Abstract
Background Locally advanced breast cancer is commonly found in Indonesia. In this group of patients,
aggressive treatment such as axillary lymph nodes dissection (ALND) with or without
regional nodal irradiation (RNI) will increase the risk of breast cancer treatment-related
lymphedema (BCRL) in our patients. Lymphaticovenular anastomosis (LVA) has been established
as a minimally invasive approach in lymphedema surgery. In this study, we report our
first experience of LVAs in BCRL patients.
Methods This was a cross-sectional study taken from breast cancer patients receiving ALND
with or without RNI. From December 2018 until June 2020, we collected and described
general patient information, tumor characteristics, diagnostic methods, and the outcome
of LVA. Postoperative subjective symptoms scores (lymphedema quality-of-life score
[LeQOLiS]) and lymphedematous volume (upper extremity lymphedema [UEL] index) were
compared with preoperative ones.
Results Seventy patients experienced BCRL with the mean age of 54.8 (9.4) years and mean
body mass index of 28.1 (4.5). ALND was performed in 66 (97.1%) cases and RNI was
given in 58 (82.9%) patients. Thirty-one (44.3%) patients were in the International
Society of Lymphology stage 1, 24 (34.3%) in stage 2A, and 15 (21.4%) in stage 2B.
The mean lymphatic vessel diameter was 0.5 (0.26) mm and 0.80 (0.54) mm for the vein.
Lymphosclerosis severity was 7 (4%) in S0 type, 129 (74.1%) in S1 type, 37 (21.3%)
in S2 type, and 1 (0.6%) in S3 type. In histopathology examination, S1 types were
in lower grade injury, while S2 and S3 types were in the higher grade. Seven (53.8%)
cases of S2 type showed severe fibrosis from trichrome staining. Postoperative LeQOLiSs
were significantly lower than preoperative ones (5.6 ± 2.4 vs. 3.7 ± 2.6; p = 0.000). With the mean follow-up of 7.4 (3.7) months, the overall UEL index reduction
was 9.2%; mean –11 (16.8). Postoperative UEL index was significantly lower than preoperative
ones (117.7 ± 26.5 vs. 106.9 ± 18.5; p = 0.000). No complications were observed during this period.
Conclusion LVA reduced the subjective symptoms and UEL index in BCRL cases. Future studies using
updated imaging technologies of the lymphatic system and longer follow-up time are
needed to confirm our results.
Keywords
lymphaticovenular anastomosis - breast cancer treatment-related lymphedema - axillary
lymph nodes dissection
