Abstract
Lymphedema represents a chronic condition with impaired lymphatic transport, having primary and secondary etiologies. The most common type of secondary lymphedema in western countries is represented by breast cancer related upper limb lymphedema. This condition, once installed, determines limb structure changes, progressive functional impairment, specific complications, consequently impacting the quality of patient’s life. An accurate diagnosis is mandatory, using both clinical and imagistic methods with clear definition disease extent as per standardized staging systems, in order to further provide an adequate therapeutic strategy. The main therapeutic goal in patients with lymphedema is represented by limb volume reduction with subsequent symptoms relief, improving quality of life and avoiding complications such as recurrent infections. Through this paper, we aim to present a comprehensive overview of current therapeutic options of breast cancer upper limb related lymphedema. Therapeutic approach comprises of non-surgical (conservative) therapy, which is mandatory as initial therapy and surgical procedures for selected cases. Most patients with lymphedema benefit from conservative treatment alone. In non-responsive cases, in patients with progressive disease, in late stage complicated lymphedema, and also recently added as prophylactic strategy, surgical treatment, trough recent developed techniques, offer very good results in long-term control of disease. Surgical options are classified firstly in physiologic procedures that aim to create new lymphatic channels, promote physiologic drainage of the lymph and should be considered early in the course of the disease, and secondly ablative procedures that reduce through liposuction or various excision techniques the volume of the affected limb. Both types of techniques can be combined to ensure the best functional outcome of the patient.
Highlights
This condition, once installed, determines limb structure changes, progressive functional impairment, specific complications, impacting the quality of patient’s life
Lymphedema is a progressive and debilitating condition affecting 250 million people worldwide characterized by impaired lymphatic transport due to structurally and functionally altered lymphatic vessels caused by obstruction, malformation or hypoplasia, resulting in functional deficit, decreased quality of life and high infection rate[1-5]
To further facilitate lymphatic sparing, Campisi et al described the technique of Fibro-Lipo-Lymph-Aspiration (FLLA) with a Lymph Vessel Sparing Procedure (LVSP) in which liposuction is performed in association with 2 mapping methods (a patent blue violet dye test, together with indocyanine green (ICG) fluorescence) and a photo dynamic eye (PDE) camera is used to mark and map the superficial lymphatic channels of the limb
Summary
Lymphedema is a progressive and debilitating condition affecting 250 million people worldwide characterized by impaired lymphatic transport due to structurally and functionally altered lymphatic vessels caused by obstruction, malformation or hypoplasia, resulting in functional deficit, decreased quality of life and high infection rate[1-5]. The most frequent treatment related risk factors for BCRL include axillary node dissection (ALND) and regional lymph node radiation (RLNR), mastectomy, lack of breast reconstruction and chemotherapy. Axillary surgery, both ALND and SLNB( sentinel lymph node biopsy) put the patient at increased risk of developing lymphedema, the incidence being four time higher for ALND11, 14. BCRL progress to irreversible upper limb edema, fibrosis, persistent symptoms as pain and paresthesia, marked functional impairment, ulceration, decrease in immune responsivity, posing high infectious risk(recurrent cellulitis and erysipelas) and a rare but very severe complication represented by the occurrence of lymphangiosarcoma (Stewart-Treves syndrome) 37, .
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