Five-Year Breast Surgeon Experience in LYMPHA at Time of ALND for Treatment of Clinical T1–4N1–3M0 Breast Cancer

Herremans, Kelly M.; Cribbin, Morgan P; Riner, Andrea N.; Neal, Dan; Hollen, Tracy L.; Clevenger, Pamela; Munoz, Derly; Blewett, S; Giap, Fantine; Okunieff, Paul; Mendenhall, Nancy P.; Bradley, Julie A.; Mendenhall, William M.; Vega, R. Mailhot; Brooks, Eric D.; Daily, Karen; Heldermon, Coy D.; Marshall, Julia; Hanna, Mariam; Leyngold, Mark; Virk, Sarah S; Shaw, Christiana; Spiguel, Lisa

doi:10.1245/s10434-021-10551-8

Cited by 14 publications

(17 citation statements)

References 48 publications

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“…The use of microsurgical procedures to prevent lymphedema was introduced in 2008 by Boccardo and et al [30]. The LYMPHA ("lymphatic microsurgical preventive healing approach") procedure consists of performing preventive LVA between the arm lymphatics and collateral branches of the axillary vein at the same time as nodal dissection in order to reduce postoperative lymphedema, improving patients' quality of life [13,31]. Immediate lymphatic reconstruction is a method which may decrease the risk of lymphedema development to 6.6% [32].…”

Section: Discussionmentioning

confidence: 99%

Distally Prophylactic Lymphaticovenular Anastomoses after Axillary or Inguinal Complete Lymph Node Dissection Followed by Radiotherapy: A Case Series

Pierazzi

Arleo

Faini³

2022

Medicina

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Background and Objectives: Lymphedema is an important and underestimated condition, and this progressive chronic disease has serious implications on patients’ quality of life. The main goal of research would be to prevent lymphedema, instead of curing it. Patients receiving radiotherapy after lymph node dissection have a significantly higher risk of developing lymphedema. Through the prophylactic use of microsurgical lymphaticovenular anastomoses in selected patients, we could prevent the development of lymphedema. Materials and Methods: Six patients who underwent prophylactic lymphaticovenular anastomoses in a distal site to the axillary or groin region after axillary or inguinal complete lymph node dissection followed by radiotherapy were analyzed. Patients characteristics, comorbidities, operative details, postoperative complications and follow-up assessments were recorded. Results: Neither early nor late generic surgical complications were reported. We observed no lymphedema development throughout the post-surgical follow-up. In particular, we observed no increase in limb diameter measured at 1, 3, 6 and 12 months postoperatively. Conclusion: In our experience, performing LVA after axillary or groin lymphadenectomy and after adjuvant radiotherapy, and distally to the irradiated area, allows us to ensure the long-term patency of anastomoses in order to obtain the best results in terms of reducing the risk of iatrogenic lymphedema. This preliminary report is encouraging, and the adoption of our approach should be considered in selected patients.

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Section: Discussionmentioning

confidence: 99%

Distally Prophylactic Lymphaticovenular Anastomoses after Axillary or Inguinal Complete Lymph Node Dissection Followed by Radiotherapy: A Case Series

Pierazzi

Arleo

Faini³

2022

Medicina

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“…al., LYMPHA has been shown to decrease rates of lymphedema from 30% to as low as 4%. [75][76][77]79 In Boccardo, et al's original study, none of the 18 included patients who underwent LYMPHA developed lymphedema at 12-month follow-up. 75 On four-year follow up of 71 patients, 4% of LYMPHA patients developed lymphedema versus 30% observed in patients who underwent axillary node dissection without LYMPHA.…”

Section: Lymphamentioning

confidence: 99%

“…75 Several techniques have been described to identify candidate lymphatic channels, including use of isosulfan blue, methylene blue dye, or fluorescein isothiocyanate. [76][77][78] First described in 2009 by Boccardo, et. al., LYMPHA has been shown to decrease rates of lymphedema from 30% to as low as 4%.…”

Section: Lymphamentioning

confidence: 99%

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Breast Cancer-Related Lymphedema: A Review of Management and Innovative Surgical Techniques

Newsom

Xiang

Yang

et al. 2022

MRAJ

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Lymphedema is one of the most feared complications of breast cancer treatment. The objective of this article is to review the basic workup, staging, and diagnostic criteria for lymphedema and to discuss non-surgical and surgical treatments, with a focus on breast-cancer related lymphedema. Non-surgical treatment consists of intensive physical therapy including manual lymphatic drainage via massage, daily compression wraps, and exercises to prevent scarring and increase mobility. Surgical intervention is considered when non-surgical treatment is ineffective or more recently as a preventive measure. Surgical interventions, used once lymphedema has developed, include 1) lympho-venous bypass, which is the anastomosis of lymphatic vessels distal to the site of dermal backflow to neighboring venules to shunt lymphatic drainage away from the area of lymphatic injury; 2) vascularized lymph node transplant, in which lymph nodes are harvested from a donor site with their supporting artery and vein and transferred to the affected recipient site; and 3) debulking procedures including liposuction and direct excision. Preventive surgical interventions include 1) lymphatic microsurgical preventive healing approach, known as LYMPHA, which also utilizes lympho-venous anastomoses but at the time of lymph node dissection to anastomose lymphatic channels transected during lymph node dissection with adjacent veins to preserve lymphatic drainage of the arm; and 2) axillary reverse mapping, which involves tracer or dye injection within the ipsilateral arm before axillary surgery so that the breast surgeons are able to delineate nodal drainage and therefore attempt to spare nodes specific to arm tissue provided they are not the sentinel lymph node. Patient selection is critical for these procedures, and requires a multi-disciplinary approach.

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“…Immediate lymphatic reconstruction (ILR), or lymphatic microsurgical preventing healing approach (LYMPHA), has been proposed to decrease the occurrence of breast cancer‐related lymphedema (BCRL) by anastomosing the arm lymphatic vessels to nearby branches of the axillary vein in the axillary wound immediately after axillary lymph node dissection (Boccardo et al, 2009; Boccardo et al, 2011; Boccardo et al, 2014; Cook et al, 2021; Coriddi et al, 2021; Feldman et al, 2015; Herremans et al, 2021; Johnson et al, 2021; Johnson & Singhal, 2018; Jørgensen et al, 2018; Mele et al, 2021; Rodriguez et al, 2020; Schwarz et al, 2019; Shaffer et al, 2020). During the operation, the technique of axillary reverse mapping was used to identify the arm lymphatics (Beek et al, 2016; Nos et al, 2008; Thompson et al, 2007), and lymphovenous anastomosis was performed with the help of a surgical microscope.…”

Section: Introductionmentioning

confidence: 99%

The effect of immediate lymphatic reconstruction on the post‐operative drain output after axillary lymph node dissection for breast cancer: A retrospective comparative study

et al. 2023

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IntroductionAxillary lymph node dissection (ALND) for breast cancer has been considered to be associated with a variety of complications, such as excessive postoperative wound drainage, prolonged drain placement, or seroma formation in the short term, or arm lymphedema in the long run. Immediate lymphedema reconstruction (ILR) has been proposed to reduce the occurrence of arm lymphedema by anastomosing the transected arm lymphatics to nearby branches of the axillary vein immediately after ALND. This study aims to demonstrate that ILR can also reduce the postoperative drainage amount.Patients and MethodsBetween April 2020 and January 2022, a total of 76 breast cancer patients receiving ALND were reviewed. Forty four of them also received ILR immediately after ALND. The assignment of ILR surgery was non‐random, based on patients' willingness and plastic surgeons' availability. The lymphatic vessels in the axillary wound were anastomosed with nearby terminal branches of the axillary vein under surgical microscope. Patients' characteristics, including age, body mass index (BMI), neoadjuvant therapy, type of breast surgery, the occurrence of seroma formation, number of removed lymph nodes, number of positive nodes, and the drainage amount from the operative wounds were compared between ILR and non‐ILR groups.ResultsNo statistically significant difference was noted between groups in terms of age (56.5 ± 9.8 vs. 60.9 ± 10.7, p = .09), BMI (22.6 ± 3.7 vs. 23.7 ± 3.8, p = .27), type of breast surgery (p = .32), the occurrence of seroma formation (p = 1.0), the likelihood of receiving neoadjuvant therapy (p = .12), number of lymph nodes removed (17.5 ± 7.6 vs. 17.4 ± 8.3, p = .96), or number of positive nodes on final pathology (3.7 ± 5.4 vs. 4.8 ± 8.5, p = .53) except the ILR group had statistically significantly less drainage amount than non‐ILR group (39.3 ± 2.6 vs. 48.3 ± 3.7, p = .046).ConclusionFor breast cancer patients receiving ALND, the immediate lymphatic reconstruction can reduce the postoperative drainage amount from the operative wound.

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Five-Year Breast Surgeon Experience in LYMPHA at Time of ALND for Treatment of Clinical T1–4N1–3M0 Breast Cancer

Cited by 14 publications

References 48 publications

Distally Prophylactic Lymphaticovenular Anastomoses after Axillary or Inguinal Complete Lymph Node Dissection Followed by Radiotherapy: A Case Series

Distally Prophylactic Lymphaticovenular Anastomoses after Axillary or Inguinal Complete Lymph Node Dissection Followed by Radiotherapy: A Case Series

Breast Cancer-Related Lymphedema: A Review of Management and Innovative Surgical Techniques

The effect of immediate lymphatic reconstruction on the post‐operative drain output after axillary lymph node dissection for breast cancer: A retrospective comparative study

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