment including breast cancer-related lymphedema (BCRL), sexual dysfunction, and psychological distress. This study aimed to investigate the potential risk factors of BCRL in long term breast cancer survivors. A total of 160 female breast cancer subjects were recruited on a voluntary basis and arm lymphedema was assessed through self-reporting of diagnosis, arm circumference measurement, and ultrasound examination. A total of 33/160 or 20.5% of the women developed BCRL with significantly higher scores for upper extremity disability (37.14 ± 18.90 vs. 20.08 ± 15.29, p < 0.001) and a lower score for quality of life (103.91 ± 21.80 vs. 115.49 ± 16.80, p = 0.009) as compared to non-lymphedema cases. Univariate analysis revealed that multiple surgeries (OR = 5.70, 95% CI: 1.21–26.8, p < 0.001), axillary lymph nodes excision (>10) (OR = 2.83, 95% CI: 0.94–8.11, p = 0.047), being overweight (≥25 kg/m2) (OR = 2.57, 95% CI: 1.04 – 6.38, p = 0.036), received fewer post-surgery rehabilitation treatment (OR = 2.37, 95% CI: 1.05–5.39, p = 0.036) and hypertension (OR = 2.38, 95% CI: 1.01–5.62, p = 0.043) were associated with an increased risk of BCRL. Meanwhile, multivariate analysis showed that multiple surgeries remained significant and elevated the likelihood of BCRL (OR = 5.83, 95% CI: 1.14–29.78, p = 0.034). Arm swelling was more prominent in the forearm area demonstrated by the highest difference of arm circumference measurement when compared to the upper arm (2.07 ± 2.48 vs. 1.34 ± 1.91 cm, p < 0.001). The total of skinfold thickness of the affected forearm was also significantly higher than the unaffected arms (p < 0.05) as evidenced by the ultrasound examination. The continuous search for risk factors in specific populations may facilitate the development of a standardized method to reduce the occurrence of BCRL and provide better management for breast cancer patients.

The Long-term Patency of Lymphaticovenular Anastomosis in Breast Cancer–Related Lymphedema

2019 ◽  
Vol 82 (2) ◽  
pp. 196-200 ◽  
Author(s):  
Harm Winters ◽  
Hanneke J. P. Tielemans ◽  
Arico C. Verhulst ◽  
Vera A. A. Paulus ◽  
Nicholas J. Slater ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Related Lymphedema

Prevention of Breast Cancer Related Lymphedema

2021 ◽  
Author(s):  
Maureen P. McEvoy ◽  
Ethan Ravetch ◽  
Gunj Patel ◽  
Jana Fox ◽  
Sheldon Feldman
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Related Lymphedema ◽  
Prevention Of Breast Cancer

The Quality of Life in Long-Term Breast Cancer Survivors with Breast Cancer Related Lymphedema

2014 ◽  
Vol 114 (4) ◽  
pp. 239-244 ◽  
Author(s):  
T. R. Lopez Penha ◽  
J. van Bodegraven ◽  
B. Winkens ◽  
E. M. Heuts ◽  
A. C. Voogdi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Breast Cancer Related Lymphedema

scholarly journals Microsurgical techniques in the treatment of breast cancer-related lymphedema: a systematic review of efficacy and patient outcomes

Breast Cancer ◽  
2021 ◽  
Author(s):  
Konstantinos Gasteratos ◽  
Antonios Morsi-Yeroyannis ◽  
Nikolaos Ch. Vlachopoulos ◽  
Georgia-Alexandra Spyropoulou ◽  
Gabriel Del Corral ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Patient Outcomes ◽  
Systematic Reviews ◽  
Donor Site ◽  
Surgical Techniques ◽  
Current Data ◽  
Lymph Vessel ◽  
Compression Garments ◽  
Breast Cancer Related Lymphedema

Abstract Introduction Secondary lymphedema is the abnormal collection of lymphatic fluid within subcutaneous structures. Patients with lymphedema suffer a low quality of life. In our study, we aim to provide a systematic review of the current data on patient outcomes regarding breast cancer-related lymphedema (BCRL), and the most prevalent reconstructive techniques. Methods A PubMed (MEDLINE) and Scopus literature search was performed in September 2020. Studies were screened based on inclusion/exclusion criteria. The protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO), and it was reported in line with the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Results The search yielded 254 papers from 2010 to 2020. 67 were included in our study. Lymphaticovenous anastomosis (LVA)—a minimally invasive procedure diverting the lymph into the dermal venous drainage system—combined with postoperative bandaging and compression garments yields superior results with minimal donor site lymphedema morbidity. Vascularized lymph node transfer (VLNT)—another microsurgical technique, often combined with autologous free flap breast reconstruction—improves lymphedema and brachial plexus neuropathies, and reduces the risk of cellulitis. The combination of LVA and VLNT or with other methods maximizes their effectiveness. Vascularized lymph vessel transfer (VLVT) consists of harvesting certain lymph vessels, sparing the donor site’s lymph nodes. Conclusion Together with integrated lymphedema therapy, proper staging, and appropriate selection of procedure, safe and efficient surgical techniques can be beneficial to many patients with BCRL.

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