Ciudad Pedro, Escandón Joseph M, Duarte-Bateman Daniela, Escandón Lauren, Maruccia Michele, Forte Antonio J, Mayer Horacio F, Manrique Oscar J
Department of Plastic, Reconstructive, and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru.
Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
Ann Transl Med. 2023 Dec 20;11(12):418. doi: 10.21037/atm-23-292. Epub 2023 Oct 16.
Breast cancer-related lymphedema (BCRL) represents a colossal burden in terms of health and patient-reported outcomes. Surgical management plays a prominent role in the psychological and physical well-being of women suffering from BCRL. Therefore, we performed a narrative review of the current surgical management of BCRL and analyzed the postoperative results.
A literature search was conducted across PubMed MEDLINE, Scopus, and Web of Science from database inception through January 2, 2023. We included English-written studies evaluating postoperative outcomes of lymphatic surgery for the management of BCRL.
The surgical management of lymphedema can be classified into two approaches: (I) physiologic procedures and (II) debulking or ablative procedures. While ablative procedures are intended to lessen the symptomatic burden of lymphedema via the removal of pathological tissues, physiologic procedures are performed to restore the abnormal lymphatic flow by creating bypasses into the venous or lymphatic circulation, or by creating new lymphatic connections by means of lymphangiogenesis. Physiologic procedures generate better outcomes in the early stages of lymphedema as there is some residual physiologic flow and vessels are less fibrotic, while ablative procedures are regarded to be the best alternative in very advanced lymphedema stages. A combination of physiologic and ablative procedures provides more comprehensive surgical management to BCRL.
Lymphedema is a common complication of breast cancer treatment with an extensive incidence range. Postoperative outcomes of the surgical management of BCRL are heterogeneous despite most studies indicating favorable results after lymphatic surgery.
乳腺癌相关淋巴水肿（BCRL）在健康和患者报告结局方面带来了巨大负担。手术治疗在BCRL女性患者的心理和身体健康中起着重要作用。因此，我们对当前BCRL的手术治疗进行了叙述性综述，并分析了术后结果。
从数据库建立至2023年1月2日，在PubMed MEDLINE、Scopus和Web of Science上进行文献检索。我们纳入了评估淋巴手术治疗BCRL术后结局的英文研究。
淋巴水肿的手术治疗可分为两种方法：（I）生理性手术和（II）减容或消融性手术。消融性手术旨在通过切除病理组织减轻淋巴水肿的症状负担，而生理性手术则是通过建立通向静脉或淋巴循环的旁路，或通过淋巴管生成建立新的淋巴连接来恢复异常的淋巴流动。生理性手术在淋巴水肿早期产生更好的效果，因为存在一些残留的生理性流动且血管纤维化程度较低，而消融性手术被认为是非常晚期淋巴水肿阶段的最佳选择。生理性手术和消融性手术相结合为BCRL提供了更全面的手术治疗。
淋巴水肿是乳腺癌治疗的常见并发症，发病率范围广泛。尽管大多数研究表明淋巴手术后结果良好，但BCRL手术治疗的术后结局存在异质性。
