Multisite Lymphaticovenular Bypass Using Supermicrosurgery Technique for Lymphedema Management in Lower Lymphedema Cases

Mihara, Makoto; Hara, Hisako; Tange, Shuichi; Zhou, Han; Kawahara, Mari; Shimizu, Y.; Murai, Noriyuki

doi:10.1097/prs.0000000000002254

Cited by 88 publications

(84 citation statements)

References 41 publications

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“…In the present study, a mean 52·3 per cent increase in excess volume was observed in non‐responders at 12 months. Other published series have reported no change, or a deterioration, in lymphoedema in up to 40 per cent of patients treated with LVA, compared with the 22 per cent (6 of 27) non‐response rate in the present series. Although the numbers in the no‐response group are too small to demonstrate causality between non‐response to LVA and worsening limb volume, further data are required to differentiate between increases in limb volume attributable to LVA failure and the natural evolution of volume changes in lymphoedema.…”

Section: Discussioncontrasting

confidence: 67%

Feasibility study of combined dynamic imaging and lymphaticovenous anastomosis surgery for breast cancer-related lymphoedema

Khan

Hernán

Adamthwaite

et al. 2018

British Journal of Surgery

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Background Breast cancer‐related lymphoedema (BCRL) presents a significant healthcare burden and adversely affects quality of life of breast cancer survivors. A prospective feasibility study was performed on lymphaticovenous anastomosis (LVA) for the treatment of BCRL. Methods Patients with BCRL underwent near‐infrared spectroscopy with indocyanine green lymphatic mapping to identify suitable lymphatic channels for LVA. End‐to‐end anastomoses to subdermal venules were performed and patients recommenced compression garment therapy (CGT) after surgery. Volumetric assessment of the affected limb was performed at regular intervals using infrared perometry to calculate the excess volume reduction. Results Over a 24‐month interval, 27 patients with BCRL underwent LVA. The mean duration of lymphoedema was 3·5 (range 0·5–18) years, and the mean number of LVAs performed was 3 (range 2–5). Twenty‐four of the 27 patients completed 12‐month follow‐up. Patients exhibited three patterns of volumetric response following LVA: sustained response (16 patients), transient response (5) or no response (6). Sustained responders showed an excess volume reduction of −33·2 per cent at 12 months, and this correlated positively with the number of LVAs performed (r = −0·56, P = 0·034). Overall, ten patients were able to downgrade CGT after surgery, and two patients were CGT‐free at 12 months. Conclusion LVA resulted in a sustained volume reduction in selected patients and may offset the burden of CGT. Further work is required to identify biomarkers that predict a favourable response to LVA surgery.

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Section: Discussioncontrasting

confidence: 67%

Feasibility study of combined dynamic imaging and lymphaticovenous anastomosis surgery for breast cancer-related lymphoedema

Khan

Hernán

Adamthwaite

et al. 2018

British Journal of Surgery

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“…Similarly, reductions in upper or lower extremity circumference as well as subjective symptom improvements were greater in patients who underwent both LVA and reduction surgery. Mihara and colleagues solely compared pre‐ and postoperative cellulitis episodes following LVA (with or without excess tissue resection), so that detailed information on volume or circumference reduction following LVA is not available (Mihara et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…Nevertheless, there is no reported consensus on the optimal number of anastomoses required to yield a significant reduction in lymphedema. Some authors stated that the number of anastomoses is of "paramount importance" in lymphedema treatment (Chang, Suami, & Skoracki, 2013;Mihara et al, 2016;Szuba & Rockson, 1998). Yet other studies included in this review did not clearly specify the number of anastomoses nor how it influenced lymphedema treatment (Koshima et al, 2003;Mihara et al, 2016;O'Brien et al, 1990;Szuba & Rockson, 1998).…”

Section: Discussionmentioning

confidence: 99%

“…Initially, ablative techniques were developed, but led to significant morbidity and have therefore mostly been abandoned or left for the most extreme cases (Chang, ). More recent surgical techniques for treating lymphedema of the upper and lower extremities include liposuction, lympho‐lymphatic bypass, vascularized lymph node transfer (VLNT) and lymphovenous anastomosis (LVA) (Brorson, ; Granzow et al, ; Leung et al, ; Mihara et al, ; Saaristo et al, ; Scaglioni et al, ). Cormier et al report in their systematic review of the literature until 2010 that different surgical approaches showed beneficial effects for lymphedema treatment up to a 118% reduction and promising reports of LVA for lymphedema treatment (Cormier et al, ).…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema

et al. 2017

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“…Previous studies achieved similar percentages in the subjective symptoms after LVA (61.5–100%) [11–13, 27–29]. A wide variety of methods were used to measure these subjective symptoms, such as retrospective interviews [30], scale scoring systems for subjective pre- and postoperative complaints [31, 32] or subjective assessment by a skin therapist [33].…”

Section: Discussionmentioning

confidence: 99%

Lymphatico-venous anastomosis as treatment for breast cancer-related lymphedema: a prospective study on quality of life

Cornelissen

Kool

Penha

et al. 2017

Breast Cancer Res Treat

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PurposeLymphedema is a chronic and disabling sequel of breast cancer treatment that can be treated by lymphatico-venous anastomosis (LVA). Artificial connections between the venous and lymphatic system are performed supermicrosurgically. This prospective study analyses the effect of LVA on quality of life.MethodsA prospective study was performed between November 2015 and July 2016 on consecutive patients in the Maastricht University Medical Centre. Quality of life was considered as the primary outcome, and the Lymphedema International Classification of Functioning (Lymph-ICF) questionnaire was used. Discontinuation of compressive stockings and arm volume, using the Upper Extremity Lymphedema index (UEL-index), were the secondary outcomes.ResultsTwenty women with early-stage breast cancer-related lymphedema (BCRL) were included. The mean age was 55.9 ± 4 years and the median BMI was 25.1 [21–30] kg/m2. The mean follow-up was 7.8 ± 1.5 months. Statistically significant improvement in quality of life was achieved in the total score and for all the quality of life domains after one year of follow-up (p < 0.05). The discontinuation rate in compressive stockings use was 85%. The difference in mean relative volume did not show a statistically significant decrease.ConclusionsLVA for early-stage BCRL resulted in a significant improvement in quality of life and a high rate in stocking discontinuation.

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Multisite Lymphaticovenular Bypass Using Supermicrosurgery Technique for Lymphedema Management in Lower Lymphedema Cases

Abstract: Therapeutic, IV.

Cited by 88 publications

References 41 publications

Feasibility study of combined dynamic imaging and lymphaticovenous anastomosis surgery for breast cancer-related lymphoedema

Feasibility study of combined dynamic imaging and lymphaticovenous anastomosis surgery for breast cancer-related lymphoedema

Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema

Lymphatico-venous anastomosis as treatment for breast cancer-related lymphedema: a prospective study on quality of life

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