Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema: A 3-Year Follow-up Matched Cohort Study
Adam S Levy, MD, Anya Peysakhovich, PA, Bret Taback, MD, Jeffrey A. Ascherman, MD and Christine H Rohde, MD, Columbia University Medical Center, New York, NY
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 47 matched historical controls without LYMPHA. Demographics were similar between the two groups (mean age 53.8 vs 50.6y, p=0.21; BMI 27.6 vs 29.2, p=0.26). 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 31.3). Of the 47 who underwent successful LYMPHA procedure, 12 (25.5%) patients had clinical evidence of lymphedema compared with 24% (11/47) who did not undergo LYMPHA. Rates of lymphedema were increased following XRT for both groups: 31% in the LYMPHA group versus 33% (p=n.s.).
Conclusion: 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 of LYMPHA is warranted before recommending it as a routine treatment to help prevent lymphedema in patients undergoing ALND for breast cancer.
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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