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Breast Cancer Research and Treatment

, Volume 113, Issue 2, pp 199–206 | Cite as

Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

  • R. J. Damstra
  • H. G. J. Voesten
  • W. D. van Schelven
  • B. van der Lei
Review

Abstract

Objective The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic, this study was undertaken to prospectively determine the effect of Lympho Venous Anastomosis (LVA) on BCRL and to review the current literature. Study design and methods Ten patients who were previously treated for breast cancer by surgery, radiotherapy, and chemotherapy, and were unresponsive to 12-weeks of non-operative treatment, underwent an LVA procedure (Degni-Cordeiro). Objective measurements were gathered for circumferential measurement and water volumetry, and quality of life. Various types of lymphoscintigraphy were carried out pre-operatively and post-operatively at 3 and 12 months. Treatment was embedded in a multidisciplinary setting. Results Post-operative volume measurements initially showed a 4.8% reduction of lymphedema at 3 months and a 2% reduction after one year. Various scintigraphic parameters showed some improvement. Quality of life questionnaires reported minimal improvement. Reviewing the literature, only retrospective studies were found; these reported varying results for LVA procedures. The selection of patients, classification of lymphedema, indications and types of LVA, and additional therapeutic options were heterogeneous, not comparable, and lacked a validated method of effect-assessment. Conclusions Our results showed a minimal reduction in volume of lymphedema following LVA; in the literature, there was no convincing evidence of the success of LVA. Non-operative treatment and elastic stockings are still preferred by most patients with lymphedema, especially in early stages with few irreversible changes.

Keywords

Lympho-venous anastomosis (LVA) Microsurgery Evidence-based medicine Lymphoscintigraphy Inverse water volumetry Review Breast cancer related lymphedema 

Notes

Acknowledgements

Contributions R.J. Damstra was the lead author in the overall conceptualization and design of the study and the manuscript. He collected the data and prepared the databases. H.G.J Voesten participated in revising and editing the text. W.D. van Schelven participated in the design and the execution of the (semi) quantitative scintigraphic studies, as well as the analysis and the interpretation of the scans. He had the primary responsibility for the scintigraphic paragraphs. B. van de Lei performed all microsurgical procedures, participated in drafting the text and provided overall supervision of the manuscript.

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Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • R. J. Damstra
    • 1
  • H. G. J. Voesten
    • 2
  • W. D. van Schelven
    • 3
  • B. van der Lei
    • 4
  1. 1.Department of Dermatology, Phlebology and LymphologyNij Smellinghe HospitalDrachtenThe Netherlands
  2. 2.Department of SurgeryNij Smellinghe HospitalDrachtenThe Netherlands
  3. 3.Department of Nuclear MedicineMedical Centre LeeuwardenLeeuwardenThe Netherlands
  4. 4.Department of Plastic Reconstructive, Aesthetic and Hand SurgeryUniversity Medical Centre GroningenGroningenThe Netherlands

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