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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgments

Supported in part by a Columbia University Department of Surgery Start-up Award. We wish to thank Francesco Boccardo, Coradino Campisi, and the staff of the IRCCS Università Ospedale San Martino–IST Istituto Nazionale per la Ricerca sul Cancro, Department of Surgery, Operative Unit of Lymphatic Surgery, and Section of Lymphology, Lymphatic Surgery, and Microsurgery, Genoa, Italy, for their mentorship and collaboration, which has been instrumental in helping to advance the LYMPHA method at Columbia University Medical Center.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Breast Surgery, Columbia University Medical Center, New York-Presbyterian Hospital, Columbia University, New York, NY, USA

    Sheldon Feldman MD, Hannah Bansil MD, Adewuni Ojo MD, Bret Taback MD, Margaret Chen MD, Preya Ananthakrishnan MD, Amiya Vaz BA & Fatih Balci MD

  2. Division of Plastic Surgery, Columbia University Medical Center, New York-Presbyterian Hospital, Columbia University, New York, NY, USA

    Jeffrey Ascherman MD, Robert Grant MD, Peter Henderson MD & Christine Rohde MD

  3. Columbia University College of Physicians and Surgeons, New York, NY, USA

    Billie Borden BA

  4. Department of Radiology, Columbia University Medical Center, New York-Presbyterian Hospital, Columbia University, New York, NY, USA

    Chaitanya R. Divgi MD & David Leung MD

  5. Department of Surgery, Atakent Hospital, Acibadem University, Istanbul, Turkey

    Fatih Balci MD

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  1. Sheldon Feldman MD
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  2. Hannah Bansil MD
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  3. Jeffrey Ascherman MD
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  7. Adewuni Ojo MD
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  10. Preya Ananthakrishnan MD
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  13. Chaitanya R. Divgi MD
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  14. David Leung MD
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  15. Christine Rohde MD
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Corresponding author

Correspondence to Sheldon Feldman MD.

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Feldman, S., Bansil, H., Ascherman, J. et al. Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema. Ann Surg Oncol 22, 3296–3301 (2015). https://doi.org/10.1245/s10434-015-4721-y

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  • DOI: https://doi.org/10.1245/s10434-015-4721-y

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