Lymphatic Venous Anastomosis Can Release the Lymphedema-Associated Pain of Upper Limb after Breast Cancer Treatment

Abstract

Background Sometimes, chronic pain in the arm or chest could occur in postmastectomy patients. Although the pathology of the pain is unclear, the involvement of neurological mechanism, cicatricial contracture, or lymphedema is considered. The purpose of this study was to investigate the effectiveness of lymphaticovenous anastomosis (LVA) in reducing chronic pain in upper limb lymphedema patients. Patients and Methods This prospective study included consecutive 13 patients with upper limb lymphedema who received LVA. Preoperative lymphoscintigraphy and indocyanine green lymphography were performed. Pre-and postoperative pain scale were recorded using the visual analog scale (VAS). The number of cellulitis 1 year before and after LVA were compared. LVA was performed under local anesthesia, using a surgical microscope, and 12-0 nylon suture was used in the anastomosis. Results Two out of 13 patients were excluded from this study, and 11 patients were subjected to this study. All subjects were females with an average age of 64.3 years. The average lymphedema duration was 76.7 months. The average number of LVA sites was 5.7 per limb and the average follow-up period was 10.6 months. The average pre-and postoperative VAS scores were 3.5 and 0.59, respectively; the significant decrease was observed (p ¼ 0.017). Three of the patients who had experienced cellulitis (once, twice, and four times, respectively) did not develop any cellulitis after LVA. Conclusion LVA was shown to be an effective surgical remedy for treating the lymphedema-associated pain of upper limb after breast cancer treatment.

Surgical treatment algorithm for breast cancer lymphedema—a systematic review

“…Among the 26 articles, 16 (61.2%) were prospective studies ( 20 , 27 - 41 ), one being a randomized controlled trial ( 20 ), one single cross-sectional study ( 42 ), and nine (31.0%) followed a retrospective design ( 43 - 51 ). Geographically, the Netherlands (seven articles) ( 20 , 30 , 31 , 36 , 41 , 48 , 50 ) and Japan (six articles) ( 34 , 39 , 42 , 43 , 45 , 47 ) were the most represented regions/areas in the literature. Other contributing regions/areas included Italy (three articles) ( 27 , 29 , 51 ), France (two articles) ( 35 , 38 ), United Kingdom (two articles) ( 32 , 33 ), United States (two articles), Chile (one article) ( 28 ), Peru (one article) ( 44 ), Korea (one article) ( 46 ) and Taiwan (one article) ( 49 ), see Figure 2 .…”

“…A significant number of studies further divided stage II into sub-groups, with 42.1% classified as stage IIa and 25.3% as stage IIb. Other classifications systems employed, included the Campisi staging of lymphedema (n=5) ( 35 , 37 , 40 , 41 , 50 ), lymphoscintigraphy (n=5) ( 28 , 29 , 34 , 42 , 46 ), ICG-L (n=3) ( 30 , 32 , 34 ), Arm Dermal Backflow Scale (n=1) ( 20 ), and Cheng Lymphedema Grading System (n=1) ( 49 ).…”

“…All 26 articles evaluated the efficacy of LVA by monitoring changes in arm volume. Additionally, 11 articles provided insights into the patients’ quality of life ( 20 , 30 - 32 , 34 , 36 , 41 , 42 , 46 , 48 , 50 ), and three articles examined alterations in lymphatic flow ( 29 , 41 , 46 ). Patients were followed for a mean period of 14 months, with the majority having a follow-up period of 12 months.…”

“…Arm volume measurements in the included articles were conducted using three distinct methods: manual arm circumference (n=20) ( 20 , 27 - 31 , 34 - 36 , 38 , 39 , 42 - 47 , 49 - 51 ), perometer (n=4) ( 32 , 33 , 37 , 40 ), and water displacement (n=3) ( 41 , 48 , 50 ). Manual arm circumference measurements involved assessing the arm circumference at several predefined points to assess changes in arm circumferences or calculate total arm volume using the formula of a blunt cone.…”

“…In evaluating patients’ quality of life, the Lymph-ICF questionnaire was the predominant patient-reported outcome measure (PROM) used in five articles ( 20 , 30 , 31 , 36 , 46 ). Other PROMs included Lymphedema Quality of Life (LYMQOL) (n=2) ( 32 , 48 ), LymphQol (n=1) ( 50 ), LeQOLiS (n=1) ( 42 ), Short Form-36 (SF-36) (n=1) ( 41 ), Visual Analog Scale (VAS) (n=1) ( 34 ), and a self-developed questionnaire addressing clinical condition and quality of life (n=1) ( 51 ). Patient responses to the Lymph-ICF questionnaire generate a total score within each scale, ranging from 0 to 100, with 0 being the highest health-related quality of life and 100 reflecting the lowest.…”