The Impact of Lymphedema on Patient-Reported Outcomes After Breast Reconstruction: A Preliminary Propensity Score-Matched Analysis

Coriddi, Michelle; Kim, Leslie; Haglich, Kathryn; McGrath, Leslie; Monge, Jasmine J. L.; Shamsunder, Meghana G.; Mehrara, Babak J.; Dayan, Joseph H.; Nelson, Jonas A.

doi:10.1245/s10434-022-12994-z

Cited by 13 publications

(13 citation statements)

References 25 publications

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“…Patient follow up was variable but up to 24 months, the window in which most patients develop secondary lymphedema after cancer treatment. 115…”

Section: Prevention and Surveillancementioning

confidence: 99%

Advances in lymphedema: An under-recognized disease with a hopeful future for patients

Carroll,

Singhal

2024

Vasc Med

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Lymphedema has traditionally been underappreciated by the healthcare community. Understanding of the underlying pathophysiology and treatments beyond compression have been limited until recently. Increased investigation has demonstrated the key role of inflammation and resultant fibrosis and adipose deposition leading to the clinical sequelae and associated reduction in quality of life with lymphedema. New imaging techniques including magnetic resonance imaging (MRI), indocyanine green lymphography, and high-frequency ultrasound offer improved resolution and understanding of lymphatic anatomy and flow. Conservative therapy with compression, exercise, and weight loss remains the mainstay of therapy, but growing surgical options show promise. Physiologic procedures (lymphovenous anastomosis and vascularized lymph node transfers) improve lymphatic flow in the diseased limb and may reduce edema and the burden of compression. Debulking, primarily with liposuction to remove the adipose deposition that has accumulated, results in a dramatic decrease in limb girth in appropriately selected patients. Though early, there are also exciting developments of potential therapeutic targets tackling the underlying drivers of the disease. Multidisciplinary teams have developed to offer the full breadth of evaluation and current management, but the development of a greater understanding and availability of therapies is needed to ensure patients with lymphedema have greater opportunity for optimal care.

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“…Patient follow up was variable but up to 24 months, the window in which most patients develop secondary lymphedema after cancer treatment. 115…”

Section: Prevention and Surveillancementioning

confidence: 99%

Advances in lymphedema: An under-recognized disease with a hopeful future for patients

Carroll,

Singhal

2024

Vasc Med

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“…4 Accumulating evidence has suggested the efficacy of lymphedema risk reduction from this procedure. 5,6 In a meta-analysis by Hill et al in 2022, 6.7% of patients in the ILR (LYMPHA) group developed lymphedema. In the control group, 34% of patients developed lymphedema.…”

Section: Introductionmentioning

confidence: 99%

“…5 In a randomized controlled trial by Coriddi et al, the preliminary results show that ILR decreases BCRL incidences, which are 9.5% in the ILR group, and 32% in the control group. 6 However, understanding of the oncologic safety of ILR after ALND is still lacking. This concern comes from that this procedure involves surgically diverting lymphatic ducts directly into nearby venules in an axillary wound that was node-positive before ALND, and some breast cancer cells might be still present after ALND.…”

Section: Introductionmentioning

confidence: 99%

Is Immediate Lymphatic Reconstruction on Breast Cancer Patients Oncologically Safe? A Preliminary Study

Lin,

Kuan,

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: In breast cancer patients receiving axillary lymph node dissection (ALND), immediate lymphatic reconstruction (ILR) with lymphovenous anastomosis is an emerging technique for reducing the risk of arm lymphedema. However, the oncologic safety of surgically diverting lymphatic ducts directly into venules in a node-positive axilla is still a concern of inadvertently inducing metastasis of remaining cancer cells. This study aimed to assess the oncologic safety of ILR. Methods: From January 2020 to January 2022, 95 breast cancer patients received ALND, and 45 of them also received ILR. Patients with recurrent cancer, with follow-up less than 12 months, and with missed data were excluded. Variables were compared between ILR and non-ILR groups, and the outcome of interest was the rate of distant recurrence after follow-up for at least 1 year. Results: Thirty-four patients in the ILR group and 32 patients in the non-ILR group fulfilled the inclusion criteria for analysis. No statistically significant difference was noted between groups in terms of age, body mass index, type of breast surgery, pathologic cancer staging, histologic type and grade of breast cancer, molecular subtypes, frequency of axillary lymph node metastasis, or adjuvant therapy. For the patients receiving follow-up for at least 1 year, no statistically significant difference was found in terms of distant recurrence rates between ILR and non-ILR groups (P = 0.44). Conclusion: For breast cancer patients receiving ALND, ILR with lymphovenous anastomosis is oncologically safe, within an average follow-up period of 21 months.

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“…Consequently, a prophylactic microsurgical LVB technique, also known as immediate lymphatic reconstruction (ILR), or Lymphatic Microsurgical Healing Approach, was developed to prevent BCRL. ILR is significantly associated with reduced lymphedema postoperatively with minimal to no complications 12–17 . With prophylactic treatment, patients may avoid the potential lifelong morbidity associated with lymphedema; however, insurance does not routinely cover ILR, even though it has been revealed to be more cost effective than the current treatment options 18 .…”

Section: Introductionmentioning

confidence: 99%

United States insurance coverage of immediate lymphatic reconstruction

La‐Anyane,

Alba,

Harmon

et al. 2023

Journal of Surgical Oncology

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IntroductionImmediate Lymphatic Reconstruction (ILR) is a prophylactic microsurgical lymphovenous bypass technique developed to prevent breast cancer related lymphedema (BCRL). We investigated current coverage policies for ILR among the top insurance providers in the United States and compared it to our institutional experience with obtaining coverage for ILR.MethodsThe study analyzed the publicly available ILR coverage statements for American insurers with the largest market share and enrollment per state to assess coverage status. Institutional ILR coverage was retrospectively analyzed using deidentified claims data and categorizing denials based on payer reason codes.ResultsOf the 63 insurance companies queried, 42.9% did not have any publicly available policies regarding ILR coverage. Of the companies with a public policy, 75.0% deny coverage for ILR. In our institutional experience, $170,071.80 was charged for ILR and $166 118.99 (97.7%) was denied by insurance.ConclusionsOver half of America's major insurance providers currently deny coverage for ILR, which is consistent with our institutional experience. Randomized trials to evaluate the efficacy of ILR are underway and focus should be shifted towards sharing high level evidence to increase insurance coverage for BCRL prevention.

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The Impact of Lymphedema on Patient-Reported Outcomes After Breast Reconstruction: A Preliminary Propensity Score-Matched Analysis

Cited by 13 publications

References 25 publications

Advances in lymphedema: An under-recognized disease with a hopeful future for patients

Advances in lymphedema: An under-recognized disease with a hopeful future for patients

Is Immediate Lymphatic Reconstruction on Breast Cancer Patients Oncologically Safe? A Preliminary Study

United States insurance coverage of immediate lymphatic reconstruction

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