Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL.
Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL.
Surgery. 2024 Nov;176(5):1485-1491. doi: 10.1016/j.surg.2024.07.028. Epub 2024 Sep 4.
The lymphatic microsurgical preventive healing approach reduces the risk of lymphedema after axillary lymph node dissection. We identified surgical factors of Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) that influence lymphedema rates focusing on the vein caliber used.
A single-institution retrospective cohort study included breast cancer patients undergoing axillary lymph node dissection and LYMPHA (April 2021-November 2022) with a follow-up of at least 1 year. Lymphedema was defined as an increase of ≥10 units in the lymphedema index (measured using bioimpedance spectroscopy) from baseline. The primary outcome was the correlation between the lymphedema index of patients with a vein caliber of ≤2 mm vs > 2 mm.
Forty-eight patients with documented vein caliber were analyzed. The median baseline lymphedema index in patients with a vein caliber ≤2 mm was 2 (SD 3.04) and 2.2 (SD 2.03) for vein caliber >2 mm. (P = .57). After 1-year follow-up, the L-dex was 6.20 (SD 7.48) for vein caliber ≤2 mm and 1.60 (SD 5.85) for vein caliber >2 mm (P = .02). The L-dex difference from baseline was higher for vein caliber ≤2 mm compared to >2 mm (2.9 vs 0.10, P = .02). Larger vein caliber was associated with a lower L-dex at 3 months (P = .04) and a lesser difference from the baseline after 1 year (P = .03). This was maintained on univariate analysis and multivariate analysis controlling for radiation, chemotherapy, and number of lymph nodes excised.
Vein caliber >2 mm during LYMPHA axillary lymph node dissection is associated with a lower postoperative lymphedema index. These results can be enhanced by a multi-institutional study to improve standardization of this technique.
淋巴显微外科预防性愈合方法可降低腋窝淋巴结清扫术后淋巴水肿的风险。我们确定了影响淋巴显微外科预防性愈合方法（LYMPHA）淋巴水肿发生率的手术因素，重点关注使用的静脉口径。
这是一项单机构回顾性队列研究，纳入了 2021 年 4 月至 2022 年 11 月期间接受腋窝淋巴结清扫和 LYMPHA 的乳腺癌患者，随访时间至少为 1 年。淋巴水肿的定义为淋巴水肿指数（使用生物阻抗光谱法测量）从基线增加≥10 个单位。主要结局是静脉口径≤2mm 与>2mm 的患者的淋巴水肿指数之间的相关性。
分析了 48 例有记录的静脉口径患者。静脉口径≤2mm 的患者基线淋巴水肿指数中位数为 2（SD 3.04），静脉口径>2mm 的患者为 2.2（SD 2.03）。（P=0.57）。在 1 年随访时，静脉口径≤2mm 的 L-dex 为 6.20（SD 7.48），静脉口径>2mm 的为 1.60（SD 5.85）（P=0.02）。与静脉口径>2mm 相比，静脉口径≤2mm 的 L-dex 从基线增加更多（2.9 与 0.10，P=0.02）。在 3 个月时，较大的静脉口径与较低的 L-dex 相关（P=0.04），在 1 年时与基线的差异较小（P=0.03）。这在单变量分析和控制放疗、化疗和切除的淋巴结数量的多变量分析中得到了维持。
LYMPHA 腋窝淋巴结清扫术中静脉口径>2mm 与术后淋巴水肿指数较低相关。通过多机构研究可以进一步提高该技术的标准化，从而增强这些结果。
