Evidence-Based Analysis of Lymph Node Transfer in Postmastectomy Upper Extremity Lymphedema
Identifieur interne : 002543 ( Pmc/Corpus ); précédent : 002542; suivant : 002544Evidence-Based Analysis of Lymph Node Transfer in Postmastectomy Upper Extremity Lymphedema
Auteurs : Stamatis Sapountzis ; Fabio Nicoli ; Ram Chilgar ; Pedro CiudadSource :
- Archives of Plastic Surgery [ 2234-6163 ] ; 2013.
Url:
DOI: 10.5999/aps.2013.40.4.450
PubMed: 23898446
PubMed Central: 3724010
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Evidence-Based Analysis of Lymph Node Transfer in Postmastectomy Upper Extremity Lymphedema</title><author><name sortKey="Sapountzis, Stamatis" sort="Sapountzis, Stamatis" uniqKey="Sapountzis S" first="Stamatis" last="Sapountzis">Stamatis Sapountzis</name><affiliation><nlm:aff id="A1">Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.</nlm:aff></affiliation></author><author><name sortKey="Nicoli, Fabio" sort="Nicoli, Fabio" uniqKey="Nicoli F" first="Fabio" last="Nicoli">Fabio Nicoli</name><affiliation><nlm:aff id="A1">Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.</nlm:aff></affiliation></author><author><name sortKey="Chilgar, Ram" sort="Chilgar, Ram" uniqKey="Chilgar R" first="Ram" last="Chilgar">Ram Chilgar</name><affiliation><nlm:aff id="A1">Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.</nlm:aff></affiliation></author><author><name sortKey="Ciudad, Pedro" sort="Ciudad, Pedro" uniqKey="Ciudad P" first="Pedro" last="Ciudad">Pedro Ciudad</name><affiliation><nlm:aff id="A1">Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23898446</idno><idno type="pmc">3724010</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724010</idno><idno type="RBID">PMC:3724010</idno><idno type="doi">10.5999/aps.2013.40.4.450</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002543</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002543</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Evidence-Based Analysis of Lymph Node Transfer in Postmastectomy Upper Extremity Lymphedema</title><author><name sortKey="Sapountzis, Stamatis" sort="Sapountzis, Stamatis" uniqKey="Sapountzis S" first="Stamatis" last="Sapountzis">Stamatis Sapountzis</name><affiliation><nlm:aff id="A1">Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.</nlm:aff></affiliation></author><author><name sortKey="Nicoli, Fabio" sort="Nicoli, Fabio" uniqKey="Nicoli F" first="Fabio" last="Nicoli">Fabio Nicoli</name><affiliation><nlm:aff id="A1">Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.</nlm:aff></affiliation></author><author><name sortKey="Chilgar, Ram" sort="Chilgar, Ram" uniqKey="Chilgar R" first="Ram" last="Chilgar">Ram Chilgar</name><affiliation><nlm:aff id="A1">Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.</nlm:aff></affiliation></author><author><name sortKey="Ciudad, Pedro" sort="Ciudad, Pedro" uniqKey="Ciudad P" first="Pedro" last="Ciudad">Pedro Ciudad</name><affiliation><nlm:aff id="A1">Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.</nlm:aff></affiliation></author></analytic><series><title level="j">Archives of Plastic Surgery</title><idno type="ISSN">2234-6163</idno><idno type="eISSN">2234-6171</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Lin, Ch" uniqKey="Lin C">CH Lin</name></author><author><name sortKey="Ali, R" uniqKey="Ali R">R Ali</name></author><author><name sortKey="Chen, Sc" uniqKey="Chen S">SC Chen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Becker, C" uniqKey="Becker C">C Becker</name></author><author><name sortKey="Assouad, J" uniqKey="Assouad J">J Assouad</name></author><author><name sortKey="Riquet, M" uniqKey="Riquet M">M Riquet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Becker, C" uniqKey="Becker C">C Becker</name></author><author><name sortKey="Pham, Dn" uniqKey="Pham D">DN Pham</name></author><author><name sortKey="Assouad, J" uniqKey="Assouad J">J Assouad</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gharb, Bb" uniqKey="Gharb B">BB Gharb</name></author><author><name sortKey="Rampazzo, A" uniqKey="Rampazzo A">A Rampazzo</name></author><author><name sortKey="Spanio Di Spilimbergo, S" uniqKey="Spanio Di Spilimbergo S">S Spanio di Spilimbergo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Saaristo, Am" uniqKey="Saaristo A">AM Saaristo</name></author><author><name sortKey="Niemi, Ts" uniqKey="Niemi T">TS Niemi</name></author><author><name sortKey="Viitanen, Tp" uniqKey="Viitanen T">TP Viitanen</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Arch Plast Surg</journal-id><journal-id journal-id-type="iso-abbrev">Arch Plast Surg</journal-id><journal-id journal-id-type="publisher-id">APS</journal-id><journal-title-group><journal-title>Archives of Plastic Surgery</journal-title></journal-title-group><issn pub-type="ppub">2234-6163</issn><issn pub-type="epub">2234-6171</issn><publisher><publisher-name>The Korean Society of Plastic and Reconstructive Surgeons</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23898446</article-id><article-id pub-id-type="pmc">3724010</article-id><article-id pub-id-type="doi">10.5999/aps.2013.40.4.450</article-id><article-categories><subj-group subj-group-type="heading"><subject>Letter</subject></subj-group></article-categories><title-group><article-title>Evidence-Based Analysis of Lymph Node Transfer in Postmastectomy Upper Extremity Lymphedema</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Sapountzis</surname><given-names>Stamatis</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><name><surname>Nicoli</surname><given-names>Fabio</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><name><surname>Chilgar</surname><given-names>Ram</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><name><surname>Ciudad</surname><given-names>Pedro</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib></contrib-group><aff id="A1">Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.</aff><author-notes><corresp>Correspondence: Stamatis Sapountzis. Department of Plastic Surgery, China Medical University Hospital, 2 Yuh-der Road, Taichung, Taiwan. Tel: +886-9-75682159, Fax: +886-4-22030777, <email>ssapountzis@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>7</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>17</day><month>7</month><year>2013</year></pub-date><volume>40</volume><issue>4</issue><fpage>450</fpage><lpage>451</lpage><history><date date-type="received"><day>17</day><month>3</month><year>2013</year></date><date date-type="rev-recd"><day>01</day><month>4</month><year>2013</year></date><date date-type="accepted"><day>09</day><month>4</month><year>2013</year></date></history><permissions><copyright-statement>Copyright © 2013 The Korean Society of Plastic and Reconstructive Surgeons</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions></article-meta></front><body><p>Upper extremity lymphedema is one of the most important sequelae of mastectomy and affects an estimated 16 to 39% of breast cancer patients [<xref ref-type="bibr" rid="B1">1</xref>]. Few surgical options for lymphedema have achieved satisfactory long-term results. Amongst previously described methods, the microvascular lymph node transfer (LNT) is the most promising and appears to provide significant improvement, especially in early stage lymphedema.</p><p>We evaluated the existing literature, looking at the influence of LNT on postmastectomy upper extremity lymphedema through a systematic review.</p><p>We searched the PubMed database for English articles published from January of 1990 to March of 2012. Our keywords included "postmastectomy lymphedema", "upper extremity lymphedema", "lymph node transfer", and "vascularized lymph node". This search was supplemented by a review of reference lists of potentially eligible studies. We excluded experimental studies, case reports, and studies in which the results were not separated for the upper and lower limbs. Two reviewers independently extracted data in two steps: titles and abstracts, and then full-text articles. Through our electronic and reference search, we identified 5 clinical studies (<xref ref-type="table" rid="T1">Table 1</xref>) [<xref ref-type="bibr" rid="B1">1</xref>-<xref ref-type="bibr" rid="B5">5</xref>]. All of the studies were case series (level IV evidence).</p><p>In total, 73 patients received LNT for postmastectomy upper extremity lymphedema. The recipient site was the wrist in 32 patients (43.8%), the axilla in 32 patients (43.8%), the forearm in 2 patients (2.7%), and 7 patients (9.5%) received two LNTs (axilla and elbow).</p><p>Lin et al. [<xref ref-type="bibr" rid="B1">1</xref>] used a groin flap containing lymph nodes based on the superficial circumflex iliac vessels and the anastomoses were performed to the superficial radial artery and cephalic vein. Becker et al. [<xref ref-type="bibr" rid="B2">2</xref>,<xref ref-type="bibr" rid="B3">3</xref>] used a similar groin flap but as recipient vessels, used the circumflex scapula vessels. Gharb et al. [<xref ref-type="bibr" rid="B4">4</xref>] described a modification of the classic groin lymph node flap. The authors used the superficial branch of the superficial circumflex iliac artery as the dominant vessel responsible for the vascularization of the lymph nodes. The wrist was used as a recipient site, with the anastomosis to the radial artery end-to-side, and the concomitant veins of the radial artery end-to-end. Saaristo et al. [<xref ref-type="bibr" rid="B5">5</xref>] combined the breast reconstruction using abdominal flaps with the transfer of vascularized inguinal lymph nodes based on the superficial circumflex iliac vessels or the superficial inferior epigastric vessels, and the anastomoses were performed from the deep inferior epigastric vessels end-to-end to the thoracodorsal vessels.</p><p>According to the research, there is no consensus on the staging of lymphedema. Only three studies [<xref ref-type="bibr" rid="B2">2</xref>-<xref ref-type="bibr" rid="B4">4</xref>] have reported precise preoperative staging systems; however, each study used different criteria. Fifty-seven of 73 patients (78%) had postoperative improvement of the affected limb. In every study, a different postoperative evaluation method was used, and the relationship between the lymph node recipient site (axilla, elbow, or wrist) and the anatomical site with the maximum improvement was not clearly reported.</p><p>Becker et al. [<xref ref-type="bibr" rid="B2">2</xref>] reported that from the 18 patients, the upper limb perimeter returned to normal in 10 cases, remained unchanged in 2 cases, and decreased by more than 50% of its value in 6 patients and less than 50% of its value in 6 other patients. Two years later, Becker et al. [<xref ref-type="bibr" rid="B3">3</xref>] evaluated the influence of LNT in postmastectomy neuropathic pain in 6 patients. All of the patients had relief of the symptoms and in 5 patients the lymphedema resolved. Gharb et al. [<xref ref-type="bibr" rid="B4">4</xref>] compared the classic groin lymph node flap with a groin flap based on hilar perforators and reported that differences between the preoperative and postoperative measurements were statistically significant only in the perforator-based group at the levels below the elbow, wrist, and midpalm. Saaristo et al. [<xref ref-type="bibr" rid="B5">5</xref>] achieved reduction of the affected limb in 7 of 9 patients.</p><p>Even though it is implied that at early stage lymphedema, the LNT has better results, the influence of LNT at each stage of lymphedema is not clear. In addition, 17.8% of the patients required an additional procedure (suction assisted lipectomy [SAL] or skin excision) due to lack of sufficient improvement after LNT.</p><p>According to existing clinical studies, LNT is able to alleviate postmastectomy upper extremity lymphedema. However, the improvement is variable and no conclusions have been drawn regarding which technique, group of donor lymph nodes, or recipient site can ensure the maximum reduction of the affected limb.</p><p>More clinical studies are needed, and a consensus about the staging system of lymphedema and the evaluation methods for postoperative results should be established to enable drawing more certain conclusions.</p></body><back><fn-group><fn fn-type="conflict"><p>No potential conflict of interest relevant to this article was reported.</p></fn></fn-group><ref-list><ref id="B1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lin</surname><given-names>CH</given-names></name><name><surname>Ali</surname><given-names>R</given-names></name><name><surname>Chen</surname><given-names>SC</given-names></name><etal></etal></person-group><article-title>Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema</article-title><source>Plast Reconstr Surg</source><year>2009</year><volume>123</volume><fpage>1265</fpage><lpage>1275</lpage><pub-id pub-id-type="pmid">19337095</pub-id></element-citation></ref><ref id="B2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Becker</surname><given-names>C</given-names></name><name><surname>Assouad</surname><given-names>J</given-names></name><name><surname>Riquet</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation</article-title><source>Ann Surg</source><year>2006</year><volume>243</volume><fpage>313</fpage><lpage>315</lpage><pub-id pub-id-type="pmid">16495693</pub-id></element-citation></ref><ref id="B3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Becker</surname><given-names>C</given-names></name><name><surname>Pham</surname><given-names>DN</given-names></name><name><surname>Assouad</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Postmastectomy neuropathic pain: results of microsurgical lymph nodes transplantation</article-title><source>Breast</source><year>2008</year><volume>17</volume><fpage>472</fpage><lpage>476</lpage><pub-id pub-id-type="pmid">18450444</pub-id></element-citation></ref><ref id="B4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gharb</surname><given-names>BB</given-names></name><name><surname>Rampazzo</surname><given-names>A</given-names></name><name><surname>Spanio di Spilimbergo</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Vascularized lymph node transfer based on the hilar perforators improves the outcome in upper limb lymphedema</article-title><source>Ann Plast Surg</source><year>2011</year><volume>67</volume><fpage>589</fpage><lpage>593</lpage><pub-id pub-id-type="pmid">21540737</pub-id></element-citation></ref><ref id="B5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Saaristo</surname><given-names>AM</given-names></name><name><surname>Niemi</surname><given-names>TS</given-names></name><name><surname>Viitanen</surname><given-names>TP</given-names></name><etal></etal></person-group><article-title>Microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients</article-title><source>Ann Surg</source><year>2012</year><volume>255</volume><fpage>468</fpage><lpage>473</lpage><pub-id pub-id-type="pmid">22233832</pub-id></element-citation></ref></ref-list></back><floats-group><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><p>The five clinical studies on lymph node transfer in postmastectomy upper extremity lymphedema</p></caption><graphic xlink:href="aps-40-450-i001"></graphic><table-wrap-foot><fn><p>SAL, suction assisted lipectomy; DIEP, deep inferior epigastric perforator flap; TRAM, transverse rectus abdominis myocutaneous flap.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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