A TREATMENT FOR LYMPHEDEMA

Lymphedema Swelling Reduced by One Third with Microsurgery

March 25, 2009 — Microsurgery for lymphedema reduced arm swelling by an average of 39% at 6 months and 35% at 1 year among 20 breast cancer patients.

Nineteen of the patients reported significant clinical improvement after the procedure.

These results are from a new study of a microsurgical technique known as lymphaticovenular bypass. The study was presented at the 88th Annual Meeting of the American Association of Plastic Surgeons, which was held in Rancho Mirage, California.

"This procedure does a lot to help relieve lymphedema by giving the fluid a way out. While it does not totally eliminate the condition, there is very little downside for the patient and we may see significant improvement in its severity," said study lead author David W. Chang, MD, in a statement.

Dr. Chang is director of the plastic surgery clinic at the University of Texas MD Anderson Cancer Center, in Houston, where the study was performed.

Long-term follow-up is needed to determine whether surgery continues to promote lymphatic fluid drainage after 1 year, he added.

The surgery redirects lymphatic fluid to microscopic vessels approximately 0.3 to 0.8 mm in diameter to promote drainage. The fluid accumulates and causes swelling when lymph nodes are removed or blocked.

Dr. Chang believes that the surgery could possibly be used as a preventive measure for lymphedema in the future. "Working toward a definitive technique to cure this encumbering side effect of cancer and improve a patient's quality of life as a cancer survivor is a priority for those of us in this field," he said.

An estimated 25% to 30% of women undergoing breast cancer surgery with lymph-node dissection and radiation therapy develop lymphedema, according to the National Cancer Institute.

The new microsurgery can also be performed on lymphedema of the leg in patients with cancers in the pelvic region, said Dr. Chang.

Patients Had Advanced Lymphedema

The patients in the prospective study presented with stage II and III treatment-related lymphedema of the upper arm, with a mean duration of 4.8 years. All patients had axillary lymph-node dissection and 16 had preoperative radiation therapy.

Prior to the microsurgery, affected arms in the study were an average of 34% larger than unaffected arms.

The mean number of bypasses performed per patient was 3.5 and the mean operative time was 3.3 hours. After surgery, the mean lymphedema volume reduction was 29% at 1 month, 36% at 3 months, 39% at 6 months, and 35% at 1 year.

In 3 of the 19 patients who reported clinical improvement, no significant quantitative improvement was noted, said the MD Anderson researchers. Also, there were no postoperative complications or exacerbation of lymphedema.

Surgical Options Limited

There is no cure or prevention for lymphedema. The goal of treatment is to decrease the excess limb volume as much as possible and to maintain the limb at its smallest size. This reduces the amount of stagnant fluid in the tissues, potentially preventing or eliminating infections, as previously reported by Medscape Oncology

The gold-standard treatment for lymphedema is widely recognized to be complete decongestive therapy, which consists of a treatment and a maintenance phase; the latter is life-long and principally involves self-care, which includes skin care, wearing a compression garment, and exercise .

Surgical approaches to lymphedema include another microsurgery, lymphatic-venous anastomoses. However, there is room for improvement here, suggested Dr. Chang. "Surgical techniques, in particular, have been limited and therefore have been met with skepticism by surgeons, making it extremely important to determine which new techniques promise to bring real benefits to patients," he said.