Preoperative ultrasound evaluation for lymphaticovenous anastomosis surgery in advanced breast cancer-related lymphedema

Aim:Lymphaticovenous anastomosis(LVA)is the mainstay for treating breast cancer-related lymphedema(BCRL).Preoperative ultrasonography is useful to assess the locations and characteristics of lymphatics and veins to improve LVA success remarkably even in cases of advanced BCRL.Aim:The aim of the study was to describe the use of ultrasonography to reliably map suitable lymphatics and veins and successfully perform LVA surgery in cases of advanced BCRL.Method:This retrospective cohort study included 41 cases of BCRL who underwent LVA surgery using preoperative ultrasound to map and characterize lymphatics and veins.Cases were analyzed for the following:(1)whether preoperative ultrasonographic detection of both lymphatics and veins correlate to actual intraoperative findings and(2)improvement in mean limb circumference measurements at 1 and 3 months of follow-up in this patient cohort.Results:For 155 LVA incisions,212 LVA procedures were performed.Among them,133(62.7%)lymphatics and 196(92.4%)anti-reflux veins were successfully detected and characterized on preoperative sonography.Mean preoperative circumference at the wrist,10cm below elbow,elbow,and 10cm above elbow were 18.86 cm,27.79 cm,29.75 cm,and 33.77 cm,respectively.The mean measurements improved at 1 month correspondingly to 17.14 cm,24.86 cm,26.91 cm,and 30.50 cm(9.12%,10.54%,9.54%,9.70%improvement,respectively),and at 3 months to 16.59 cm,24.28 cm,26.55 cm,and 30.05 cm(12.02%,12.63%,10.73%,11.02%improvement,respectively).For each individual patient,their four measured circumferences were also added to obtain the Total Circumference(TC).The TC ranged from 89-135 cm(mean 109.46 cm)preoperatively,83.5-129.5 cm(mean 98.74 cm)1-month post-op,and 80.5-128 cm(mean 96.55 cm)3 months post-op.Compared to the preoperative value,each patient had a TC decrease of 2.79%-20.35%(mean 9.80%)at 1-month post-op and 4.39-28.30%(mean 11.80%)at 3 months post-op.These differences were all statistically significant(P<0.0001).Conclusion:Preoperative ultrasonography is a useful adjunct to detect lymphatic vessels and anti-reflux veins,thereby increasing the chances of successfully performing LVA surgery even in cases of advanced upper limb lymphedema.It can contribute to long-lasting outcomes.

Lymphovenous anastomosis and complex decongestive therapy for severe deformed lymphedema with recurrent infection:A case report

BACKGROUND Lower extremity lymphedema is a common complication following treatment for gynecological malignancies.Its incidence rate can reach up to 70%,affecting~20 million people worldwide.However,specialized treatment centers are scarce,and there is a lack of consensus on treatment approaches.Furthermore,there are even fewer reports on the systematic and effective treatment of severe lymphedema with malformations.Effective management of this condition remains a significant challenge for clinicians.CASE SUMMARY A 40-year-old woman developed bilateral leg swelling 6 years after receiving treatment for endometrial cancer.Since August 2018,she experienced>30 episodes of lymphangitis.Upon presentation,she exhibited bilateral leg swelling and deformation,with four large swellings in the posterior thigh that impeded movement,and pain in the limbs.Skin manifestations included lichenoid lesions and features of deep sclerosis.Radionuclide lymphoscintigraphy confirmed the diagnosis of lower limb lymphedema.After 6 mo of complex decongestive therapy(CDT)and three lymphaticovenous anastomosis(LVA)treatments,the patient lost 49 kg in weight.She also experienced a maximum circumference reduction of 35.2 cm in the left lower limb and 37.5 cm in the right lower limb.The leg pain disappeared,her swelling significantly decreased,and she regained the ability to walk,cycle,and run normally.CONCLUSION The combined application of CDT and LVA therapy demonstrates significant positive effects in the treatment of severe,deformed stage III lymphedema.

Breast cancer-related lymphedema: focus on surgical treatment

Breast cancer-related lymphedema(BCRL)can affect breast cancer patients,especially after axillary surgery and radiation treatment,for life.First line treatment is conservative and involves physical therapy and compression.It requires absolute,life-long compliance with treatment by the patient and,in some cases,it is ineffective.In recent years,surgery has emerged as a possible alternative or even,complementary therapy for BCRL.The most commonly reported techniques are reconstructive or debulking procedures.Reconstructive procedures are aimed at restoring the lymphatic pathways and can be effective early in the disease process,when increased arm volumes are mostly due to the accumulation of protein-rich fluid in the interstitial space.In more advanced stages,where fibrotic and hypertrophic adipose tissues are dominant,debulking techniques such as liposuction can be recommended.A standard of care for the treatment of BCRL has not been established.Currently,different techniques can be combined to optimize clinical outcomes,and the surgical approach must be individualized for each patient,based on sound clinical and imaging assessment.BCRL surgical treatment remains a challenging topic that requires further study before it can be standardized.