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

Ann Surg Oncol. 2015 Oct;22(10):3296-301. doi: 10.1245/s10434-015-4721-y. Epub 2015 Jul 23.

Abstract

Background: As many as 40 % of breast cancer patients undergoing axillary lymph node dissection (ALND) and radiotherapy develop lymphedema. We report our experience performing lymphatic-venous anastomosis using the lymphatic microsurgical preventive healing approach (LYMPHA) at the time of ALND. This technique was described by Boccardo, Campisi in 2009.

Methods: LYMPHA was offered to node-positive women with breast cancer requiring ALND. Afferent lymphatic vessels, identified by injection of blue dye in the ipsilateral arm, were sutured into a branch of the axillary vein distal to a competent valve. Follow-up was with pre- and postoperative lymphoscintigraphy, arm measurements, and (L-Dex®) bioimpedance spectroscopy.

Results: Over 26 months, 37 women underwent attempted LYMPHA, with successful completion in 27. Unsuccessful attempts were due to lack of a suitable vein (n = 3) and lymphatic (n = 5) or extensive axillary disease (n = 1). There were no LYMPHA-related complications. Mean follow-up time was 6 months (range 3-24 months). Among completed patients, 10 (37%) had a body mass index of ≥30 kg/m(2) (mean 27.9 ± 6.8 kg/m(2), range 17.4-47.6 kg/m(2)), and 17 (63%) received axillary radiotherapy. Excluding two patients with preoperative lymphedema and those with less than 3-month follow-up, the lymphedema rate was 3 (12.5%) of 24 in successfully completed and 4 (50 %) of 8 in unsuccessfully treated patients.

Conclusions: 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.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Lymph Node Excision / adverse effects*
  • Lymphatic Vessels / surgery*
  • Lymphedema / diagnosis
  • Lymphedema / etiology
  • Lymphedema / prevention & control*
  • Microsurgery
  • Middle Aged
  • Neoplasm Staging
  • Postoperative Complications*
  • Primary Prevention
  • Prognosis
  • Retrospective Studies