Abstract

PurposeBreast cancer-related lymphedema (BCRL) is caused by an interruption of the lymphatic system after breast cancer treatment. Lymphaticovenous anastomosis (LVA), by which one or more patent lymphatic collecting vessels are connected to subcutaneous veins, shows promising results. Postoperatively, the patency of these anastomosis can be evaluated; however, little is known concerning the long-term patency after LVA in patients with BCRL. The aim of this study was to analyse the long-term patency, quality of life (QoL) and arm circumference after LVA, and to explore differences between patent and non-patent anastomosis and its correlation with clinical improvement.MethodsTwenty-five patients underwent indocyanine green (ICG) lymphography, lymph ICF-questionnaire, and arm circumference measurement preoperatively and 12 months after the LVA procedure.ResultsSeventy-six percent of the patients showed at least one patent anastomosis after 12 months. Quality of life according to the Lymph-ICF increased significantly (p < 0.000); however, arm circumference showed no significant decrease. Sixty-five percent discontinued wearing compression stockings. The patent anastomosis group, compared with the non-patent anastomosis group showed, without significance, more improvement in QoL, arm circumference, and discontinuation of compression stockings, as well as a lower rate of infections both pre- and postoperatively, a shorter duration of lymphedema preoperatively, and a higher rate of early lymphedema and ICG stage.ConclusionsLVA showed an acceptable patency and positive correlation between a patent anastomosis and clinical improvement after 12 months. Further research with a larger study population is required to determine whether outcomes or patient characteristics significantly correlate with a patent anastomosis after LVA operation.

Highlights

  • Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Secondary lymphedema in the upper extremity is caused by an interruption of the lymphatic system following cancer, trauma, injury, or infection

  • The aim of the current study was to analyse the long-term patency rate, quality of life (QoL) according to the Lymph-ICF, arm circumference, and compression stockings discontinuation after Lymphaticovenous anastomosis (LVA), as well as exploring the differences between patients presenting patent or non-patent anastomosis and correlations with clinical improvement

  • An additional video of a patent anastomosis by indocyanine green (ICG) lymphography is given in Online Resource 1

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Summary

Introduction

Secondary lymphedema in the upper extremity is caused by an interruption of the lymphatic system following cancer, trauma, injury, or infection. The most frequent cancer among women, affects over 2 million women each year [1, 2]. Breast cancer treatment involving lymph node dissection or radiotherapy is the most common cause in developing upper extremity lymphedema, known as breast cancer-related lymphedema (BCRL) [3, 4]. Symptoms may negatively affect their quality of life. Breast Cancer Research and Treatment (2020) 179:131–138. With the increasing breast cancer survival rate and the profound impact on QoL, lymphedema treatment is in high demand [5, 6, 9, 10]

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