Cho Min-Jeong, Senger Jenna-Lynn, Park Ko Un, Hansotia Kyle, Chratian Sydney, Kadle Rohini, Skoracki Roman J
Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH, USA.
Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, BC, Canada.
Ann Surg Oncol. 2025 Mar;32(3):2007-2015. doi: 10.1245/s10434-024-16640-8. Epub 2024 Dec 23.
Prophylactic lymphovenous bypass (pLVB) is a microsurgical technique aimed to prevent breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND) by redirecting lymphatic flow from the ligated lymphatics into neighboring veins. This report describes the authors' 9-year institutional experience of pLVB in patients undergoing ALND to prevent BCRL.
Patients who underwent ALND were reviewed. Demographic and oncologic data were analyzed. The primary outcomes included limb circumference and perometry. The secondary outcomes included patient-reported outcomes, incidence of cellulitis, and need for therapeutic lymphovenous bypass (LVB). Furthermore, the study identified risk factors for the development of BCRL within the ALND plus pLVB population.
Of the 370 patients, 25% underwent ALND plus pLVB. Demographic and oncologic features were similar between the two cohorts, and the average follow-up time was 23 months. The rate of BCRL was 8.7% in the ALND plus pLVB group and 20.1% in the no-pLVB group (p < 0.05), whereas the postoperative circumferential measurements were significantly improved among the ALND plus pLVB patients. In addition, the patients treated with ALND plus pLVB had a lower incidence of positive symptoms of lymphedema (pain, tightness, heaviness) and were less likely to require therapeutic LVB. The medical history of cardiac arrythmia was identified as a risk factor for the development of lymphedema in the ALND plus pLVB cohort.
Prophylactic lymphovenous bypass contributes to a decreased incidence of lymphedema as well as improved patient symptoms and limb functionality. Furthermore, pLVB modulates disease severity for patients who experience BCRL. The authors advocate that pLVBs should be routinely offered to breast cancer patients undergoing ALND.
预防性淋巴静脉分流术（pLVB）是一种显微外科技术，旨在通过将结扎淋巴管的淋巴引流重定向至邻近静脉，预防腋窝淋巴结清扫术（ALND）后与乳腺癌相关的淋巴水肿（BCRL）。本报告描述了作者在9年中对接受ALND的患者进行pLVB的机构经验，以预防BCRL。
对接受ALND的患者进行回顾。分析人口统计学和肿瘤学数据。主要结局包括肢体周长和周径测量。次要结局包括患者报告的结局、蜂窝织炎发病率以及治疗性淋巴静脉分流术（LVB）的需求。此外，该研究确定了ALND加pLVB人群中发生BCRL的危险因素。
在370例患者中，25%接受了ALND加pLVB。两组队列的人口统计学和肿瘤学特征相似，平均随访时间为23个月。ALND加pLVB组的BCRL发生率为8.7%，未进行pLVB组为20.1%（p<0.05），而ALND加pLVB患者术后的周径测量有显著改善。此外，接受ALND加pLVB治疗的患者淋巴水肿阳性症状（疼痛、紧绷、沉重）的发生率较低，且较少需要治疗性LVB。心律失常病史被确定为ALND加pLVB队列中发生淋巴水肿的危险因素。
预防性淋巴静脉分流术有助于降低淋巴水肿的发生率，并改善患者症状和肢体功能。此外，pLVB可调节发生BCRL患者的疾病严重程度。作者主张应常规为接受ALND的乳腺癌患者提供pLVB。
