Drobot Denis, Zeltzer Assaf Aviram
Department of Plastic and Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel.
Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel.
Gland Surg. 2023 Dec 26;12(12):1746-1759. doi: 10.21037/gs-23-247. Epub 2023 Dec 22.
Breast cancer therapy is a common cause of lymphedema, a chronic condition resulting from impaired fluid drainage through the lymphatic system. The accumulation of fluid in the affected limb leads to swelling, inflammation, and fibrosis, causing irreversible changes. While conservative therapy is the initial treatment for lymphedema, it may prove ineffective for advanced-stage cases that require surgical intervention. Physiological approaches such as lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) aim to restore lymphatic circulation, while reductive approaches such as excision of excess tissue and liposuction (LS) aim to eliminate fibrofatty tissue. In advanced stages of breast cancer-related lymphedema, a treatment that incorporates both physiological and reductive methods is advantageous. The timing of these approaches varies, and recent simultaneous procedures have been introduced to address both aspects in one surgery. Additionally, lymphedema treatment can be combined with breast reconstruction. Current imaging techniques provide a better assessment of the lymphedematous limb, aiding in the tailoring of a personalized combined approach within a single surgery. This study aims to review the combined approach for breast cancer-related lymphedema treatment and propose a new therapeutic algorithm based on recent literature. The research aims to optimize the management of breast cancer-related lymphedema and improve patient outcomes.
PubMed/MEDLINE was used as the database to conduct a review of the currently available literature concerning combined surgical techniques for treating breast cancer related lymphedema (BCRL).
In our review, we discuss imaging methods for assessing lymphatic system anatomy and function in surgical preparation and decision-making. Simultaneously, we examine a range of combined surgical techniques for treating BCRL, encompassing the combined physiologic approach, breast reconstruction with physiologic surgery, and the combination of reductive and physiologic procedures. Our emphasis remains on key parameters, including patient demographics, lymphedema staging, procedure types, follow-up duration, and objective limb measurements.
Surgical treatment of BCRL can include several surgical modalities that can be performed simultaneously. Current imaging techniques enable the tailoring of a personalized combined one-stage surgery for BCRL patients.
乳腺癌治疗是淋巴水肿的常见病因，淋巴水肿是一种因淋巴系统液体引流受损导致的慢性疾病。患侧肢体液体蓄积会导致肿胀、炎症和纤维化，引起不可逆的改变。虽然保守治疗是淋巴水肿的初始治疗方法，但对于需要手术干预的晚期病例可能无效。诸如淋巴管静脉吻合术（LVA）和带血管蒂淋巴结转移术（VLNT）等生理性方法旨在恢复淋巴循环，而诸如切除多余组织和抽脂术（LS）等减容性方法旨在消除纤维脂肪组织。在乳腺癌相关淋巴水肿的晚期，采用生理性和减容性相结合的治疗方法具有优势。这些方法的时机各不相同，最近引入了同期手术来在一次手术中解决两个方面的问题。此外，淋巴水肿治疗可与乳房重建相结合。当前的成像技术能更好地评估淋巴水肿肢体，有助于在一次手术中制定个性化的联合治疗方案。本研究旨在综述乳腺癌相关淋巴水肿治疗的联合方法，并根据近期文献提出一种新的治疗算法。该研究旨在优化乳腺癌相关淋巴水肿的管理并改善患者预后。
使用PubMed/MEDLINE作为数据库，对目前可用的关于治疗乳腺癌相关淋巴水肿（BCRL）的联合手术技术的文献进行综述。
在我们的综述中，我们讨论了在手术准备和决策中评估淋巴系统解剖结构和功能的成像方法。同时，我们研究了一系列治疗BCRL的联合手术技术，包括联合生理性方法、生理性手术乳房重建以及减容性和生理性手术的联合。我们重点关注关键参数，包括患者人口统计学特征、淋巴水肿分期、手术类型、随访时间以及客观的肢体测量。
BCRL的手术治疗可包括几种可同时进行的手术方式。当前的成像技术能够为BCRL患者定制个性化的一期联合手术。
