The breast cancer-related lymphedema multidisciplinary approach: Algorithm for conservative and multimodal surgical treatment.
Journal
Microsurgery
ISSN: 1098-2752
Titre abrégé: Microsurgery
Pays: United States
ID NLM: 8309230
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
revised:
17
10
2022
received:
15
04
2022
accepted:
18
11
2022
medline:
13
7
2023
pubmed:
27
11
2022
entrez:
26
11
2022
Statut:
ppublish
Résumé
Multiple surgical alternatives are available to treat breast cancer-related lymphedema (BCRL) providing a variable spectrum of outcomes. This study aimed to present the breast cancer-related lymphedema multidisciplinary approach (B-LYMA) to systematically treat BCRL. Seventy-eight patients presenting with BCRL between 2017 and 2021 were included. The average age and BMI were 49.4 ± 7.8 years and 28.1 ± 3.5 kg/m Stage II patients were treated with lymphaticovenous anastomosis (LVA) (n = 18), vascularized lymph node transfer (VLNT) (n = 12), and combined DIEP flap and VLNT (n = 10). Stage III patients underwent combined suction-assisted lipectomy (SAL) and LVA (n = 36) or combined SAL and VLNT (n = 2). Circumferential reduction rates (CRR) were comparable between patients treated with LVA (56.5 ± 8.4%), VLNT (54.4 ± 10.2%), and combined VLNT-DIEP flap (56.5 ± 3.9%) (p > .05). In comparison to LVA, VLNT, and combined VLNT-DIEP flap, combined SAL-LVA exhibited higher CRRs (85 ± 10.5%, p < .001). The CRR for combined SAL-VLNT was 75 ± 8.5%. One VLNT failed and minor complications occurred in the combined DIEP-VLNT group. The B-LYMA protocol directs the treatment of BCRL according to the lymphatic system's condition. In advanced stages where a single physiologic procedure is not sufficient, additional excisional surgery is implemented. Preoperative and postoperative CDT is mandatory to improve the outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Multiple surgical alternatives are available to treat breast cancer-related lymphedema (BCRL) providing a variable spectrum of outcomes. This study aimed to present the breast cancer-related lymphedema multidisciplinary approach (B-LYMA) to systematically treat BCRL.
METHODS
METHODS
Seventy-eight patients presenting with BCRL between 2017 and 2021 were included. The average age and BMI were 49.4 ± 7.8 years and 28.1 ± 3.5 kg/m
RESULTS
RESULTS
Stage II patients were treated with lymphaticovenous anastomosis (LVA) (n = 18), vascularized lymph node transfer (VLNT) (n = 12), and combined DIEP flap and VLNT (n = 10). Stage III patients underwent combined suction-assisted lipectomy (SAL) and LVA (n = 36) or combined SAL and VLNT (n = 2). Circumferential reduction rates (CRR) were comparable between patients treated with LVA (56.5 ± 8.4%), VLNT (54.4 ± 10.2%), and combined VLNT-DIEP flap (56.5 ± 3.9%) (p > .05). In comparison to LVA, VLNT, and combined VLNT-DIEP flap, combined SAL-LVA exhibited higher CRRs (85 ± 10.5%, p < .001). The CRR for combined SAL-VLNT was 75 ± 8.5%. One VLNT failed and minor complications occurred in the combined DIEP-VLNT group.
CONCLUSION
CONCLUSIONS
The B-LYMA protocol directs the treatment of BCRL according to the lymphatic system's condition. In advanced stages where a single physiologic procedure is not sufficient, additional excisional surgery is implemented. Preoperative and postoperative CDT is mandatory to improve the outcomes.
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
427-436Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Chang, E. I., Masià, J., & Smith, M. L. (2018). Combining autologous breast reconstruction and vascularized lymph node transfer. Seminars in Plastic Surgery, 32(1), 36-41.
Chang, E. I., Schaverien, M. V., Hanson, S. E., Chu, C. K., & Hanasono, M. M. (2020). Evolution in surgical management of breast cancer-related lymphedema. Plastic and Reconstructive Surgery-Global Open, 8(3), e2674.
Chen, W. F., Zhao, H., Yamamoto, T., Hara, H., & Ding, J. (2016). Indocyanine green lymphographic evidence of surgical efficacy following microsurgical and supermicrosurgical lymphedema reconstructions. Journal of Reconstructive Microsurgery, 32(9), 688-698.
Ciudad, P., Agko, M., Huang, T. C. T., Manrique, O. J., Chang, W. L., Nicoli, F., Maruccia, M., Lo Torto, F., & Chen, H. C. (2019). Comprehensive multimodal surgical treatment of end-stage lower extremity lymphedema with toe management: The combined Charles', Homan's, and vascularized lymph node transfer (CHAHOVA) procedures. Journal of Surgical Oncology, 119(4), 430-438.
Ciudad, P., Agko, M., Patel, K. M., Lo Torto, F., Forte, A. J., & Chen, H. C. (2020). A single-stage triple-inset vascularized gastroepiploic lymph node transfers for the surgical treatment of extremity lymphedema. Microsurgery, 41(1), 97-99.
Ciudad, P., Agko, M., Perez Coca, J. J., Manrique, O. J., Chang, W. L., Nicoli, F., Chen, S. H., & Chen, H. C. (2017). Comparison of long-term clinical outcomes among different vascularized lymph node transfers: 6-year experience of a single center's approach to the treatment of lymphedema. Journal of Surgical Oncology, 116(6), 671-682.
Ciudad, P., Escandón, J. M., Bustos, V. P., Manrique, O. J., & Kaciulyte, J. (2022). Primary prevention of cancer-related lymphedema using preventive lymphatic surgery: Systematic review and meta-analysis. Indian Journal of Plastic Surgery, 55(1), 18-25.
Ciudad, P., Escandón, J. M., Manrique, O. J., & Bustos, V. P. (2022). Lessons learnt from an 11-year experience with lymphatic surgery and a systematic review of reported complications: Technical considerations to reduce morbidity. Archives of Plastic Surgery, 49(2), 227-239.
Ciudad, P., Escandón, J. M., Manrique, O. J., Gutierrez-Arana, J., & Mayer, H. F. (2022). Lymphedema prevention and immediate breast reconstruction with simultaneous gastroepiploic vascularized lymph node transfer and deep inferior epigastric perforator flap: A case report. Microsurgery, 42, 617-621. https://doi.org/10.1002/micr.30939
Ciudad, P., Huayllani, M. T., Forte, A. J., Boczar, D., Avila, F. R., Escandón, J. M., Manrique, O. J., & Chen, H. C. (2022). Vascularized lymph node transfer for the treatment of posttraumatic lower extremity lymphedema: A preliminary report. Indian Journal of Plastic Surgery, 55(1), 97-101.
Ciudad, P., Manrique, O. J., Adabi, K., Huang, T. C. T., Agko, M., Trignano, E., Chang, W. L., Chen, T. W., Salgado, C. J., & Chen, H. C. (2019). Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema. Journal of Surgical Oncology, 119(4), 439-448. https://doi.org/10.1002/jso.25360
Ciudad, P., Manrique, O. J., Bustos, S. S., Agko, M., Huang, T. C., Vizcarra, L., Nuñez, M. L., Lo Torto, F., & Forte, A. J. (2020). Single-stage VASER-assisted liposuction and lymphatico-venous anastomoses for the treatment of extremity lymphedema: A case series and systematic review of the literature. Gland Surgery, 9(2), 545-557.
Ciudad, P., Manrique, O. J., Bustos, S. S., Coca, J. J. P., Chang, C. C., Shih, P. K., Nicoli, F., Lo Torto, F., Agko, M., Huang, T. C. T., Maruccia, M., & Chen, H. C. (2020). Comparisons in long-term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer. Microsurgery, 40(2), 130-136.
Ciudad, P., Manrique, O. J., Bustos, S. S., Vargas, M. I., Reynaga, C., Agko, M., Huang, T. C. T., Benites, E. F., Mayer, H. F., & Forte, A. J. (2020). Combined microvascular breast and lymphatic reconstruction with deep inferior epigastric perforator flap and gastroepiploic vascularized lymph node transfer for postmastectomy lymphedema patients. Gland Surgery, 9(2), 512-520. https://doi.org/10.21037/gs.2020.01.14
Ciudad, P., Vargas, M. I., Bustamante, A., Agko, M., Manrique, O. J., Ludeña, J., Castro, J., Wiegering, G., Navarro, W., & Reynaga, C. (2020). Combined radical reduction with preservation of perforators and distal lymphaticovenular anastomosis for advanced lower extremity lymphedema. Microsurgery, 40(3), 417-418.
Corkum, J. P., & Bezuhly, M. (2020). Combining vascularized lymph node transfer with autologous breast reconstruction: A Surveillance, Epidemiology and End Results (SEER) database cost-utility analysis. Journal of Plastic, Reconstructive & Aesthetic Surgery, 73(10), 1879-1888.
Di Taranto, G., Bolletta, A., Chen, S. H., Losco, L., Elia, R., Cigna, E., Rubino, C., Ribuffo, D., & Chen, H. C. (2021). A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy. Microsurgery, 41(1), 34-43.
Escandón, J. M., Ciudad, P., Mayer, H. F., Pencek, M., Mantilla-Rivas, E., Mohammad, A., Langstein, H. N., & Manrique, O. J. (2022). Free flap transfer with supermicrosurgical technique for soft tissue reconstruction: A systematic review and meta-analysis. Microsurgery. https://doi.org/10.1002/micr.30894. Epub ahead of print. PMID: 35551691.
Feng, G.-M., Yang, W., Huang, C.-H., Wang, S.-Y., & Chen, H.-C. (2003). Lymph nodes transfer for treating mild to moderate limb lymphedema-A preliminary result. Journal of Plastic and Reconstructive Surgical Association R.O.C., 12, 95-105.
Forte, A. J., Huayllani, M. T., Boczar, D., Ciudad, P., & Manrique, O. (2019). Lipoaspiration and lymph node transfer for treatment of breast cancer-related lymphedema: A systematic review. Cureus., 11(11), e6096.
Forte, A. J., Sisti, A., Huayllani, M. T., Boczar, D., Cinotto, G., Ciudad, P., Manrique, O. J., Lu, X., & McLaughlin, S. (2020). Lymphaticovenular anastomosis for breast cancer-related upper extremity lymphedema: A literature review. Gland Surgery, 9(2), 539-544.
Gärtner, R., Jensen, M. B., Kronborg, L., Ewertz, M., Kehlet, H., & Kroman, N. (2010). Self-reported arm-lymphedema and functional impairment after breast cancer treatment-A nationwide study of prevalence and associated factors. Breast, 19(6), 506-515.
International Society of Lymphology. (2020). The diagnosis and treatment of peripheral lymphedema: 2020 consensus document of the International Society of Lymphology. Lymphology, 53(1), 3-19.
Johnson, A. R., Kimball, S., Epstein, S., Recht, A., Lin, S. J., Lee, B. T., James, T. A., & Singhal, D. (2019). Lymphedema incidence after axillary lymph node dissection: Quantifying the impact of radiation and the lymphatic microsurgical preventive healing approach. Annals of Plastic Surgery, 82(4 S Suppl 3), S234-S241.
Kim, Y. H., Hwang, J. H., Bae, J. H., & Choi, J. Y. (2019). Predictive value of lymphoscintigraphy in patients with breast cancer-related lymphedema undergoing complex decongestive therapy. Breast Cancer Research and Treatment, 173(3), 735-741.
Kung, T. A., Champaneria, M. C., Maki, J. H., & Neligan, P. C. (2017). Current concepts in the surgical management of lymphedema. Plastic and Reconstructive Surgery, 139(4), 1003 e-1013 e.
Liu, H. L., Pang, S. Y., Lee, C. C., Wong, M. M. K., Chung, H. P., & Chan, Y. W. (2018). Orthotopic transfer of vascularized groin lymph node flap in the treatment of breast cancer-related lymphedema: Clinical results, lymphoscintigraphy findings, and proposed mechanism. Journal of Plastic, Reconstructive & Aesthetic Surgery, 71(7), 1033-1040.
Manrique, O. J., Bustos, S. S., Ciudad, P., Adabi, K., Chen, W. F., Forte, A. J., Cheville, A. L., Jakub, J. W., SA, M. L., & Chen, H. C. (2020). Overview of lymphedema for physicians and other clinicians: A review of fundamental concepts. Mayo Clinic Proceedings, 97, 1920-1935.
Manrique, O. J., Bustos, S. S., Kuruoglu, D., Yan, M., Ciudad, P., Forte, A. J., & Chen, H. C. (2020). Gastroepiploic lymph node flap harvest for patients with lymphedema: Minimally invasive versus open approach. Annals of Plastic Surgery, 85(S1), S87-S91.
Masia, J., Pons, G., & Nardulli, M. L. (2016). Combined surgical treatment in breast cancer-related lymphedema. Journal of Reconstructive Microsurgery, 32(1), 16-27.
Masià, J., Pons, G., & Rodríguez-Bauzà, E. (2016). Barcelona lymphedema algorithm for surgical treatment in breast cancer-related lymphedema. Journal of Reconstructive Microsurgery, 32(5), 329-335.
Matsui, C., Yamamoto, T., Tsukuura, R., Sakai, H., Miyazaki, T., Escandón, J. M., & Mohammad, A. (2022). Intraoperative monitoring of lymphatic vessel characteristics using video-capillaroscopy in the procedure of lymphaticovenular anastomosis. Microsurgery, 42, 850-851. https://doi.org/10.1002/micr.30964
Mazeron, J. J., Otmezguine, Y., Huart, J., & Pierquin, B. (1985). Conservative treatment of breast cancer: Results of management of axillary lymph node area in 3353 patients. Lancet, 325(8442), 1387.
Nicoli, F., Constantinides, J., Ciudad, P., Sapountzis, S., Kiranantawat, K., Lazzeri, D., Lim, S. Y., Nicoli, M., Chen, P. Y., Yeo, M. S. W., Chilgar, R. M., & Chen, H. C. (2015). Free lymph node flap transfer and laser-assisted liposuction: A combined technique for the treatment of moderate upper limb lymphedema. Lasers in Medical Science, 30(4), 1377-1385.
Oh, A., Kajita, H., Imanishi, N., Sakuma, H., Takatsume, Y., Okabe, K., Aiso, S., & Kishi, K. (2022). Three-dimensional analysis of dermal backflow in cancer-related lymphedema using photoacoustic lymphangiography. Archives of Plastic Surgery, 49(1), 99-107.
Ozcan, D. S., Dalyan, M., Unsal Delialioglu, S., Duzlu, U., Polat, C. S., & Koseoglu, B. F. (2018). Complex decongestive therapy enhances upper limb functions in patients with breast cancer-related lymphedema. Lymphatic Research and Biology, 16(5), 446-452.
R Core Team (R Core Development Team). (2021). R: A language and environment for statistical computing. (Version 4.0) [Computer Software]. Retrieved from https://cran.r-project.org/
Saaristo, A. M., Niemi, T. S., Viitanen, T. P., Tervala, T. V., Hartiala, P., & Suominen, E. A. (2012). Microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients. Annals of Surgery, 255(3), 468-473.
Schaverien, M. V., & Chang, E. I. (2021). Combined deep inferior epigastric artery perforator flap with vascularized groin lymph node transplant for treatment of breast cancer-related lymphedema. Gland Surgery, 10(1), 460-468.
Thompson, M., Korourian, S., Henry-Tillman, R., Adkins, L., Mumford, S., Westbrook, K. C., & Klimberg, V. S. (2007). Axillary reverse mapping (ARM): A new concept to identify and enhance lymphatic preservation. Annals of Surgical Oncology, 14(6), 1890-1895.
Tourani, S. S., Taylor, G. I., & Ashton, M. W. (2016). Long-term patency of lymphovenous anastomoses: A systematic review. Plastic and Reconstructive Surgery, 138(2), 492-498.