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J Reconstr Microsurg
DOI: 10.1055/s-0044-1785680
Original Article

Lymphovenous Bypass for Immediate Lymphatic Reconstruction in Breast Cancer Patients Undergoing Axillary Lymph Node Dissection: Minimizing the Risk of Upper Extremity Lymphedema

Maria C. Médor
1   Division of Plastic Surgery, University of Montreal, Montreal, Quebec, Canada
,
Isabella F. Churchill
2   Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
,
Diego Pereira
3   Division of Plastic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
,
Amanda Roberts
4   Division of General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
,
Erin Cordeiro
4   Division of General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
,
Lisa Findlay-Shirras
4   Division of General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
,
Jing Zhang
3   Division of Plastic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
,
Moein Momtazi
5   Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada
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Abstract

Background Studies have shown a significant reduction in breast cancer-related lymphedema (BCRL) rates in patients undergoing complete axillary lymph node dissection (cALND) combined with immediate lymphatic reconstruction (ILR) using lymphovenous bypass (LVB).The purpose of this study was to determine if ILR with LVB at the time of cALND results in a decreased incidence of BCRL and its impact on patient quality of life (QOL).

Methods In this prospective cohort study, patients ≥ 18 years requiring cALND underwent ILR from 2019 to 2021. The primary outcome was bilateral upper limb volumes measured by Brørson's truncated cone formula and the Pero-System (3D Körper Scanner). The secondary outcome was QOL measured by the Lymphedema Quality of Life (LYMQOL) arm patient-reported outcome measurement.

Results Forty-two patients consented to ILR using LVB. ILR was completed in 41 patients with a mean of 1.9 ± 0.9 lymphovenous anastomosis performed. Mean age of patients was 52.4 ± 10.5 years with a mean body mass index of 27.5 ± 4.9 kg/m2. All patients (n = 39, 100%) received adjuvant therapy after ILR. Mean follow-up was 15.2 ± 5.1 months. Five patients met criteria for lymphedema throughout the duration of the study (12.8%), with two patients having resolution, with an overall incidence of 7.7% by the end of the study period. Patients with lymphedema were found to have statistically significant lower total LYMQOL values at 18 months (8.44 ± 1.17 vs. 3.23 ± 0.56, p < 0.001). A mean increase of 0.73 ± 3.5 points was observed for overall QOL average for upper limb function at 18 months compared with 3 months (t = 0.823, p = 0.425).

Conclusion This study showed an incidence of 7.7% lymphedema development throughout the duration of study. We also showed that ILR has the potential to reduce the significant long-term adverse outcomes of lymphedema and improve QOL for patients undergoing cALND

Keywords

lymphedema - ILR - breast cancer


Publication History

Received: 24 September 2023

Accepted: 08 March 2024

Article published online:
24 April 2024

© 2024. Thieme. All rights reserved.

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