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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2015

01-10-2015 | Breast Oncology

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

Authors: Sheldon Feldman, MD, Hannah Bansil, MD, Jeffrey Ascherman, MD, Robert Grant, MD, Billie Borden, BA, Peter Henderson, MD, Adewuni Ojo, MD, Bret Taback, MD, Margaret Chen, MD, Preya Ananthakrishnan, MD, Amiya Vaz, BA, Fatih Balci, MD, Chaitanya R. Divgi, MD, David Leung, MD, Christine Rohde, MD

Published in: Annals of Surgical Oncology | Issue 10/2015

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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/m2 (mean 27.9 ± 6.8 kg/m2, range 17.4–47.6 kg/m2), 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.
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Metadata
Title
Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema
Authors
Sheldon Feldman, MD
Hannah Bansil, MD
Jeffrey Ascherman, MD
Robert Grant, MD
Billie Borden, BA
Peter Henderson, MD
Adewuni Ojo, MD
Bret Taback, MD
Margaret Chen, MD
Preya Ananthakrishnan, MD
Amiya Vaz, BA
Fatih Balci, MD
Chaitanya R. Divgi, MD
David Leung, MD
Christine Rohde, MD
Publication date
01-10-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 10/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4721-y

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