Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema

Sheldon M. Feldman, Hannah Bansil, Jeffrey Ascherman, Robert Grant, Billie Borden, Peter Henderson, Adewuni Ojo, Bret Taback, Margaret Chen, Preya Ananthakrishnan, Amiya Vaz, Fatih Balci, Chaitanya R. Divgi, David Leung, Christine Rohde

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: As many as 40 % of breast cancer patients undergoing axillary lymph node dissection (ALND) and radiotherapy develop lymphedema. We report our experience performing lymphatic–venous anastomosis using the lymphatic microsurgical preventive healing approach (LYMPHA) at the time of ALND. This technique was described by Boccardo, Campisi in 2009. Methods: LYMPHA was offered to node-positive women with breast cancer requiring ALND. Afferent lymphatic vessels, identified by injection of blue dye in the ipsilateral arm, were sutured into a branch of the axillary vein distal to a competent valve. Follow-up was with pre- and postoperative lymphoscintigraphy, arm measurements, and (L-Dex®) bioimpedance spectroscopy. Results: Over 26 months, 37 women underwent attempted LYMPHA, with successful completion in 27. Unsuccessful attempts were due to lack of a suitable vein (n = 3) and lymphatic (n = 5) or extensive axillary disease (n = 1). There were no LYMPHA-related complications. Mean follow-up time was 6 months (range 3–24 months). Among completed patients, 10 (37 %) had a body mass index of ≥30 kg/m2 (mean 27.9 ± 6.8 kg/m2, range 17.4–47.6 kg/m2), and 17 (63 %) received axillary radiotherapy. Excluding two patients with preoperative lymphedema and those with less than 3-month follow-up, the lymphedema rate was 3 (12.5 %) of 24 in successfully completed and 4 (50 %) of 8 in unsuccessfully treated patients. Conclusions: Our transient lymphedema rate in this high-risk cohort of patients was 12.5 %. Early data show that LYMPHA is feasible, safe, and effective for the primary prevention of breast cancer-related lymphedema.

Original languageEnglish (US)
Pages (from-to)3296-3301
Number of pages6
JournalAnnals of Surgical Oncology
Volume22
Issue number10
DOIs
StatePublished - Oct 29 2015
Externally publishedYes

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Lymphedema
Primary Prevention
Lymph Node Excision
Radiotherapy
Axillary Vein
Breast Neoplasms
Lymphoscintigraphy
Lymphatic Vessels
Veins
Spectrum Analysis
Body Mass Index
Coloring Agents
Injections

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema. / Feldman, Sheldon M.; Bansil, Hannah; Ascherman, Jeffrey; Grant, Robert; Borden, Billie; Henderson, Peter; Ojo, Adewuni; Taback, Bret; Chen, Margaret; Ananthakrishnan, Preya; Vaz, Amiya; Balci, Fatih; Divgi, Chaitanya R.; Leung, David; Rohde, Christine.

In: Annals of Surgical Oncology, Vol. 22, No. 10, 29.10.2015, p. 3296-3301.

Research output: Contribution to journalArticle

Feldman, SM, 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 2015, 'Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema', Annals of Surgical Oncology, vol. 22, no. 10, pp. 3296-3301. https://doi.org/10.1245/s10434-015-4721-y
Feldman, Sheldon M. ; Bansil, Hannah ; Ascherman, Jeffrey ; Grant, Robert ; Borden, Billie ; Henderson, Peter ; Ojo, Adewuni ; Taback, Bret ; Chen, Margaret ; Ananthakrishnan, Preya ; Vaz, Amiya ; Balci, Fatih ; Divgi, Chaitanya R. ; Leung, David ; Rohde, Christine. / Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema. In: Annals of Surgical Oncology. 2015 ; Vol. 22, No. 10. pp. 3296-3301.
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abstract = "Background: As many as 40 {\%} of breast cancer patients undergoing axillary lymph node dissection (ALND) and radiotherapy develop lymphedema. We report our experience performing lymphatic–venous anastomosis using the lymphatic microsurgical preventive healing approach (LYMPHA) at the time of ALND. This technique was described by Boccardo, Campisi in 2009. Methods: LYMPHA was offered to node-positive women with breast cancer requiring ALND. Afferent lymphatic vessels, identified by injection of blue dye in the ipsilateral arm, were sutured into a branch of the axillary vein distal to a competent valve. Follow-up was with pre- and postoperative lymphoscintigraphy, arm measurements, and (L-Dex{\circledR}) bioimpedance spectroscopy. Results: Over 26 months, 37 women underwent attempted LYMPHA, with successful completion in 27. Unsuccessful attempts were due to lack of a suitable vein (n = 3) and lymphatic (n = 5) or extensive axillary disease (n = 1). There were no LYMPHA-related complications. Mean follow-up time was 6 months (range 3–24 months). Among completed patients, 10 (37 {\%}) had a body mass index of ≥30 kg/m2 (mean 27.9 ± 6.8 kg/m2, range 17.4–47.6 kg/m2), and 17 (63 {\%}) received axillary radiotherapy. Excluding two patients with preoperative lymphedema and those with less than 3-month follow-up, the lymphedema rate was 3 (12.5 {\%}) of 24 in successfully completed and 4 (50 {\%}) of 8 in unsuccessfully treated patients. Conclusions: Our transient lymphedema rate in this high-risk cohort of patients was 12.5 {\%}. Early data show that LYMPHA is feasible, safe, and effective for the primary prevention of breast cancer-related lymphedema.",
author = "Feldman, {Sheldon M.} and Hannah Bansil and Jeffrey Ascherman and Robert Grant and Billie Borden and Peter Henderson and Adewuni Ojo and Bret Taback and Margaret Chen and Preya Ananthakrishnan and Amiya Vaz and Fatih Balci and Divgi, {Chaitanya R.} and David Leung and Christine Rohde",
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T1 - Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema

AU - Feldman, Sheldon M.

AU - Bansil, Hannah

AU - Ascherman, Jeffrey

AU - Grant, Robert

AU - Borden, Billie

AU - Henderson, Peter

AU - Ojo, Adewuni

AU - Taback, Bret

AU - Chen, Margaret

AU - Ananthakrishnan, Preya

AU - Vaz, Amiya

AU - Balci, Fatih

AU - Divgi, Chaitanya R.

AU - Leung, David

AU - Rohde, Christine

PY - 2015/10/29

Y1 - 2015/10/29

N2 - Background: As many as 40 % of breast cancer patients undergoing axillary lymph node dissection (ALND) and radiotherapy develop lymphedema. We report our experience performing lymphatic–venous anastomosis using the lymphatic microsurgical preventive healing approach (LYMPHA) at the time of ALND. This technique was described by Boccardo, Campisi in 2009. Methods: LYMPHA was offered to node-positive women with breast cancer requiring ALND. Afferent lymphatic vessels, identified by injection of blue dye in the ipsilateral arm, were sutured into a branch of the axillary vein distal to a competent valve. Follow-up was with pre- and postoperative lymphoscintigraphy, arm measurements, and (L-Dex®) bioimpedance spectroscopy. Results: Over 26 months, 37 women underwent attempted LYMPHA, with successful completion in 27. Unsuccessful attempts were due to lack of a suitable vein (n = 3) and lymphatic (n = 5) or extensive axillary disease (n = 1). There were no LYMPHA-related complications. Mean follow-up time was 6 months (range 3–24 months). Among completed patients, 10 (37 %) had a body mass index of ≥30 kg/m2 (mean 27.9 ± 6.8 kg/m2, range 17.4–47.6 kg/m2), and 17 (63 %) received axillary radiotherapy. Excluding two patients with preoperative lymphedema and those with less than 3-month follow-up, the lymphedema rate was 3 (12.5 %) of 24 in successfully completed and 4 (50 %) of 8 in unsuccessfully treated patients. Conclusions: Our transient lymphedema rate in this high-risk cohort of patients was 12.5 %. Early data show that LYMPHA is feasible, safe, and effective for the primary prevention of breast cancer-related lymphedema.

AB - Background: As many as 40 % of breast cancer patients undergoing axillary lymph node dissection (ALND) and radiotherapy develop lymphedema. We report our experience performing lymphatic–venous anastomosis using the lymphatic microsurgical preventive healing approach (LYMPHA) at the time of ALND. This technique was described by Boccardo, Campisi in 2009. Methods: LYMPHA was offered to node-positive women with breast cancer requiring ALND. Afferent lymphatic vessels, identified by injection of blue dye in the ipsilateral arm, were sutured into a branch of the axillary vein distal to a competent valve. Follow-up was with pre- and postoperative lymphoscintigraphy, arm measurements, and (L-Dex®) bioimpedance spectroscopy. Results: Over 26 months, 37 women underwent attempted LYMPHA, with successful completion in 27. Unsuccessful attempts were due to lack of a suitable vein (n = 3) and lymphatic (n = 5) or extensive axillary disease (n = 1). There were no LYMPHA-related complications. Mean follow-up time was 6 months (range 3–24 months). Among completed patients, 10 (37 %) had a body mass index of ≥30 kg/m2 (mean 27.9 ± 6.8 kg/m2, range 17.4–47.6 kg/m2), and 17 (63 %) received axillary radiotherapy. Excluding two patients with preoperative lymphedema and those with less than 3-month follow-up, the lymphedema rate was 3 (12.5 %) of 24 in successfully completed and 4 (50 %) of 8 in unsuccessfully treated patients. Conclusions: Our transient lymphedema rate in this high-risk cohort of patients was 12.5 %. Early data show that LYMPHA is feasible, safe, and effective for the primary prevention of breast cancer-related lymphedema.

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