Arch Hand Microsurg.  2021 Dec;26(4):276-284. 10.12790/ahm.21.0101.

Six-Month Follow-up for Investigating the Effect of Prophylactic Lymphovenous Anastomosis on the Prevention of Breast Cancer-Related Lymphedema: A Preliminary Study in a Single Institution

Affiliations
  • 1Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
  • 2Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
  • 3Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
  • 4Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea

Abstract

Purpose
This study was performed to assess the effect of prophylactic lymphovenous anastomosis on the prevention of arm lymphedema after axillary lymph node dissection for breast cancer treatment.
Methods
Among 69 women referred to undergo axillary lymph node dissection from January 2020 to June 2020, 21 were assigned to the treatment group and 48 to the control group. In the treatment group, 21 patients underwent prophylactic lymphovenous anastomosis for the prevention of breast cancer-related lymphedema. The other 48 patients in the control group did not undergo any preventive surgical treatment. Prophylactic lymphovenous anastomosis was performed at the same time as axillary lymph node dissection and breast cancer surgery. Postoperatively, all patients underwent circumferential measurements at 1, 3, and 6 months and lymphography at 6 months after the surgery.
Results
None of the patients in the treatment group had lymphedema after the surgery (0%). In the control group, lymphedema occurred in nine patients (18.8%, p=0.049). No significant differences in the arm circumference were observed in the treatment group during follow-up (p>0.05), whereas the arm circumference in the control group showed a significant increase at 1, 3, and 6 months after axillary lymph node dissection (p<0.05). There were no significant differences between the two groups in the arm circumference changes with respect to baseline at 1, 3, and 6 months after axillary lymph node dissection (p>0.05).
Conclusion
Prophylactic lymphovenous anastomosis represents a valid super microsurgical technique for the primary prevention of breast cancer-related lymphedema.

Keyword

Breast cancer lymphedema; Anastomosis; Surgery; Microsurgery; Primary prevention

Figure

  • Fig. 1. Prophylactic lymphovenous anastomosis (LVA) operative technique application. The images show anastomosis between the 0.3-mm lymphatic drainage vessel and the 0.4-mm vein using an end-to-end technique with nylon 11-0 interrupted sutures. (A) Prophylactic LVA operative technique applied on the axillary region. (B) Prophylactic LVA operative technique at microscopic magnification.

  • Fig. 2. Locations of three areas in the upper limb. The upper extremity circumference is measured at the olecranon, 10 cm above and 10 cm below the olecranon, and at the wrist.

  • Fig. 3. Lymphography performed at the 6-month follow-up after prophylactic lymphovenous anastomosis. Linear patterns in bilateral upper limbs are shown in lymphography (right, affected side; left, unaffected side).

  • Fig. 4. Arm circumference differences at the preoperative (Pre), postoperative 1 month (F1), postoperative 3 months (F3), and postoperative 6 months (F6) in the treatment group and control group. Arm circumference differences are represented by the gradient (blue, treatment group; yellow, control group). (A) Arm circumference differences 10 cm above the olecranon with different follow-up periods. (B) Arm circumference differences 10 cm below the olecranon with different follow-up periods. (C) Arm circumference differences at the wrist with different follow-up periods.


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