BACKGROUND: Breast cancer-related lymphedema (BCRL) is a source of postoperative morbidity for breast cancer survivors. Lymphatic microsurgical preventive healing approach (LYMPHA) is a technique used to prevent BCRL at the time of axillary lymph node dissection (ALND). We report the 5-year experience of a breast surgeon trained in LYMPHA and investigate the outcomes of patients who underwent LYMPHA following ALND for treatment of cT1-4N1-3M0 breast cancer. METHODS: A retrospective review of patients with cT1-4N1-3M0 breast cancer was performed in patients who underwent ALND with and without LYMPHA. Diagnosis of BCRL was made by certified lymphedema therapists. Descriptive statistics and lymphedema surveillance data were analyzed using results of Fisher's exact or Wilcoxon rank-sum tests. Logistic regression and propensity matching were performed to assess the reduction of BCRL occurrence following LYMPHA. RESULTS: In a 5-year period, 132 patients met inclusion criteria with 76 patients undergoing LYMPHA at the time of ALND and 56 patients undergoing ALND alone. Patients who underwent LYMPHA at the time of ALND were significantly less likely to develop BCRL than those who underwent ALND alone (p = 0.045). Risk factors associated with BCRL development were increased patient age (p = 0.007), body mass index (BMI) (p = 0.003), and, in patients undergoing LYMPHA, number of positive nodes (p = 0.026). CONCLUSIONS: LYMPHA may be successfully employed by breast surgeons trained in lymphatic-venous anastomosis at the time of ALND. While research efforts should continue to focus on prevention and surveillance of BCRL, LYMPHA remains an option to reduce BCRL and improve patient quality of life.
BACKGROUND: Breast cancer-related lymphedema (BCRL) is a source of postoperative morbidity for breast cancer survivors. Lymphatic microsurgical preventive healing approach (LYMPHA) is a technique used to prevent BCRL at the time of axillary lymph node dissection (ALND). We report the 5-year experience of a breast surgeon trained in LYMPHA and investigate the outcomes of patients who underwent LYMPHA following ALND for treatment of cT1-4N1-3M0 breast cancer. METHODS: A retrospective review of patients with cT1-4N1-3M0 breast cancer was performed in patients who underwent ALND with and without LYMPHA. Diagnosis of BCRL was made by certified lymphedema therapists. Descriptive statistics and lymphedema surveillance data were analyzed using results of Fisher's exact or Wilcoxon rank-sum tests. Logistic regression and propensity matching were performed to assess the reduction of BCRL occurrence following LYMPHA. RESULTS: In a 5-year period, 132 patients met inclusion criteria with 76 patients undergoing LYMPHA at the time of ALND and 56 patients undergoing ALND alone. Patients who underwent LYMPHA at the time of ALND were significantly less likely to develop BCRL than those who underwent ALND alone (p = 0.045). Risk factors associated with BCRL development were increased patient age (p = 0.007), body mass index (BMI) (p = 0.003), and, in patients undergoing LYMPHA, number of positive nodes (p = 0.026). CONCLUSIONS: LYMPHA may be successfully employed by breast surgeons trained in lymphatic-venous anastomosis at the time of ALND. While research efforts should continue to focus on prevention and surveillance of BCRL, LYMPHA remains an option to reduce BCRL and improve patient quality of life.
Authors: Bernard Fisher; Jong-Hyeon Jeong; Stewart Anderson; John Bryant; Edwin R Fisher; Norman Wolmark Journal: N Engl J Med Date: 2002-08-22 Impact factor: 91.245
Authors: Sarah A McLaughlin; Alicia C Staley; Frank Vicini; Paul Thiruchelvam; Nancy A Hutchison; Jane Mendez; Fiona MacNeill; Stanley G Rockson; Sarah M DeSnyder; Suzanne Klimberg; Michael Alatriste; Francesco Boccardo; Mark L Smith; Sheldon M Feldman Journal: Ann Surg Oncol Date: 2017-08-01 Impact factor: 5.344
Authors: Anna Rose Johnson; Sarah Kimball; Sherise Epstein; Abram Recht; Samuel J Lin; Bernard T Lee; Ted A James; Dhruv Singhal Journal: Ann Plast Surg Date: 2019-04 Impact factor: 1.539
Authors: Á Sávolt; G Péley; C Polgár; N Udvarhelyi; G Rubovszky; E Kovács; B Győrffy; M Kásler; Z Mátrai Journal: Eur J Surg Oncol Date: 2017-01-16 Impact factor: 4.424
Authors: Jean-Francois Boileau; Brigitte Poirier; Mark Basik; Claire M B Holloway; Louis Gaboury; Lucas Sideris; Sarkis Meterissian; Angel Arnaout; Muriel Brackstone; David R McCready; Stephen E Karp; Isabelle Trop; Andre Lisbona; Frances C Wright; Rami J Younan; Louise Provencher; Erica Patocskai; Atilla Omeroglu; Andre Robidoux Journal: J Clin Oncol Date: 2014-12-01 Impact factor: 44.544
Authors: Mila Donker; Geertjan van Tienhoven; Marieke E Straver; Philip Meijnen; Cornelis J H van de Velde; Robert E Mansel; Luigi Cataliotti; A Helen Westenberg; Jean H G Klinkenbijl; Lorenzo Orzalesi; Willem H Bouma; Huub C J van der Mijle; Grard A P Nieuwenhuijzen; Sanne C Veltkamp; Leen Slaets; Nicole J Duez; Peter W de Graaf; Thijs van Dalen; Andreas Marinelli; Herman Rijna; Marko Snoj; Nigel J Bundred; Jos W S Merkus; Yazid Belkacemi; Patrick Petignat; Dominic A X Schinagl; Corneel Coens; Carlo G M Messina; Jan Bogaerts; Emiel J T Rutgers Journal: Lancet Oncol Date: 2014-10-15 Impact factor: 41.316
Authors: Lisa Spiguel; Christiana Shaw; Adam Katz; Lifei Guo; Hung-Chi Chen; Bernard T Lee; Dhruv Singhal Journal: Ann Plast Surg Date: 2017-06 Impact factor: 1.539
Authors: Nadine R Taghian; Cynthia L Miller; Lauren S Jammallo; Jean O'Toole; Melissa N Skolny Journal: Crit Rev Oncol Hematol Date: 2014-07-02 Impact factor: 6.312