Lymphovenous Bypass for Immediate Lymphatic Reconstruction in Breast Cancer Patients Undergoing Axillary Lymph Node Dissection: Minimizing the Risk of Upper Extremity Lymphedema

Maria C. Médor; Isabella F. Churchill; Diego Pereira; Amanda Roberts; Erin Cordeiro; Lisa Findlay-Shirras; Jing Zhang; Moein Momtazi

doi:10.1055/s-0044-1785680

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2024; 40(09): 713-721
DOI: 10.1055/s-0044-1785680

Original Article

Lymphovenous Bypass for Immediate Lymphatic Reconstruction in Breast Cancer Patients Undergoing Axillary Lymph Node Dissection: Minimizing the Risk of Upper Extremity Lymphedema

Maria C. Médor

¹Division of Plastic Surgery, University of Montreal, Montreal, Quebec, Canada

,

Isabella F. Churchill

²Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada

,

Diego Pereira

³Division of Plastic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada

,

Amanda Roberts

⁴Division of General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada

,

Erin Cordeiro

⁴Division of General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada

,

Lisa Findlay-Shirras

⁴Division of General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada

,

Jing Zhang

³Division of Plastic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada

,

Moein Momtazi

⁵Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada

› Author Affiliations

Abstract

Background Studies have shown a significant reduction in breast cancer-related lymphedema (BCRL) rates in patients undergoing complete axillary lymph node dissection (cALND) combined with immediate lymphatic reconstruction (ILR) using lymphovenous bypass (LVB).The purpose of this study was to determine if ILR with LVB at the time of cALND results in a decreased incidence of BCRL and its impact on patient quality of life (QOL).

Methods In this prospective cohort study, patients ≥ 18 years requiring cALND underwent ILR from 2019 to 2021. The primary outcome was bilateral upper limb volumes measured by Brørson's truncated cone formula and the Pero-System (3D Körper Scanner). The secondary outcome was QOL measured by the Lymphedema Quality of Life (LYMQOL) arm patient-reported outcome measurement.

Results Forty-two patients consented to ILR using LVB. ILR was completed in 41 patients with a mean of 1.9 ± 0.9 lymphovenous anastomosis performed. Mean age of patients was 52.4 ± 10.5 years with a mean body mass index of 27.5 ± 4.9 kg/m². All patients (n = 39, 100%) received adjuvant therapy after ILR. Mean follow-up was 15.2 ± 5.1 months. Five patients met criteria for lymphedema throughout the duration of the study (12.8%), with two patients having resolution, with an overall incidence of 7.7% by the end of the study period. Patients with lymphedema were found to have statistically significant lower total LYMQOL values at 18 months (8.44 ± 1.17 vs. 3.23 ± 0.56, p < 0.001). A mean increase of 0.73 ± 3.5 points was observed for overall QOL average for upper limb function at 18 months compared with 3 months (t = 0.823, p = 0.425).

Conclusion This study showed an incidence of 7.7% lymphedema development throughout the duration of study. We also showed that ILR has the potential to reduce the significant long-term adverse outcomes of lymphedema and improve QOL for patients undergoing cALND

Keywords

lymphedema - ILR - breast cancer

Full Text

References

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