Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema

Feldman, Sheldon; Bansil, Hannah; Ascherman, Jeffrey A.; Grant, Robert T.; Borden, Billie; Henderson, Peter W.; Ojo, Adewuni; Taback, Bret; Chen, Margaret; Ananthakrishnan, Preya; Vaz, Amiya; Balcı, Fatih Levent; Divgi, Chaitanya; Leung, David; Rohde, Christine

doi:10.1245/s10434-015-4721-y

Cited by 140 publications

(116 citation statements)

References 30 publications

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“…Bioimpedance spectroscopy (BIS) is one of the few techniques of body composition analysis which differentiates the extracellular fluid compartment from the total limb volume [27]. The use of BIS for clinical monitoring of the risk of lymphedema and of lymphedema progression is under increasingly wide application and has been validated in numerous prospective clinical studies [28, 29]. Multi-frequency BI analysis is based on the fact that the resistance to the flow of electric current through the body is inversely proportional to the volume of fluid in the tissue.…”

Section: Methodsmentioning

confidence: 99%

Aligned nanofibrillar collagen scaffolds – Guiding lymphangiogenesis for treatment of acquired lymphedema

et al. 2016

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Secondary lymphedema is a common disorder associated with acquired functional impairment of the lymphatic system. The goal of this study was to evaluate the therapeutic efficacy of aligned nanofibrillar collagen scaffolds (BioBridge) positioned across the area of lymphatic obstruction in guiding lymphatic regeneration. In a porcine model of acquired lymphedema, animals were treated with BioBridge scaffolds, alone or in conjunction with autologous lymph node transfer as a source of endogenous lymphatic growth factor. They were compared with a surgical control group and a second control group in which the implanted BioBridge was supplemented with exogenous vascular endothelial growth factor-C (VEGF-C). Three months after implantation, immunofluorescence staining of lymphatic vessels demonstrated a significant increase in lymphatic collectors within close proximity to the scaffolds. To quantify the functional impact of scaffold implantation, bioimpedance was used as an early indicator of extracellular fluid accumulation. In comparison to the levels prior to implantation, the bioimpedance ratio was significantly improved only in the experimental BioBridge recipients with or without lymph node transfer, suggesting restoration of functional lymphatic drainage. These results further correlated with quantifiable lymphatic collectors, as visualized by contrast-enhanced computed tomography. They demonstrate the therapeutic potential of BioBridge scaffolds in secondary lymphedema.

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Section: Methodsmentioning

confidence: 99%

Aligned nanofibrillar collagen scaffolds – Guiding lymphangiogenesis for treatment of acquired lymphedema

et al. 2016

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“…Conversion from a single site deep upper brachial injection to a subdermal injection of several aliquots of dye circumferentially in the medial upper arm resulted in superior visualization and preservation of uninvolved lymphatics. This represents an improvement over the report by Feldman et al where 5/35 patients were unable to undergo LVB because of the inability to identify suitable lymphatics. Our results are consistent with, and reveal a slight improvement over the lymphatic identification rate of 96% (75/78 patients) reported by Boccardo et al in their 4‐year follow‐up report.…”

Section: Discussionmentioning

confidence: 60%

“…Although it is inevitable that some lymphatics will be divided for oncologic control, ARM allows for differentiation of UE and breast drainage pathways. Prior studies evaluating reverse mapping have demonstrated success rates in identifying UE lymphatic channels from 61%‐71% . In patients undergoing ALND, ARM has facilitated lymphatic sparing in up to 67.3% of patients …”

Section: Introductionmentioning

confidence: 99%

“…Prior studies evaluating reverse mapping have demonstrated success rates in identifying UE lymphatic channels from 61%-71%. 9,10 In patients undergoing ALND, ARM has facilitated lymphatic sparing in up to 67.3% of patients. 6 Lymphaticovenous bypass (LVB) is a microsurgical technique that reroutes lymphatic fluid into the venous system via anastomosis of divided lymphatics with recipient veins proximal to the level of obstruction.…”

Section: Introductionmentioning

confidence: 99%

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Axillary reverse mapping and lymphaticovenous bypass: Lymphedema prevention through enhanced lymphatic visualization and restoration of flow

Schwarz

Grobmyer

Djohan

et al. 2019

Journal of Surgical Oncology

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Background A lymphedema (LE) prevention surgery (LPS) paradigm for patients undergoing axillary lymphadenectomy (ALND) was developed to protect against LE through enhanced lymphatic visualization during axillary reverse mapping (ARM) and refinement in decision making during lymphaticovenous bypass (LVB). Methods A retrospective analysis of a prospective database was performed evaluating patients with breast cancer who underwent ALND, ARM, and LVB from September 2016 to December 2018. Patient and tumor characteristics, oncologic and reconstructive operative details, complications and LE development were analyzed. Results LPS was completed in 58 patients with a mean age of 51.7 years. An average of 14 lymph nodes (LN) were removed during ALND. An average of 2.1 blue lymphatic channels were visualized with an average of 1.4 LVBs performed per patient. End to end anastomosis was performed in 37 patients and a multiple lymphatic intussusception technique in 21. Patency was confirmed 96.5% of patients. Adjuvant radiation was administered to 89% of patients. Two patients developed LE with a median follow‐up of 11.8 months. Conclusion We report on our experience using a unique LPS technique. Refinements in ARM and a systematic approach to LVB allows for maximal preservation of lymphatic continuity, identification of transected lymphatics, and reestablishment of upper extremity lymphatic drainage pathways.

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“…procedure in the prevention of secondary arm lymphedema and LY.M.P.H.A. technique was included among the surgical procedures to prevent breast cancer related lymphedema [19][20][21][22] .…”

Section: Figure 4 -Lympha Technique At the Groin A -Tributary Omentioning

confidence: 99%

Surgical prevention of Lymphedema following lymph node dissection: LY.M.P.H.A. technique.

Boccardo¹,

Dessalvi²,

Villa³

et al. 2018

JTAVR

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Background A side-effect of axillary lymph node excision and radiotherapy for breast cancer is arm lymphedema in about 25% patients (ranging from 13 to 52%). Sentinel lymph node (SLN) biopsy has reduced the severity of swelling to nearly 6% patients (from 2 to 7%) and, in case of positive SLN, complete axillary dissection (AD) is still required. That is why Axillary Reverse Mapping method (ARM) was developed aiming at identifying and preserve lymphatics draining the arm. Leaving in place lymph nodes related to arm lymphatic drainage would decrease the risk of arm lymphedema, but not retrieving all nodes, the main risk is to leave metastatic disease in the axilla. Based on long term experience in lymphatic-venous anastomoses (LVA) for lymphedema treatment, Authors conceived and carried out preventive LVA during nodal dissection (Lymphatic Microsurgical Preventing Healing Approach -LY.M.P.H.A. technique). Methods 78 patients underwent axillary nodal dissection for breast cancer treatment and in 74 of them LY.M.P.H.A. procedure was performed. Indications to LY.M.P.H.A. technique were based on clinical and lymphoscintigraphic parameters. All blue nodes were resected and 2 to 4 main afferent lymphatics from the arm could be prepared and used for anastomoses. Lymphatics were introduced inside the vein cut-end by a U-shaped stitch. Volumetry was performed preoperatively in all patients and after 1, 6, 12 months and once a year. Lymphoscintigraphy was performed in 45 patients preoperatively and in 30 also postoperatively after at least over 1 year. Results Seventy-one patients had no sign of lymphedema. In 3 patients, lymphedema occurred after 8-12 months postoperatively. The incidence of secondary arm lymphedema after LY.M.P.H.A. technique was therefore 4.05%. Conclusion LVA proved not only to prevent lymphedema but also to reduce early lymphatic complications (i.e. lymphorrhea, lymphocele). LY.M.P.H.A. technique is also useful in patients with melanoma of the trunk and vulvar cancer, in whom it is possible to perform preventive LVA simultaneously with inguinal lymphadenectomy. Lymphedema is a consequence of cancer treatment. The use of the blue dye and of LVA helps to solve the problem of preventing secondary arm and leg lymphedema. LY.M.P.H.A. represents a rational approach to the prevention of lymphedema following axillary and groin surgery in the therapy of breast cancer, melanoma, vulvar cancer and other tumors.Keywords Lymphedema, lymph node dissection, prevention, LY.M.P.H.A. technique, lymphatic-venous anastomosis.

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Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema

Abstract: Our transient lymphedema rate in this high-risk cohort of patients was 12.5%. Early data show that LYMPHA is feasible, safe, and effective for the primary prevention of breast cancer-related lymphedema.

Cited by 140 publications

References 30 publications

Aligned nanofibrillar collagen scaffolds – Guiding lymphangiogenesis for treatment of acquired lymphedema

Aligned nanofibrillar collagen scaffolds – Guiding lymphangiogenesis for treatment of acquired lymphedema

Axillary reverse mapping and lymphaticovenous bypass: Lymphedema prevention through enhanced lymphatic visualization and restoration of flow

Surgical prevention of Lymphedema following lymph node dissection: LY.M.P.H.A. technique.

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