Microsurgical techniques in the treatment of breast cancer-related lymphedema: a systematic review of efficacy and patient outcomes

Abstract

Introduction Secondary lymphedema is the abnormal collection of lymphatic fluid within subcutaneous structures. Patients with lymphedema suffer a low quality of life. In our study, we aim to provide a systematic review of the current data on patient outcomes regarding breast cancer-related lymphedema (BCRL), and the most prevalent reconstructive techniques. Methods A PubMed (MEDLINE) and Scopus literature search was performed in September 2020. Studies were screened based on inclusion/exclusion criteria. The protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO), and it was reported in line with the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Results The search yielded 254 papers from 2010 to 2020. 67 were included in our study. Lymphaticovenous anastomosis (LVA)—a minimally invasive procedure diverting the lymph into the dermal venous drainage system—combined with postoperative bandaging and compression garments yields superior results with minimal donor site lymphedema morbidity. Vascularized lymph node transfer (VLNT)—another microsurgical technique, often combined with autologous free flap breast reconstruction—improves lymphedema and brachial plexus neuropathies, and reduces the risk of cellulitis. The combination of LVA and VLNT or with other methods maximizes their effectiveness. Vascularized lymph vessel transfer (VLVT) consists of harvesting certain lymph vessels, sparing the donor site’s lymph nodes. Conclusion Together with integrated lymphedema therapy, proper staging, and appropriate selection of procedure, safe and efficient surgical techniques can be beneficial to many patients with BCRL.

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

“…Nevertheless, the target should be to perform prophylactic surgical procedures in order to prevent lymphedema development following axillary or inguinal complete lymph node dissection and adjuvant radiotherapy [27]. Lymphedema after standard axillary lymph node dissection can occur in up to approximately 50% of patients, and adjuvant radiotherapy to the breast or lymph nodes increases the risk of lymphedema [28,29].…”

Vascularized Lymph Node Transfer for Treatment of Breast Cancer-Related Lymphedema: Indications, Donor Sites and Complications

“…VLNT is preferred for patients with moderate and severe lymphedema aiming to replace sclerosed and dysfunctional lymph nodes with new ones that properly functioning and providing physiologic function [2,4]. This microsurgical technique should be considered in case of complete blockage (Cheng's stage II and above), failed conservative treatment, recurrent episodes of cellulitis, and loss of lymph nodes as seen by the absent signal in the lymphoscintigraphy and magnetic resonance lymphography [5].…”

“…Iatrogenic lymphedema or donor site lymphedema refers to the risk of introducing lymphedema to the limb drained by donor lymph nodes that were removed as part of the VLNT harvest. There are few donor sites for VLNT with the inguinal site being the most popular, followed by thoracic, supraclavicular, omental, and submental [5,6].…”

“…Inguinal donor site. The inguinal region is the most common donor site for VLNT [2,5]. Harvesting of lymph nodes from this region is preferable due to well-described anatomic structures, abundant lymph nodes and soft tissue, and well-hidden donor site scar [5].…”

“…The inguinal region is the most common donor site for VLNT [2,5]. Harvesting of lymph nodes from this region is preferable due to well-described anatomic structures, abundant lymph nodes and soft tissue, and well-hidden donor site scar [5]. Furthermore, lymph nodes can be harvested in conjunction with a deep inferior epigastric perforator (DIEP) flap for breast reconstruction [3].…”