Weinstein Brielle, Le Nicole K, Robertson Ellen, Zimmerman Amanda, Tavares Tina, Tran Thanh, Laronga Christine, Panetta Nicholas J
From the University of South Florida Morsani College of Medicine and the Moffitt Cancer Center.
Plast Reconstr Surg. 2022 May 1;149(5):1061-1069. doi: 10.1097/PRS.0000000000008986. Epub 2022 Mar 7.
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.
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.
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).
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.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
乳腺癌相关淋巴水肿是一种渐进性疾病，给患者带来巨大的身体、心理社会和经济负担。腋窝淋巴结清扫时立即进行淋巴管静脉吻合术正成为一种潜在的治疗模式，以降低高危患者乳腺癌相关淋巴水肿的发生率。
在一家三级医疗癌症中心，81例连续患者接受了逆向淋巴造影，可行时在腋窝淋巴结清扫时进行超显微外科立即淋巴管静脉吻合术。患者在多学科淋巴水肿诊所（整形外科、认证淋巴治疗、饮食、病例管理）进行前瞻性随访，每隔3个月进行临床检查、肢体周径测量和生物电阻抗光谱分析。对一个机构对照队列进行评估，以确定是否存在经客观诊断和治疗的乳腺癌相关淋巴水肿。数据由大学统计学家进行分析。
78例患者符合纳入标准，66例进行了立即淋巴管静脉吻合术。平均随访250天。与回顾性对照组相比，接受立即淋巴管静脉吻合术的患者淋巴水肿发生率显著更低（6%对44%；p<0.0001）。与未接受联合辅助治疗的患者相比，接受辅助放疗和化疗联合治疗且随访6个月的患者发生乳腺癌相关淋巴水肿的风险显著更高（p=0.04）。树枝状吻合技术的手术时间在统计学上比端端吻合术更短（p=0.005）。
这一系列连续患者显示，立即进行淋巴管静脉吻合术的早期乳腺癌相关淋巴水肿发生率为6%，联合辅助治疗患者的风险增加。这些早期数据表明高危患者的乳腺癌相关淋巴水肿有令人鼓舞且显著的降低。
临床问题/证据水平：治疗性，III级。
