Microsurgery for treatment of peripheral lymphedema: Long‐term outcome and future perspectives

Campisi, Corradino; Eretta, Costantino; Pertile, Davide; Rin, E. Da; Campisi, C.; Macciò, Alberto; Campisi, Mirko; Accogli, P T Susanna; Bellini, Carlo; Bonioli, E; Boccardo, Francesco

doi:10.1002/micr.20346

Cited by 111 publications

(68 citation statements)

References 11 publications

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“…In a recent personal communication, Campisi [24] suggested that from his point of view, LVA is most suitable in the early stages 1B, II and early III. No other postoperative therapeutic modalities such as elastic stockings, decongestive treatment or anti platelet clotting medication were mentioned.…”

Section: Discussionmentioning

confidence: 99%

Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

Damstra

Voesten

Schelven

et al. 2008

Breast Cancer Res Treat

165

149

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Objective The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic, this study was undertaken to prospectively determine the effect of Lympho Venous Anastomosis (LVA) on BCRL and to review the current literature. Study design and methods Ten patients who were previously treated for breast cancer by surgery, radiotherapy, and chemotherapy, and were unresponsive to 12-weeks of non-operative treatment, underwent an LVA procedure (Degni-Cordeiro). Objective measurements were gathered for circumferential measurement and water volumetry, and quality of life. Various types of lymphoscintigraphy were carried out pre-operatively and post-operatively at 3 and 12 months. Treatment was embedded in a multidisciplinary setting. Results Post-operative volume measurements initially showed a 4.8% reduction of lymphedema at 3 months and a 2% reduction after one year. Various scintigraphic parameters showed some improvement. Quality of life questionnaires reported minimal improvement. Reviewing the literature, only retrospective studies were found; these reported varying results for LVA procedures. The selection of patients, classification of lymphedema, indications and types of LVA, and additional therapeutic options were heterogeneous, not comparable, and lacked a validated method of effect-assessment. Conclusions Our results showed a minimal reduction in volume of lymphedema following LVA; in the literature, there was no convincing evidence of the success of LVA. Non-operative treatment and elastic stockings are still preferred by most patients with lymphedema, especially in early stages with few irreversible changes.Keywords Lympho-venous anastomosis (LVA) Á Microsurgery Á Evidence-based medicine Á Lymphoscintigraphy Á Inverse water volumetry Á Review Á Breast cancer related lymphedema

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Section: Discussionmentioning

confidence: 99%

Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

Damstra

Voesten

Schelven

et al. 2008

Breast Cancer Res Treat

165

149

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“…Supermicrosurgical techniques are required as most lymphatics range from 0.1 to 0.6 mm in diameter. [42][43][44][45][46][47][48] Intraoperative identification of lymphatic vessels is facilitated both with Lymphazurin dye and also with laser angiography using indocyanine green (Fig. 4).…”

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confidence: 99%

Review of Current Surgical Treatments for Lymphedema

et al. 2014

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Background. The current mainstay of lymphedema therapy has been conservative nonsurgical treatment. However, surgical options for lymphedema have been reported for over a century. Early surgical procedures were often invasive and disfiguring, and they often had only limited long-term success. In contrast, contemporary surgical techniques are much less invasive and have been shown to be effective in reducing excess limb volume, the risk of cellulitis, and the need for compression garment use and lymphedema therapy. Microsurgical procedures such as lymphaticovenous anastomosis and vascularized lymph node transfer lymphaticolymphatic bypass can treat the excess fluid component of lymphedema swelling that presents as pitting edema. Suction-assisted protein lipectomy is a minimally invasive procedure that addresses the solid component of lymphedema swelling that typically occurs later in the disease process and presents as chronic nonpitting lymphedema. These surgical techniques are becoming increasingly popular and their success continues to be documented in the medical literature. We review the efficacy and limitations of these contemporary surgical procedures for lymphedema. Methods. A Medline literature review was performed of lymphedema surgery, vascularized lymph node transfer, lymphaticovenous anastomosis, lymphatic liposuction, and lymphaticolymphatic bypass with particular emphasis on developments within the past 10 years. A literature review of technique, indications, and outcomes of the surgical treatments for lymphedema was undertaken.Results. Surgical treatments have evolved to become less invasive and more effective. Conclusions. With proper diagnosis and the appropriate selection of procedure, surgical techniques can be used to treat lymphedema safely and effectively in many patients when combined with integrated lymphedema therapy.Lymphedema is a progressive and debilitating condition associated with dysfunction of the lymphatic system. While a small percentage of cases are congenital, most patients in developed countries present with lymphedema resulting from treatment of malignancy. The true incidence of lymphedema is difficult to determine as a result of significant differences in diagnostic criteria. However, lymphedema is reported to occur in up to 49 % of breast, 20 % of gynecologic, 16 % of melanoma, 10 % of genitourinary, and 6 % head and neck cancer patients after lymph node dissection and/or radiotherapy. Even among patients who undergo isolated axillary sentinel lymph node biopsy, up to 7 % have measurable arm differences, and up to 10 % have subjective symptoms of lymphedema.

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“…[5][6][7][8] Lymphaticovenous anastomosis (LVA) is also a microsurgical procedure in which lymphatic vessels, usually between 0.1 and 0.6 mm in diameter, are sewn to small adjacent venules to bypass an area of poor lymphatic flow or obstruction and drain excess lymph directly into the venous system. [9][10][11][12] Suction-assisted protein lipectomy (SAPL) allows the removal of the solid components of lymphedema swelling seen in chronic lymphedema. 13,14 We used these three procedures, together with customized conservative lymphedema therapy, in an integrated treatment system to address most effectively patients with various presentations of lymphedema.…”

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confidence: 99%

An Effective System of Surgical Treatment of Lymphedema

et al. 2014

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Background. Effective surgical treatments for lymphedema now can address the fluid and solid phases of the disease process. Microsurgical procedures, including lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), target the fluid component that predominates at earlier stages of the disease. Suctionassisted protein lipectomy (SAPL) addresses the solid component that typically presents later as chronic, nonpitting lymphedema of an extremity. We assess the outcomes of patients who underwent selective application of these three surgical procedures as part of an effective system to treat lymphedema. Methods. This is a retrospective chart review of patients with lymphedema who underwent complete decongestive therapy followed by surgical treatment with SAPL, LVA, or VLNT. The primary outcomes measured were postoperative volume reduction (SAPL), daily requirement for compression garments and lymphedema therapy (VLNT and LVA), and the incidence of severe cellulitis. Results. Twenty-six patients were included in the study, of which 10 underwent SAPL and 16 underwent LVA or VLNT. The average reduction of excess volume by SAPL was 3,212 mL in legs and 943 mL in arms, or a volume reduction of 87 and 111 %, respectively, when compared with the unaffected, opposite sides. Microsurgical procedures (VLNT and LVA) significantly reduced the need for both compression garment use (p = 0.003) and lymphedema therapy (p \ 0.0001). The overall rate of cellulitis decreased from 58 % before surgery to 15 % after surgery (p \ 0.0001).Conclusions. When applied appropriately to properly selected patients, surgical procedures used in the treatment of lymphedema are effective and safe.Lymphedema in the developed world commonly occurs after lymph node dissection and/or radiotherapy to nodal basins for breast cancer, melanoma, or gynecologic malignancies. Less commonly, lymphedema occurs as a result of congenital causes.

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Microsurgery for treatment of peripheral lymphedema: Long‐term outcome and future perspectives

Cited by 111 publications

References 11 publications

Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

Review of Current Surgical Treatments for Lymphedema

An Effective System of Surgical Treatment of Lymphedema

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