Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for Lymphedema Prevention after Axillary Lymph Node Dissection—A Single Institution Experience and Feasibility of Technique

While surgical options exist to treat lymphedema after axillary lymph node dissection (ALND), the lymphatic microsurgical preventive healing approach (LYMPHA) has been introduced as a preventive measure performed during the primary surgery, thus avoiding the morbidity associated with lymphedema. Here, we highlight details of our operative technique and review postoperative outcomes. For our patients, limb measurements and body composition analyses were performed pre- and postoperatively. Intraoperatively, axillary reverse lymphatic mapping was performed with indocyanine green (ICG) and lymphazurin. SPY-PHI imaging was used to visualize the ICG uptake into axillary lymphatics. Cut lymphatics from excised nodes were preserved for lymphaticovenous anastomosis (LVA). At the completion of the microanastomosis, ICG was visualized draining from the lymphatic through the recipient vein. A retrospective review identified nineteen patients who underwent complete or partial mastectomy with ALND and subsequent LYMPHA over 19 months. The number of LVAs performed per patient ranged between 1–4 per axilla. The operating time ranged from 32–95 min. There were no surgical complications, and thus far one patient developed mild lymphedema with an average follow up of 10 months. At the clinic follow up, ICG and SPY angiography were used to confirm intact lymphatic conduits with an uptake of ICG across the axilla. This study supports LYMPHA as a feasible and effective method for lymphedema prevention.

Prevention of Breast Cancer-Related Lymphedema Using the Lymphatic Microsurgical Preventive Healing Approach: A Case Report

Breast cancer-related lymphedema is a major complication of breast cancer surgery. The lymphatic microsurgical preventive healing approach, a surgical technique that can prevent breast cancer-related lymphedema, creates a lymphovenous bypass between the damaged axillary lymphatics during axillary lymph node dissection and the axillary vein. We report a case using the unilateral lymphatic microsurgical preventive healing approach in a patient with bilateral breast cancer. A 58-year-old woman diagnosed with bilateral invasive ductal carcinoma underwent a bilateral nipple-sparing mastectomy. The lymphatic microsurgical preventive healing approach was performed on the left side after axillary lymph node dissection; the lymphatic microsurgical preventive healing approach was not performed after axillary sentinel lymph node biopsy on the right side. Six months after the surgery, MD Anderson Cancer Center stage 2 lymphedema was observed in the lymphography images of the right arm, where the lymphatic microsurgical preventive healing approach had not been performed.

Six-Months Follow-up for Investigating the Effect of Prophylactic Lymphovenous Anastomosis on the Prevention of Breast Cancer-Related Lymphedema: A Preliminary Study in a Single Institution

Purpose: This study was performed to assess the effect of prophylactic lymphovenous anastomosis on the prevention of arm lymphedema after axillary lymph node dissection for breast cancer treatment.Methods: Among 69 women referred to undergo axillary lymph node dissection from January 2020 to June 2020, 21 were assigned to the treatment group and 48 to the control group. In the treatment group, 21 patients underwent prophylactic lymphovenous anastomosis for the prevention of breast cancer-related lymphedema. The other 48 patients in the control group did not undergo any preventive surgical treatment. Prophylactic lymphovenous anastomosis was performed at the same time as axillary lymph node dissection and breast cancer surgery. Postoperatively, all patients underwent circumferential measurements at 1, 3, and 6 months and lymphography at 6 months after the surgery. Results: None of the patients in the treatment group had lymphedema after the surgery (0%). In the control group, lymphedema occurred in nine patients (18.8%, p=0.049). No significant differences in the arm circumference were observed in the treatment group during follow-up (p>0.05), whereas the arm circumference in the control group showed a significant increase at 1, 3, and 6 months after axillary lymph node dissection (p<0.05). There were no significant differences between the two groups in the arm circumference changes with respect to baseline at 1, 3, and 6 months after axillary lymph node dissection (p>0.05). Conclusion: Prophylactic lymphovenous anastomosis represents a valid super microsurgical technique for the primary prevention of breast cancer-related lymphedema.

Factors associated with return to work of breast cancer patients following axillary lymph node dissection

BACKGROUND: The identification of factors that are related to return to work after surgery for breast cancer could help healthcare professionals accurately identify patients at risk of return to work-related difficulties in order to provide them with appropriate support during breast cancer management. OBJECTIVE: The aim of this study was to identify factors related to return to work in breast cancer patients three months after axillary lymph node dissection. METHODS: Seventy-three women who were working before the surgery were evaluated. Age, body mass index, level of lymph node dissection, marital status, children, co-resident household members, preoperative chemotherapy, postoperative chemotherapy, postoperative hormonal therapy, postoperative radiotherapy, shoulder range of motion, upper limb function (Disabilities of the Arm, Shoulder and Hand; DASH), and work were evaluated. Patients who had returned to work constituted the return to work group, and those who had not returned to work constituted the no return to work group. RESULTS: Of the patients, 36 returned to work at three months. Logistic regression analysis including the five variables showed that shoulder flexion range of motion and DASH were significantly associated with return to work (p < 0.05). CONCLUSIONS: The observation that the symptoms and limitations of upper limb function and shoulder flexion range of motion affect return to work may indicate the importance of postoperative rehabilitation in breast cancer patients following axillary lymph node dissection.