A systematic review and meta-analysis of vascularized lymph node transfer for breast cancer-related lymphedema

Winters, Harm; Tielemans, H.J.P.; Paulus, Vera A A; Hummelink, Stefan; Slater, Nicholas J.; Ulrich, Dietmar

doi:10.1016/j.jvsv.2021.08.023

Cited by 17 publications

(7 citation statements)

References 40 publications

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“… 15 Evidence has shown that VLNT is able to lead to volume differences, decreased episodes of cellulitis/infection, and have a positive effect on quality of life. 43 VLNT has also shown to lead to reductions in limb volume and episodes of cellulitis in patients with cancer. 44 Other studies have determined that VLNT is an adequate surgical method for treating chronic lymphedema, although patients that have upper extremity edema tend to have superior outcomes compared with those with lower extremity edema.…”

Section: Discussionmentioning

confidence: 99%

May-Thurner Syndrome and Lymphedema Reconstruction

Gupta

Mathijs

Hart

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: May-Thurner syndrome (MTS) is an anatomical variant that results in compression of the left common iliac vein by the right common iliac artery. Although often asymptomatic, lower extremity swelling/edema, deep venous thrombosis, post-thrombotic syndrome, and eventual lymphedema (due to long-standing venous obstruction) can develop. The clinical management of patients presenting for lymphedema surgery with concomitant or undiagnosed MTS is not well described. Methods: This review investigates two patients who were evaluated for unilateral lower extremity lymphedema, both of whom were subsequently diagnosed with MTS. Standard imaging (including lymphoscintigraphy, indocyanine green lymphangiography, and magnetic resonance venography) were performed to identify proximal venous obstruction. Treatment was accomplished using vascular surgical management, including stenting of the iliac vein before lymphedema reconstruction with vascularized lymph node transfer and multiple lymphovenous bypass. Results: Both patients we examined in this review had improvement of lymphedema with vascular surgical management. Literature review reveals that MTS has an incidence as high as 20% in the population, although commonly unidentified due to lack of symptomatology. Conclusions: There are no studies documenting the incidence of MTS in patients referred for lymphedema surgical management. Routine studies should be obtained to screen for proximal venous obstruction in patients presenting for surgical management of lower extremity lymphedema. Additional research is needed regarding the approach to managing patients with both MTS and lymphedema. Careful observational and prospective studies may elucidate the appropriate time interval between venous stenting and lymphedema microsurgical reconstruction.

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Section: Discussionmentioning

confidence: 99%

May-Thurner Syndrome and Lymphedema Reconstruction

Gupta

Mathijs

Hart

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…There is significant heterogeneity in the outcomes reported by existing studies and, as with LVA surgical treatment, understanding the degree to which VLNTs reduce limb volume requires reporting of concomitant compression. 96 For patients included in the small subset of studies that do report concomitant compression, 45% (27/60) were able to discontinue compression following VLNT.…”

Section: Surgical Treatment Optionsmentioning

confidence: 99%

Advances in lymphedema: An under-recognized disease with a hopeful future for patients

Carroll,

Singhal

2024

Vasc Med

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Lymphedema has traditionally been underappreciated by the healthcare community. Understanding of the underlying pathophysiology and treatments beyond compression have been limited until recently. Increased investigation has demonstrated the key role of inflammation and resultant fibrosis and adipose deposition leading to the clinical sequelae and associated reduction in quality of life with lymphedema. New imaging techniques including magnetic resonance imaging (MRI), indocyanine green lymphography, and high-frequency ultrasound offer improved resolution and understanding of lymphatic anatomy and flow. Conservative therapy with compression, exercise, and weight loss remains the mainstay of therapy, but growing surgical options show promise. Physiologic procedures (lymphovenous anastomosis and vascularized lymph node transfers) improve lymphatic flow in the diseased limb and may reduce edema and the burden of compression. Debulking, primarily with liposuction to remove the adipose deposition that has accumulated, results in a dramatic decrease in limb girth in appropriately selected patients. Though early, there are also exciting developments of potential therapeutic targets tackling the underlying drivers of the disease. Multidisciplinary teams have developed to offer the full breadth of evaluation and current management, but the development of a greater understanding and availability of therapies is needed to ensure patients with lymphedema have greater opportunity for optimal care.

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“…Systematic reviews and meta-analyses have supported the benefits of VLNT in patients with lymphedema [ 119 , 120 ]. In one such study, among patients who underwent lymphoscintigraphy or lymphangiography, 60% demonstrated moderate or significant flow improvement, and 93% reported a high satisfaction level (Fig.…”

Section: Treatment Of Bcrlmentioning

confidence: 99%

Advances in the prevention and treatment of breast cancer-related lymphedema

Donahue¹,

MacKenzie²,

Filipović³

et al. 2023

Breast Cancer Res Treat

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Purpose Breast cancer-related lymphedema (BCRL) represents a lifelong risk for breast cancer survivors and once acquired becomes a lifelong burden. This review summarizes current BCRL prevention and treatment strategies. Findings Risk factors for BCRL have been extensively studied and their identification has affected breast cancer treatment practice, with sentinel lymph node removal now standard of care for patients with early stage breast cancer without sentinel lymph node metastases. Early surveillance and timely management aim to reduce BCRL incidence and progression, and are further facilitated by patient education, which many breast cancer survivors report not having adequately received. Surgical approaches to BCRL prevention include axillary reverse mapping, lymphatic microsurgical preventative healing (LYMPHA) and Simplified LYMPHA (SLYMPHA). Complete decongestive therapy (CDT) remains the standard of care for patients with BCRL. Among CDT components, facilitating manual lymphatic drainage (MLD) using indocyanine green fluorescence lymphography has been proposed. Intermittent pneumatic compression, nonpneumatic active compression devices, and low-level laser therapy appear promising in lymphedema management. Reconstructive microsurgical techniques such as lymphovenous anastomosis and vascular lymph node transfer are growing surgical considerations for patients as well as liposuction-based procedures for addressing fatty fibrosis formation from chronic lymphedema. Long-term self-management adherence remains problematic, and lack of diagnosis and measurement consensus precludes a comparison of outcomes. Currently, no pharmacological approaches have proven successful. Conclusion Progress in prevention and treatment of BCRL continues, requiring advances in early diagnosis, patient education, expert consensus and novel treatments designed for lymphatic rehabilitation following insults.

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A systematic review and meta-analysis of vascularized lymph node transfer for breast cancer-related lymphedema

Cited by 17 publications

References 40 publications

May-Thurner Syndrome and Lymphedema Reconstruction

May-Thurner Syndrome and Lymphedema Reconstruction

Advances in lymphedema: An under-recognized disease with a hopeful future for patients

Advances in the prevention and treatment of breast cancer-related lymphedema

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