Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema: A 3-year Follow-up Study.
Adam Levy, MD, Anya Peysakhovich, PA, Bret Taback, MD, Jeffrey A. Ascherman, MD, Christine H. Rohde, MD, MPH.
Columbia University Medical Center, New York, NY, USA.
BACKGROUND: Breast cancer patients who undergo axillary lymph node dissection (ALND) and radiation therapy (XRT) may develop lymphedema with reported rates up to 40%. Performing lymphatic-venous anastomosis at the time of ALND may prevent the development of lymphedema. Our institution has previously shown a transient lymphedema rate of 12.5% in those that underwent LYMPHA compared to 50% in unsuccessful attempts1. However, longer-term results are not well established. Here we examine long-term results of our patients.
METHODS: Women requiring ALND for breast cancer were offered Lymphatic Microsurgical Healing Approach (LYMPHA). Afferent lymphatic vessels were identified by blue dye injection into the ipsilateral arm and microsurgical anastomosis was performed to a branch of the axillary vein. Early follow up included lymphoscintigraphy, arm measurements, bioimpedance spectroscopy (L-Dex), whereas later follow up (>2yr) was largely based on clinician assessment. Patients were compared to a matched group that did not undergo LYMPHA. Unpaired t-tests and Fisher’s exact test were used to compare continuous and categorical data.
RESULTS: From 2012-2016, 47 women completed the LYMPHA procedure at a single academic medical center and were compared to a group of 33 matched historical controls without LYMPHA. Demographics were similar between the two groups (mean age 52 vs 52y, p=0.44; BMI 27.6 vs 28.9, p=0.41). For the LYMPHA group, the average number of lymph vessels anastomosed was 2 per patient (range 1-4). Patients were followed up to 71 mo (mean 36) and 75 mo (mean 35.5). Of the 47 who underwent successful LYMPHA procedure, 12 (25.5%) patients had clinical evidence of lymphedema at a mean 36mo follow-up compared with 23% (7/31) in the comparison group (p=0.7) who did not undergo LYMPHA at 35.5mo. Rates of lymphedema were increased following XRT for both groups: 31% in the LYMPHA group versus 37% (p=0.76).
CONCLUSIONS: We find that at a 3-year time-point there is no significant difference in the clinical rates of lymphedema following primary lympho-venous bypass in this high-risk cohort of patients. Further assessment is warranted with regard to future use of this technique, particularly given the small comparison group of those that did not undergo LYMPHA.
1 Feldman S, Bansil H, Ascherman J, Grant R, Borden B, Henderson P, Ojo A, Taback B, Chen M, Ananthakrishnan P, Vaz A, Balci F, Divgi CR, Leung D, Rohde C. Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema. Ann Surg Oncol. 2015;22(10):3296-301.
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