The efficacy of lymphaticovenular anastomosis in breast cancer-related lymphedema
Identifieur interne : 000101 ( Main/Exploration ); précédent : 000100; suivant : 000102The efficacy of lymphaticovenular anastomosis in breast cancer-related lymphedema
Auteurs : H. Winters [Pays-Bas] ; H. J. P. Tielemans [Pays-Bas] ; M. Hameeteman [Pays-Bas] ; V. A. A. Paulus [Pays-Bas] ; C. H. Beurskens [Pays-Bas] ; N. J. Slater [Pays-Bas] ; D. J. O. Ulrich [Pays-Bas]Source :
- Breast Cancer Research and Treatment [ 0167-6806 ] ; 2017.
Abstract
Lymphedema can be a debilitating condition, causing a great decrease in a person’s quality of life (QoL). Treatment with lymphaticovenular anastomosis (LVA), in which an anastomosis is created between the lymphatic and venous system, may attenuate lymphedema symptoms and reduce swelling. In this study, we share the results using LVA to treat breast cancer-related lymphedema (BCRL) at our institution.
Patients were eligible for inclusion if they suffered from unilateral BCRL, if functional lymphatics were available, if compression therapy was used for at least 6 months, and if the follow-up was 12 months at minimum. Lymph vessel functionality was assessed preoperatively using indocyanine green (ICG). During surgery, 1–3 anastomoses were created and shunt patency was confirmed using ICG. Arm volumes were measured before surgery and at 6- and 12-month follow-up. QoL was measured before surgery and at 6-month follow-up. Arm volume differences between the healthy arm and affected arm were compared between the time points.
Twenty-nine consecutive female patients with unilateral BCRL were included. The preoperative mean difference in arm volumes was 701 ± 435 ml (36.9%). This was reduced to 496 ± 302 ml (24.7%) at 6-month follow-up (
Treatment with LVAs is effective in reducing arm volume difference in patients suffering from BCRL. Although no complete reduction of the edema was achieved at 12-month follow-up, the procedure significantly increased the patients’ QoL.
Url:
DOI: 10.1007/s10549-017-4335-0
PubMed: 28608029
PubMed Central: 5543202
Affiliations:
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Winters</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Plastic and Reconstructive Surgery,</institution><institution>Radboud University Medical Center,</institution></institution-wrap>9101, 6500 HB Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>9101, 6500 HB Nijmegen</wicri:regionArea><wicri:noRegion>6500 HB Nijmegen</wicri:noRegion></affiliation></author><author><name sortKey="Tielemans, H J P" sort="Tielemans, H J P" uniqKey="Tielemans H" first="H. J. P." last="Tielemans">H. J. P. 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Hameeteman</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Plastic and Reconstructive Surgery,</institution><institution>Radboud University Medical Center,</institution></institution-wrap>9101, 6500 HB Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>9101, 6500 HB Nijmegen</wicri:regionArea><wicri:noRegion>6500 HB Nijmegen</wicri:noRegion></affiliation></author><author><name sortKey="Paulus, V A A" sort="Paulus, V A A" uniqKey="Paulus V" first="V. A. A." last="Paulus">V. A. A. Paulus</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Plastic and Reconstructive Surgery,</institution><institution>Radboud University Medical Center,</institution></institution-wrap>9101, 6500 HB Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>9101, 6500 HB Nijmegen</wicri:regionArea><wicri:noRegion>6500 HB Nijmegen</wicri:noRegion></affiliation></author><author><name sortKey="Beurskens, C H" sort="Beurskens, C H" uniqKey="Beurskens C" first="C. H." last="Beurskens">C. H. Beurskens</name><affiliation wicri:level="1"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Orthopaedics, Section of Physical Therapy,</institution><institution>Radboud University Medical Center,</institution></institution-wrap>9101, 6500 HB Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>9101, 6500 HB Nijmegen</wicri:regionArea><wicri:noRegion>6500 HB Nijmegen</wicri:noRegion></affiliation></author><author><name sortKey="Slater, N J" sort="Slater, N J" uniqKey="Slater N" first="N. J." last="Slater">N. J. Slater</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Plastic and Reconstructive Surgery,</institution><institution>Radboud University Medical Center,</institution></institution-wrap>9101, 6500 HB Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>9101, 6500 HB Nijmegen</wicri:regionArea><wicri:noRegion>6500 HB Nijmegen</wicri:noRegion></affiliation></author><author><name sortKey="Ulrich, D J O" sort="Ulrich, D J O" uniqKey="Ulrich D" first="D. J. O." last="Ulrich">D. J. O. Ulrich</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Plastic and Reconstructive Surgery,</institution><institution>Radboud University Medical Center,</institution></institution-wrap>9101, 6500 HB Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>9101, 6500 HB Nijmegen</wicri:regionArea><wicri:noRegion>6500 HB Nijmegen</wicri:noRegion></affiliation></author></analytic><series><title level="j">Breast Cancer Research and Treatment</title><idno type="ISSN">0167-6806</idno><idno type="eISSN">1573-7217</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p id="Par1">Lymphedema can be a debilitating condition, causing a great decrease in a person’s quality of life (QoL). Treatment with lymphaticovenular anastomosis (LVA), in which an anastomosis is created between the lymphatic and venous system, may attenuate lymphedema symptoms and reduce swelling. In this study, we share the results using LVA to treat breast cancer-related lymphedema (BCRL) at our institution.</p></sec><sec><title>Materials and methods</title><p id="Par2">Patients were eligible for inclusion if they suffered from unilateral BCRL, if functional lymphatics were available, if compression therapy was used for at least 6 months, and if the follow-up was 12 months at minimum. Lymph vessel functionality was assessed preoperatively using indocyanine green (ICG). During surgery, 1–3 anastomoses were created and shunt patency was confirmed using ICG. Arm volumes were measured before surgery and at 6- and 12-month follow-up. QoL was measured before surgery and at 6-month follow-up. Arm volume differences between the healthy arm and affected arm were compared between the time points.</p></sec><sec><title>Results</title><p id="Par3">Twenty-nine consecutive female patients with unilateral BCRL were included. The preoperative mean difference in arm volumes was 701 ± 435 ml (36.9%). This was reduced to 496 ± 302 ml (24.7%) at 6-month follow-up (<italic>p</italic> <italic>=</italic> 0.00). At 12-month follow-up, the mean difference in arm volume was 467 ± 303 ml (23.5%) (<italic>p</italic> <italic>=</italic> 0.02). The overall perceived QoL was increased from 5.8 ± 1.1 to 7.4 ± 0.7 (<italic>p</italic> <italic>=</italic> 0.00). The functionality score decreased from 2.2 to 1.8 (<italic>p</italic> <italic>=</italic> 0.00), the appearance score decreased from 2.6 to 1.9 (<italic>p</italic> <italic>=</italic> 0.00), the symptoms score decreased from 2.8 to 1.8 (<italic>p</italic> <italic>=</italic> 0.00), and the mood score decreased from 2.7 to 1.5 (<italic>p</italic> <italic>=</italic> 0.00). Fifteen patients (53.6%) were able to discontinue the use of compression garment.</p></sec><sec><title>Conclusion</title><p id="Par4">Treatment with LVAs is effective in reducing arm volume difference in patients suffering from BCRL. Although no complete reduction of the edema was achieved at 12-month follow-up, the procedure significantly increased the patients’ QoL.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ketterer, C" uniqKey="Ketterer C">C Ketterer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Suami, H" uniqKey="Suami H">H Suami</name></author><author><name sortKey="Chang, Dw" uniqKey="Chang D">DW Chang</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Brorson, H" uniqKey="Brorson H">H Brorson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Damstra, Rj" uniqKey="Damstra R">RJ Damstra</name></author><author><name sortKey="Voesten, Hgj" uniqKey="Voesten H">HGJ Voesten</name></author><author><name sortKey="Van, Schelven Wd" uniqKey="Van S">Schelven WD Van</name></author><author><name sortKey="Der, Van" uniqKey="Der 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uniqKey="Ulrich D">DJ Ulrich</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hameeteman, M" uniqKey="Hameeteman M">M Hameeteman</name></author><author><name sortKey="Verhulst, Ac" uniqKey="Verhulst A">AC Verhulst</name></author><author><name sortKey="Maal, Tj" uniqKey="Maal T">TJ Maal</name></author><author><name sortKey="Ulrich, Dj" uniqKey="Ulrich D">DJ Ulrich</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dylke, Es" uniqKey="Dylke E">ES Dylke</name></author><author><name sortKey="Yee, J" uniqKey="Yee J">J Yee</name></author><author><name sortKey="Ward, Lc" uniqKey="Ward L">LC Ward</name></author><author><name sortKey="Foroughi, N" uniqKey="Foroughi N">N Foroughi</name></author><author><name sortKey="Kilbreath, Sl" uniqKey="Kilbreath S">SL Kilbreath</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Pays-Bas</li></country></list><tree><country name="Pays-Bas"><noRegion><name sortKey="Winters, H" sort="Winters, H" uniqKey="Winters H" first="H." last="Winters">H. Winters</name></noRegion><name sortKey="Beurskens, C H" sort="Beurskens, C H" uniqKey="Beurskens C" first="C. H." last="Beurskens">C. H. Beurskens</name><name sortKey="Hameeteman, M" sort="Hameeteman, M" uniqKey="Hameeteman M" first="M." last="Hameeteman">M. Hameeteman</name><name sortKey="Paulus, V A A" sort="Paulus, V A A" uniqKey="Paulus V" first="V. A. A." last="Paulus">V. A. A. Paulus</name><name sortKey="Slater, N J" sort="Slater, N J" uniqKey="Slater N" first="N. J." last="Slater">N. J. Slater</name><name sortKey="Tielemans, H J P" sort="Tielemans, H J P" uniqKey="Tielemans H" first="H. J. P." last="Tielemans">H. J. P. Tielemans</name><name sortKey="Ulrich, D J O" sort="Ulrich, D J O" uniqKey="Ulrich D" first="D. J. O." last="Ulrich">D. J. O. Ulrich</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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