Barcelona Lymphedema Algorithm for Surgical Treatment in Breast Cancer–Related Lymphedema

Abstract

Background Breast cancer-related lymphedema is a prevalent condition that has a major impact on quality of life. Surgical treatment has become an alternative to help affected patients with good results. However, there is no consensus on surgical procedure and protocol. Methods We analyzed our data in two periods: from June 2007 to December 2011 and from January 2012 to June 2014. Data included the analysis of the limb circumferences and the subjective symptoms felt by patients. Results Of the 200 patients treated in the study, 81 had lymphaticovenous anastomosis, 7 had autologous lymph node transfer, 16 had total breast anatomy restoration, 52 had vibroliposuction, and 44 had combined reconstructive procedures. In the first period, the circumference of the superior limb showed a decrease of 0.9 to 6.1 cm (average 2.75 cm). In the second period, the circumference of the superior limb showed a decrease of 2.9 to 6.1 cm (average 3.85 cm). Clinical results and data from the questionnaires confirmed the improvement and subjective benefits. Conclusion We have obtained considerable improvements in results of limb circumferences and subjective symptoms after incorporating several modifications into our surgical strategy for lymphedema treatment. A detailed preoperative assessment should be performed to determine whether reconstructive surgery or palliative surgery is indicated.

Lymphatico-venous anastomosis as treatment for breast cancer-related lymphedema: a prospective study on quality of life

“…A wide variety of methods were used to measure these subjective symptoms, such as retrospective interviews [30], scale scoring systems for subjective pre- and postoperative complaints [31, 32] or subjective assessment by a skin therapist [33]. Masia et al [34] and Chen et al [35, 36] used two different, standardised self-developed questionnaires on lymphedema-related quality of life and reported an improvement in 100% of their patients. The drawbacks were that no detailed results per category were available on these scales, and neither were they developed according to the three stages recommended for patient reported outcome measures (PROM) nor validated according to those standard stages.…”

Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema

“…Lymphedemas resistant to conservative therapy, pain and chronic infection are the preferred indications for surgical treatment. Lymph node flap transfer has gradually gained popularity for the treatment of both upper and lower limb lymphedema (Althubaiti, Crosby, & Chang, 2013;Azuma, Yamamoto, & Koshima, 2013;Becker, 2016;Chang, Masià, & Smith, 2018;Cheng, Koshima, Chang, & Masia, 2017;Giudice et al, 2017;Gould, Mehrara, Neligan, Cheng, & Patel, 2018;Kung et al, 2017;Lin et al, 2009;Masià, Pons, & Rodríguez-Bauzà, 2016;Patel, Lin, & Cheng, 2015;Schaverien, Badash, Patel, Selber, & Cheng, 2018;Silva & Chang, 2016). Several donor sites for lymph node flaps have been described, including the abdominal area Ciudad, Kiranantawat, Sapountzis, et al, 2015;Ciudad, Manrique, Date, Agko, et al, 2017;Ciudad, Manrique, Date, Sacak, et al, 2017;Di Taranto, Chen, Elia, et al, 2019;Di Taranto, Elia, Amorosi, et al, 2018;Leuzzi et al, 2018;Maruccia et al, 2019).…”

Prevención del linfedema posquirúrgico en cáncer de mama mediante rehabilitación fisioterapéutica: estudio comparativo entre drenaje linfático manual y kinesiotape

“…(11) Masia et al hallaron que el establecimiento de una estrategia quirúrgica adecuada al diagnóstico y características casuísticas, evita el desarrollo de linfedema posoperatorio. (12) Tabla 2. Tipo de tratamiento médico y fisioterapéutico Fuente: historias clínicas de la Unidad Oncológica Solca-Chimborazo del año 2014-2019.…”