Lymphedema Volume Research Articles

The“Overlapping”Lymphaticovenous Anastomosis: an overlapped end-to-end anastomosis supermicrosurgical technique

ObjectiveLymphaticovenular anastomosis (LVA) is increasingly utilized in the treatment of lymphedema. This study aims to assess the efficacy and safety of the “Overlapping” LVA technique, which addresses the size mismatch between lymphatic and venous vessels in lymphedema treatment.MethodsBetween August 2022 and April 2023, seventeen patients diagnosed with lymphedema were enrolled in this study. The severity of lymphedema in these patients was classified according to the International Society of Lymphology (ISL) staging system.All patient underwent LVA procedures, anastomosis techniques including the Overlapping, end-to-end and octopus anastomosis. The techniques of anastomosis, anastomosis time, patency rate, and volume of limb lymphedema were evaluated.ResultsOur study enrolled 17 lymphedema patients who underwent the LVA procedure. All patients showed significant postoperative improvement in limb edema. The mean drainage volume was 472.29 ml. The Overlapping technique demonstrated a 100% success rate as assessed by clinical observation and intraoperative Indocyanine Green (ICG) lymphography. The average anastomosis time was 5.3 min, reducing operative time compared to traditional methods.ConclusionsThese findings suggest that the Overlapping technique could serve as a valuable addition to the current LVA technique. This Overlapping anastomosis technique provides a wide range of applications for lymphatic anastomosis treatment and prevention of lymphedema.

Effect of Adding a Six-Week Course of Doxycycline to Intensive Hygiene-Based Care for Improving Lymphedema in a Rural Setting of Mali: A Double-Blind, Randomized Controlled 24-Month Trial.

Lymphedema (LE) is one the most disfiguring chronic manifestations of lymphatic filariasis. Its management relies primarily on limb hygiene and local care. A previous study in Ghana demonstrating a beneficial effect of doxycycline on LE led to the current multicenter trial on the efficacy of doxycycline in filarial LE. A randomized placebo-controlled trial was initiated in two rural health districts in Mali. Patients with LE stages 1-3 were randomized to receive either doxycycline (200 mg/day) or placebo over a 6-week monitored treatment period and were then followed every 6 months for 2 years. Both groups received materials for limb hygiene that was carried out daily for the entire 2-year study. The primary endpoint was lack of progression in LE stage at 24 months. One hundred patients were enrolled in each study arm. The baseline sociodemographic characteristics of each group were largely similar. There was no significant difference at month 24 after treatment initiation in the number of subjects showing progression in LE stage between the two treatment arms (P = 0.5921). Importantly, however, the number of attacks of acute adenolymphangitis (ADLA) was reduced in both arms, but there was no significant difference between the two groups at any follow-up time point (all P >0.23). Doxycycline was well tolerated in those receiving the drug. When added to daily self-administered limb hygiene, a 6-week course of doxycycline (200 mg) was not superior to placebo in increasing the improvement associated with hygiene alone in LE volume, stage, or frequency of ADLA attacks over a 24-month period.

Abstract PO3-12-03: SAFETY AND TOLERABILITY OF SHOCKWAVE THERAPY FOR TREATMENT OF BREAST CANCER-RELATED LYMPHEDEMA: A SYSTEMATIC REVIEW

Abstract Introduction: Breast cancer is currently the most common malignancy among women, after non-melanoma skin cancer. Upper limb lymphedema is the most feared complication of breast cancer treatment. Currently, the approach described in the literature as the most effective for the treatment of lymphedema is Complex Physical Therapy. In the search for more efficient therapeutic actions, Shockwave Therapy emerges as an alternative in the treatment of upper limb lymphedema secondary to breast cancer. Objective: to systematically review the available literature and verify the safety, tolerance and efficacy of using Shockwave Therapy (ESWT) in the treatment of upper limb lymphedema secondary to breast cancer. Methods: The following databases were used: PubMed; PEDro, The Cochrane Library, EMBASE, Web of science and Scopus and through manual search of articles. The PICO research method was adopted, and the descriptors adjusted according to the respective database. This study was registered in PROSPERO: CRD42020209588. Results: Combined searches, including reference lists, manual searches, and database searches, yielded 64 articles, of which 35 articles were duplicates, 23 studies were excluded by title, abstract, or full reading. Six full-text articles were selected. Of these, only 3 randomized clinical trials and 3 non-randomized clinical trials met all established inclusion criteria and were analyzed in this systematic review. Two more RCTs were added by manual search of references from other articles. None of the studies found had safety and tolerability as their primary objective, and one reported transient redness with the use of the device. Shockwave Therapy, combined with other resources, can significantly improve lymphedema volume and shoulder range of motion, but there is not enough evidence to support the use of ESWT as a substitute for complex physical therapy (CPT). Final considerations: There is evidence that it can improve ROM and upper limb volume when used in association with CPT, which is the gold standard for the treatment of lymphedema. Keywords: Lymphedema, Breast Cancer, Extracorporeal Shockwave Therapy. Citation Format: Patricia Lima Ventura, Cinira Haddad, Afonso Nazário, Gil Facina, Vanessa Sanvido, Amanda Estevao, Samantha Lopes de Almeida Rizzi. SAFETY AND TOLERABILITY OF SHOCKWAVE THERAPY FOR TREATMENT OF BREAST CANCER-RELATED LYMPHEDEMA: A SYSTEMATIC REVIEW [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-12-03.

Vascularized omental tissue transfer for the treatment of lymphedema: a review

Lymphedema is a debilitating disorder caused by impaired drainage of the lymphatic system. In the Western world, lymphedema most often arises secondary to the treatment of malignancy. Patients with lymphedema experience progressive swelling, pain, numbness, and tingling, and decreased quality of life. Those with persistent symptoms may be subject to chronic cellulitis. The advent of microsurgery has enabled clinicians to transplant donor lymph nodes and their blood supply from a healthy site to the affected area in a procedure known as vascularized lymph node transplant (VLNT). One donor region is the omentum. Vascularized omental lymph node transfer (VOLT) has been shown to decrease limb volume, circumference, and subjective symptoms of lymphedema. The immunologic properties of the omentum make it a particularly useful lymph node donor site for patients with lymphedema-related cellulitis. The omentum may be harvested laparoscopically, with robotic assistance, or through a small laparotomy incision. In this review, we describe the relevant anatomy and history of VOLT as well as operative techniques. The risks, benefits, and relevant outcome studies will be reviewed. Recent applications of robotic surgery to VOLT will be addressed.

Laser Therapy in Comprehensive Treatment of Patients with Lymphedema of Lower Limbs

INTRODUCTION: Methods of physiotherapy using intravenous laser irradiation of blood (ILIB) that affects various pathogenetic factors of lymphedema, permits to achieve the required therapeutic effect and shows its promising perspectives.
 AIM: Evaluation of the effectiveness of ILIB to reduce the lymphedema volume in the lower limbs.
 MATERIALS AND METHODS: In 2020–2022, a comprehensive conservative treatment including compression therapy, pharmacotherapy and ILIB, was conducted in 60 patients of the mean age 45.3 ± 1.6 years with I–III stage lymphedema. Group 1 included patients with primary (n = 8) and group 2 (n = 52) with secondary lymphedema of the lower limbs. Laser radiation at 632 nm wavelength was used with standardized parameters: power 3 to 15 mW, pulse rate 80 to 2,000 Hz, exposure time 5 to 15 min, with a course (up to 10 sessions), daily, or interval (every 2nd day) load. Lymph outflow, microcirculation, soft tissues of the affected limb were evaluated using electrocoagulography, ultrasound examination of inguinal lymph nodes and soft tissues, triplex scanning, thermal imaging and McClure-Aldrich test.
 RESULTS: At the end of the treatment course, a reduction of the limb perimeter at the level of the middle third of the lower leg by 14.8 ± 0.7% was noted (from 48.7 ± 5.3 cm to 41.4 ± 0.9 cm). After 4 sessions and a treatment course, electrocoagulography revealed hypocoagulation with the formation of a loose clot with early retraction. Spearman test showed a direct relationship between changes in the fibrinolytic activity of blood and the perimeter of the lower leg in patients of group 2 with I–II stage of the disease (p 0.005). Thermography of the lower limbs showed increased IR radiation with a statistically significant increase (p 0.001) in the area of hyperthermia in the distal parts of the lower legs and the inner surface of the thighs. The results of McClure-Aldrich test showed a statistically significant slowdown of a skin papule resolution in the distal part of the lower legs from 27.13 ± 2.77 min to 35.72 ± 3.11 min (р 0.05) after ILIB in I stage of the disease.
 CONCLUSION: ILIB affects the internal factors of lymph outflow and contributes to its optimization in the comprehensive treatment of patients in the initial stage of secondary lymphedema of the lower limbs.

Lymphedema and Kaposi sarcoma: A narrative review

Kaposi sarcoma (KS), due to HHV-8 infection is classified in 4 subtypes: epidemic, endemic, HIV-related and iatrogenic essentially after organ transplant. Lymphedema is a complication of KS. We reviewed the interactions between HHV-8 infection and lymphedema according an analysis of the literature. HHV-8 can infect different types of cells, among them a privileged tropism for lymphatic endothelial cells. It induces multi-centric endothelial proliferation leading to the occlusion of lymphatic vascular lumen. Lymphatic obstruction progressively lead to the blockage of lymphatic drainage, lymph stasis and lymphedema. Lymphedema mostly involved the lower limb affected by KS. It can then develop simultaneously or after the appearance of KS lesions but also be the first sign of KS, a long time before KS skin lesion onset. Lymphedema diagnosis is clinical and lymphoscintigraphy can confirm it if necessary. Lymphedema may be associated with active lesions of KS or non-evolutive, with only cicatricial lesions. KS should be treated according to the KS subtype, aggressive form, with local or systemic treatments associating with causal treatment, such as HIV infection or reducing immuno-suppressive drugs in transplant patients. In most of the cases, KS treatment may slightly reduce (or not) lymphedema volume which remains a chronic disease. Lymphedema management should be associated in order to reduce the volume and then stabilizing it. Low-stretch bandage, elastic garments and skin care are the cornerstone of treatment. Lymphedema is a frequent complication of KS, and may reveal KS or occurs throughout its course. Association of KS and lymphedema must be known because lymphedema is a chronic disease affecting the quality of life. Beyond the treatment of KS, its management must be specific including a long follow-up to optimize the patient's observance required to maintain the best lymphedema control.

Overlapping lockup lymphaticovenous anastomosis: A useful addition to supermicrosurgery

BackgroundLymphaticovenular anastomosis (LVA) is a minimally invasive surgical procedure used to treat lymphedema. This surgical procedure connects the superficial lymphatic vessels to nearby veins to establish lymphatic–venous pathways. One of the most common challenges encountered by lymphatic surgeons when performing LVA is a mismatch in the sizes of the veins and lymphatic vessels, with the effectiveness limited by technical constraints. We conducted a pilot study to evaluate the feasibility of an overlapping lockup anastomosis (OLA) LVA technique to address these problems. MethodsIn this study, we present a novel OLA technique for LVA that addresses the challenges with conventional techniques. The OLA technique was used in 10 lymphedema patients between September 2022 and March 2023 to compare OLA and end-to-end anastomosis. The time required for anastomosis, method of anastomosis, patency rates, and lymphedema volume were evaluated in this study. ResultsOf 123 LVAs, 44 were performed using the OLA technique in 10 patients, with indocyanine green lymphangiography revealing unobstructed drainage. A single case of slight fluid leakage occurred, which was resolved by reinforcing the sutures. The average anastomosis time for OLA and the end-to-end technique was 5.55 minutes and 12.1 minutes, respectively. The wounds of the patients healed without infection, and the subjective limb circumference decreased. ConclusionsThe OLA technique could serve as a valuable addition to the current LVA technique, especially for cases with a mismatch in the sizes of the lymphatic vessels and veins. This technique has the potential to promote the broader application of LVA in the treatment and prevention of lymphedema.

Effect of Complex Decongestive Therapy (CDT) and Manual Lymphatic Drainage (MLD) on Lymphedema Control after Surgery in Breast Cancer Patients -A Literature Review

Background: Breast cancer considerably affects both developed and developing nations globally, it has been the focus of several studies. Lymphedema in breast cancer survivors is a more prevalent condition that healthcare providers often fail to completely comprehend. About five in one women who have undergone breast cancer surgery acquires Breast Cancer Related Lymphedema (BCRL). Lymphedema is a chronic and debilitating disease that that can develop as a consequence of breast cancer treatment. It can have disastrous impacts on a patient's quality of life associated with lymphedema. In general, it is underreported and undertreated. The aim of this reviews study is to determine the effectiveness of CDT on reducing the occurrence of lymphedema in breast cancer patients. Methodology: For these studies literature review, databases PubMed, Google Scholar and science direct were employed. Articles published from 2019-2023, and with the full English text met the inclusion criteria. Articles published prior to 2019 and articles having an incorrect abstract were excluded. Results: CDT has been shown to be useful in reducing the symptoms associated with BCRL. It proved that exercise is safe, in addition to it is important to continue exercise in daily life. The functional status of the patients also showed a noticeable improvement. Conclusion: In patients with BCRL, CDT improves upper extremity functioning and quality of life. Contributing factors include the decrease in volume of lymphedema, aching and heaviness, and an increase in shoulder movement. CDT is a promising therapeutic modality for the lymphedema.

Association of clinical manifestations of secondary lymphedema and lymph node dissection sites in the lower extremities of patients with melanoma

Background Lymphedema is a chronic, debilitating disease that often requires life-long management. Predicting clinical manifestations and prognosis is crucial in clinical practice because the treatment of lymphedema should be individualized for best clinical outcome. The aim of this study is to explore the location and severity of lymphedema secondary to inguinal and/or iliac lymph node dissection (LND) in patients with melanoma. Methods Patients with melanoma who received LND at a single tertiary medical center between 1 January 2010 and 31 September 2022 were retrospectively reviewed. Patient who received inguinal LND only were designate as the inguinal group while those who received both ilioinguinal LND were included in the ilioinguinal group. Volumetric measurement was used to objectify the severity and location of lymphedema. Clinical data was acquired for 12–15 months of follow-up. Results Among 81 patients, 43 (53%) had developed lymphedema in the lower extremities at an average of 33 days after the surgery. Initially, patients manifested with medial thigh lymphedema in the inguinal group while patients were presented with whole leg lymphedema in the ilioinguinal group. Lower leg volume of the ilioinguinal group was significantly higher than the inguinal group. After more than 12 months of lymphedema treatment, upper leg volume was higher in the ilioinguinal group than the inguinal group (12.7% vs 5.4%, p < 0.05). Conclusion Lymphedema developed in early post-op period. The ilioinguinal group presented with a larger volume of lymphedema in the distal area of the legs. Even after sufficient treatment, predominant lymphedema remained in the proximal leg for the ilioinguinal group. Patients with both inguinal and iliac LND were associated with more severe lymphedema. Based on the dissection sites, the clinical manifestations and prognosis of leg lymphedema can vary widely. Thus, clinicians should consider the dissection site when approaching melanoma patients with lymphedema.

Effectiveness of physical exercise programmes in reducing complications associated with secondary lymphoedema to breast cancer: a protocol for an overview of systematic reviews

IntroductionBreast cancer-related lymphoedema (BCRL) is one of the most underestimated and debilitating complications associated with the treatment that women with breast cancer receive. Several systematic reviews (SRs) of different physical...

Short term treatment of secondary lymphedema with hyaluronidase injections reduces mouse hindlimb lymphedema.

Lymphedema is a common complication following breast cancer treatment with axillary lymphadenectomy and radiotherapy. Currently, there is no curative treatment for this disease, hence there is a need for new therapeutic suggestions. The aim of this study was to investigate the effect of hyaluronidase (HYAL) injections after inducing hindlimb lymphedema in 36 female C57BL/6 mice. HYAL injections were administered every second day for 14 days in three groups: (1) HYAL for 1 week followed by saline for 1 week, (2) HYAL for 2 weeks, and (3) saline injections for 2 weeks. Volume of the lymphedema limb was weekly assessed with micro-computed tomography (μ-CT) scans for a total course of 6 weeks. Lymph vessel morphometry was assessed in the end of the study after staining cross-sections of the hindlimb for anti-LYVE-1 blindly. Lymphatic function was assessed by lymphoscintigraphy to assess lymphatic clearance. There was a significant reduction of the volume of lymphedema in mice treated with HYAL-7 compared with mice treated with HYAL-14 (p < 0.05) and saline (p < 0.05). No differences were detected in lymph vessel morphometry and the lymphoscintigraphy between groups. Short-term treatment with HYAL-7 might be a potential therapeutic suggestion for secondary lymphedema induced in mouse hindlimbs. In the future, clinical studies are needed to investigate the potential of HYAL treatment in human beings.

Effectiveness of Mobiderm Autofit in the Intensive Phase of Breast Cancer-Related Lymphedema Treatment: A Case Series.

Background: The objective of this case series was to evaluate the effectiveness of wearing Mobiderm® Autofit compressive garment as part of the complete decongestive therapy (CDT) of upper limb lymphedema. Materials and Methods: Ten women and men with stage II breast cancer-related lymphedema underwent a CDT intensive phase for 12 days, combining Mobiderm Autofit compression garment with manual lymphatic drainage. Arm volume was calculated with the truncated cone formula using circumferential measurements taken at each appointment. The pressure under the garment and the overall satisfaction of patients and physicians were also assessed. Results: The mean (standard deviation [SD]) age of the patients was 60.50 (11.70) years. The mean (SD) lymphedema excess volume decrease was 343.11 (266.14) mL, which represents a 36.68% decrease between day 1 and day 12, whereas the mean (SD) absolute volume difference was 420.03 (251.27) mL corresponding to a 10.12% decrease during this same period. The mean (SD) device pressure by using the PicoPress® was 30.01 (0.45) mmHg. The majority of patients were satisfied with the ease of use and the comfort of wearing Mobiderm Autofit. Such positive assessment was confirmed by the physicians. During this case series, no adverse event was reported. Conclusion: A lymphedema volume decrease of the upper limb was reported after 12 days of treatment with Mobiderm Autofit during the CDT intensive phase. Moreover, the device was well tolerated, and its use was appreciated by the patients and the physicians.

Benefits of Combined Upper Body Exercise and Compression Therapy for Breast Cancer Related Lymphedema: A Systematic Review

Purpose: This systematic review aimed to examine the benefit of combined upper body exercise and compression therapy for breast cancer related lymphedema. Method: Electronic searches were performed in Medline, EMBASE, CINAHL, SPORTDiscus, and PEDRO. We included randomized and controlled clinical trials that examined the effect of upper body exercise with use of compression therapy on arm lymphedema. Where data were available, effect sizes were calculated. Risk of bias was assessed using the Cochrane risk-of-bias tool. The quality of evidence was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Of 444 studies, 11 met all inclusion criteria. Two cross-over trials examined single bouts of upper body exercise with or without compression, three intervention trials examined non-resisted upper body exercise and compression, and six intervention trials examined upper body resistance exercise and compression. Only two studies reported statistically significant benefit from the combined intervention for arm lymphedema volume. Seven studies provided adequate data to allow for calculation of effect size; however, heterogeneity precluded pooling of data. The quality of evidence was moderate in intervention trials comparing combined upper body exercise and compression to standard care ( n = 1) or to exercise alone ( n = 1). For all other trials the grade of evidence was low, with quality ratings downgraded due to small sample sizes and/or high or unclear risk of bias. Conclusions: No clear conclusions could be made regarding the benefit of combined upper body exercise and compression for breast cancer related lymphedema. Further high-quality trials are warranted.

In Adult Breast Cancer Patients, the Effect of Compression Garments on Changes in the Volume of Breast Cancer lymphedema: A Literature Review

Background About 21% of women treated for cancer develop breast cancer-associated lymphedema (BCRL), which could lead to negative changes in self-image, increased anxiety and reduced quality of life. Currently, there are a variety of treatments to improve lymphedema, and wearing compression garments is considered necessary, however, evidence is lacking to assess the effectiveness of BCRL compression garments. Purpose To evaluate the efficacy and safety of wearing compression garments for lymphedema volume in adult breast cancer patients. Methods By searching MEDLINE, PubMed, Psych Articles, Academic Search Complete, CINAHL and Cochrane Library, the search was limited to peer-reviewed literature published between 2017 and 2022 in English. Inclusion criteria were participants aged ≥18 years and the intervention was wearing a compression garment. The primary outcome was lymphedema volume change and adverse events. Results A total of 903 literature were obtained, and the literature were screened through the PRISMA flow chart, and five literature that met the criteria were finally included, all of which were randomized controlled trials (RCT). Risk of bias assessment and quality of evidence graded for these five RCTs were performed by two independent researchers using the Cochrane Risk of Bias Tool and the GRADE grading System. The five included RCTs were biased to varying degrees because the intervention was obvious, and the quality of the evidences were moderate, but wearing compression garment was effective and safe in all trials. Conclusion In adult breast cancer patients, wearing compression garments could significantly reduce the volume of lymphedema, and the longer the daily wear time, the better the effect, and the safer than Kinesio Taping. Future studies should conduct higher-quality, multicenter randomized controlled trials to further determine the optimal pressure range for compression garment use.

The effect of complex decongestive therapy on spatio-temporal parameters and balance in women with breast cancer-related upper extremity unilateral lymphedema

BackgroundThe aim of this study was to investigate the effect of complex decongestive therapy on spatio-temporal parameters and balance in individuals with breast cancer-related upper extremity unilateral lymphedema. MethodsThe study was designed as a prospective, cross-sectional study. Thirty sessions of complex decongestive therapy were applied. Participants' pre-and post-treatment spatio-temporal parameters and balance parameters were evaluated with the Win Track platform. In addition, the Timed Up and Go test was used to evaluate the dynamic balance. Plethysmography, a water displacement method, was used to measure upper extremity volume. FindingsSignificant improvement was observed in limb volume asymmetry after complex decongestive therapy. While the stride length of the affected side was 409.93 mm before the treatment, it increased to 500.93 mm after the treatment, and a significant increase was observed (p = 001). Significant improvements were found in the other spatio-temporal parameters of the participants. Compared to the pre-treatment, a significant decrease was detected in the average cadence value, Timed Up and Go value, double stance time, and maximum plantar pressure point of the participants. Significant improvements were found in the participants' balance. InterpretationComplex decongestive therapy applied to individuals with unilateral upper extremity lymphedema provides significant improvement in both spatio-temporal and balance parameters. However, we recommend complex decongestive therapy as an effective and safe treatment to reduce the volume of lymphedema. Patients with unilateral lymphedema that may cause postural asymmetry should be informed about balance and gait disturbance and should be encouraged to receive lymphedema treatment as soon as possible.

Effectiveness of manual lymphatic drainage for breast cancer-related lymphoedema: an overview of systematic reviews and meta-analyses

There are several studies on the treatment of breast cancer-related lymphedema (BCRL) based on the manual lymphatic drainage (MLD) technique, making it a widely accepted conservative treatment for BCRL. In this study, PubMed, Embase and Cochrane Library databases were searched for systematic reviews (SRs) or meta-analyses (MAs) from inception till 28 March 2022. The methodological quality of the included SRs/MAs was evaluated using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and the evidence quality of outcome measures using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Grading of Recommendations, Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) was used to describe the certainty of evidence from qualitative data. The study results identified 7 eligible SRs/MAs. Evaluation using AMSTAR-2 revealed only one moderate quality study, while the others were rated as low or critically low. The GRADE criteria identified 3 very-low-quality evidence studies, 1 low-quality evidence study, and 9 moderate-quality evidence studies. The GRADE-CERQual assessment showed the confidence for decision-making was either low or moderate. Overall, the results indicated that MLD could significantly reduce lymphedema in patients aged &lt;60 years (standard mean difference (SMD): −1.77, 95% confidence interval (CI): (−2.23 to −1.31)), and the optimal intervention duration was 1 month. Although MLD for BCRL might reduce lymphoedema volume, their effects were not well established, and therefore, we could not recommend the addition of MLD to complete decongestive therapy (CDT) or compression therapy for patients with BCRL. Thus, MLD treatment appeared to be an ambiguous but potentially effective BCRL treatment. Rigorously designed high-quality randomized controlled trials with larger sample sizes are needed to further verify the effectiveness of MLD therapy in BCRL treatment.

Efectividad de la fisioterapia multimodal acuática mediante ejercicio terapéutico, autodrenaje manual y medidas de autocuidado en el linfedema de miembro superior en mujeres supervivientes de cáncer de mama. Ensayo clínico aleatorizado

IntroductionLymphedema secondary to breast cancer is a chronic pathology. Complex decongestive physiotherapy is the conservative treatment of choice, it consists of an intensive phase to minimize the volume of the limb, and a maintenance phase to promote self-control of the pathology. The objective is to evaluate if aquatic multimodal physiotherapy (AMP) composed of therapeutic exercise, manual self-drainage and upper limb self-care measures maintains or reduces the volume of lymphedema in the maintenance phase and if it is more effective than upper limb multimodal physiotherapy in-room. MethodologyA randomized clinical trial has been carried out comparing two groups, experimental N:43 that performed a pattern of exercises in an aquatic environment and control N:47 that performed the same pattern of exercises in-room. Both groups carried out 20 sessions of 45min, 2 or 3 days per week. The main variables were the changes in the volume of the lymphedema, by means of circometry, and the quality of life of the participants, by means of the FACT-B + 4 scale. ResultsNo statistically significant differences were found between the interventions carried out, both improve the volume at 20 sessions (p = 0.7855), the interaction between the frequency of treatment and the time after intervention was (p-value: < 0.01). Improvements were found in quality of life variables; «general physical state of the patient», «family and social environment», «emotional state», «personal functioning capacity» and «patient concerns» (p-value: < 0.01). ConclusionUpper limb AMP seems to improve the quality of life of surviving women with upper limb lymphedema in the maintenance phase. AMP does not show an added benefit to room multimodal physiotherapy.

Role of weight lost in breast cancer-related lymph

ObjectiveAnalysis of data collected in routine clinical practice of the combined impact of both physical activity and decrease in body mass index (BMI) on a minor prevalence of lymphedema in post-breast cancer patients. MethodsAnalysis of data obtained by the specialized rehabilitation unit, from 99 female patients for 18 months, after a specific diet, sports program and complete decongestive therapy (CDT) was indicated. Personal data, affected organ volume, weight, physical activity level and Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4) were collected in follow-up visits. ResultsAlthough the average of body-mass index showed no change during the assessment period, about 13% of patients in the second follow-up visit and 30% in the third one had lost weight. Women experiencing weight-loss in the third follow-up visit presented a reduced volume of the affected organ [−50 (−248 to 141) ml vs. 130 (−148 to 355) ml, p<0.05] as compared to weight-gaining patients. No relationship was established between physical activity and lymphedema volume changes. ConclusionsApart from the conventional treatment with orthotics and manual lymph drainage, BCRL prevention and treatment needs to focus – right from the start – on weight management or weight-loss in obese patients.

Effect of manual lymphatic drainage on upper limb lymphedema after surgery for breast cancer

Evaluation of the effect of manual lymphatic drainage on lymphedema of the upper limb after previous axillary lymphadenectomy/sentinel node bio-psy during the maintenance phase of lymphedema after the breast cancer surgery. A total of 30 patients after surgical treatment of unilateral breast cancer underwent 10 manual lymphatic drainages within 8 consecutive weeks. All patients underwent upper limb circumference measurements before and after the study and completed two specialized EORTC questionnaires (QLQ-C30 and QLQ-BR23). The average time between surgery and admission into this study was 32.5 months. In the beginning of the study, lymphedema was present for an average of 19.8 months. At the end of a series of manual lymphatic drainages, the average volume decrease of the limb with lymphedema was 3% (1.5-5.6%). In contrary, the average loss of volume on the healthy (control) upper limb was only 0.4%. The average reduction of lymphedema volume after therapy achieved 57% (37-88%). After a series of manual lymphatic drainages, the results of the EORTC QLQ-C30 questionnaire showed a statistically significant improvement in physical and role functions, fatigue, nausea and vomiting, pain, dyspnea and constipation, while the results of the EORTC QLQ-BR23 questionnaire showed a statistically significant improvement in the arm and breast symptoms. There was no statistically significant deterioration in any of the monitored parameters. The results of the study showed a positive effect of manual lymphatic drainage on the maintenance phase of lymphedema in patients after breast cancer surgery. The questionnaires showed a significant improvement in hand and arm symptoms as well as an improvement of the other functions and symptoms affecting quality of life. Further studies should be performed on groups of patients with the maintenance phase of upper limb lymphedema to confirm or disprove our results.

Contribution of Self-Lymphatic Drainage to Subclinical Lymphedema After Treatment for Breast Cancer

Lymphedema is a significant complication of breast cancer treatment. Early treatment of subclinical lymphedema may prevent its related complications. We aimed to evaluate the contribution of applying self-lymphatic drainage (SLD) in subclinical LE patients. One hundred twenty-eight women diagnosed with subclinical lymphedema were enrolled in the study. Patients were allocated into control group 1 (n=64) and SLD group 2 (n=64). Excess volume; the Visual Analog Scale (VAS) for pain, stiffness, heaviness, and tightness; the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) for disability; handgrip strength; Beck Depression Inventory (BDI) for depression were recorded before and after therapy. Statistically significant improvements in the excess volume were observed in both groups; however, there was a substantial change in the SLD group. Also, only the VAS and BDI scores were assessed significantly lower in the SLD group than in the control group. In conclusion, SLD is useful in reducing lymphedema volume, sensations of pain, stiffness, heaviness, tightness, and depression in patients with subclinical LE.