Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru.
Department of Translational Research and New Technologies in Medicine and Surgery, Plastic Surgery Unit, University of Pisa, Pisa, Italy.
Microsurgery. 2023 Jul;43(5):427-436. doi: 10.1002/micr.30990. Epub 2022 Nov 26.
Multiple surgical alternatives are available to treat breast cancer-related lymphedema (BCRL) providing a variable spectrum of outcomes. This study aimed to present the breast cancer-related lymphedema multidisciplinary approach (B-LYMA) to systematically treat BCRL.
Seventy-eight patients presenting with BCRL between 2017 and 2021 were included. The average age and BMI were 49.4 ± 7.8 years and 28.1 ± 3.5 kg/m , respectively. Forty patients had lymphedema ISL stage II (51.3%) and 38 had stage III (48.7%). The mean follow-up was 26.4 months. Treatment was selected according to the B-LYMA algorithm, which aims to combine physiologic and excisional procedures according to the preoperative evaluation of patients. All patients had pre- and postoperative complex decongestive therapy (CDT).
Stage II patients were treated with lymphaticovenous anastomosis (LVA) (n = 18), vascularized lymph node transfer (VLNT) (n = 12), and combined DIEP flap and VLNT (n = 10). Stage III patients underwent combined suction-assisted lipectomy (SAL) and LVA (n = 36) or combined SAL and VLNT (n = 2). Circumferential reduction rates (CRR) were comparable between patients treated with LVA (56.5 ± 8.4%), VLNT (54.4 ± 10.2%), and combined VLNT-DIEP flap (56.5 ± 3.9%) (p > .05). In comparison to LVA, VLNT, and combined VLNT-DIEP flap, combined SAL-LVA exhibited higher CRRs (85 ± 10.5%, p < .001). The CRR for combined SAL-VLNT was 75 ± 8.5%. One VLNT failed and minor complications occurred in the combined DIEP-VLNT group.
The B-LYMA protocol directs the treatment of BCRL according to the lymphatic system's condition. In advanced stages where a single physiologic procedure is not sufficient, additional excisional surgery is implemented. Preoperative and postoperative CDT is mandatory to improve the outcomes.
有多种手术选择可用于治疗乳腺癌相关淋巴水肿（BCRL），提供了不同的治疗效果。本研究旨在介绍乳腺癌相关淋巴水肿多学科治疗方法（B-LYMA），以系统地治疗 BCRL。
纳入了 2017 年至 2021 年间患有 BCRL 的 78 例患者。平均年龄和 BMI 分别为 49.4±7.8 岁和 28.1±3.5kg/m²。40 例患者为 II 期淋巴水肿（51.3%），38 例为 III 期淋巴水肿（48.7%）。平均随访时间为 26.4 个月。根据 B-LYMA 算法选择治疗方法，该算法旨在根据患者术前评估，结合生理和切除手术。所有患者均接受术前和术后复杂消肿治疗（CDT）。
II 期患者接受淋巴管静脉吻合术（LVA）治疗（n=18）、带血管淋巴结转移术（VLNT）治疗（n=12）和联合 DIEP 皮瓣和 VLNT 治疗（n=10）。III 期患者接受联合吸脂辅助抽脂术（SAL）和 LVA 治疗（n=36）或联合 SAL 和 VLNT 治疗（n=2）。接受 LVA、VLNT 和联合 VLNT-DIEP 皮瓣治疗的患者的周径缩小率（CRR）相似（LVA：56.5±8.4%，VLNT：54.4±10.2%，联合 VLNT-DIEP 皮瓣：56.5±3.9%）（p>.05）。与 LVA、VLNT 和联合 VLNT-DIEP 皮瓣相比，联合 SAL-LVA 具有更高的 CRR（85±10.5%，p<.001）。联合 SAL-VLNT 的 CRR 为 75±8.5%。1 例 VLNT 失败，联合 DIEP-VLNT 组发生轻微并发症。
B-LYMA 方案根据淋巴系统的情况指导 BCRL 的治疗。在单一生理手术不足的晚期阶段，实施额外的切除手术。术前和术后 CDT 是提高治疗效果的必要条件。
