Weinstein, Brielle; Le, Nicole K.; Robertson, Ellen;
Zimmerman, Amanda; Tavares, Tina; Tran, Thanh; Laronga, Christine; Panetta,
Nicholas J.
Plastic and Reconstructive Surgery: May 2022 -
Volume 149 - Issue 5 - p 1061-1069
Background:
Breast cancer–related lymphedema is a progressive disease
that poses tremendous physical, psychosocial, and financial burden on patients.
Immediate lymphaticovenular anastomosis at the time of axillary lymph node
dissection is emerging as a potential therapeutic paradigm to decrease the
incidence of breast cancer–related lymphedema in high-risk patients.
Methods:
Eighty-one consecutive patients underwent reverse lymphatic
mapping and, when feasible, supermicrosurgical immediate lymphaticovenular
anastomosis at the time of axillary lymph node dissection at a tertiary care
cancer center. Patients were followed prospectively in a multidisciplinary
lymphedema clinic (plastic surgery, certified lymphatic therapy, dietary, case
management) at 3-month intervals with clinical examination, circumferential
limb girth measurements, and bioimpedance spectroscopy. An institutional
control cohort was assessed for the presence of objectively diagnosed and
treated breast cancer–related lymphedema. Data were analyzed by a university
statistician.
Results:
Seventy-eight patients met inclusion, and 66 underwent
immediate lymphaticovenular anastomosis. Mean follow-up was 250 days. When
compared to a retrospective control group, the rate of lymphedema in patients
who underwent immediate lymphaticovenular anastomosis was significantly lower
(6 percent versus 44 percent; p < 0.0001). Patients with 6-month
follow-up treated with combined adjuvant radiation therapy and chemotherapy had
significantly greater risk of developing breast cancer–related lymphedema (p =
0.04) compared to those without combined adjuvant therapy. Arborized
anastomotic technique had a statistically shorter operative time than
end-to-end anastomosis (p = 0.005).
Conclusions:
This series of consecutive patients demonstrate a 6 percent
incidence of early-onset breast cancer–related lymphedema with immediate
lymphaticovenular anastomosis and an increased risk in those undergoing
combined adjuvant treatment. These early data represent an encouraging and
substantial decrease of breast cancer–related lymphedema in high-risk patients.
