Preventive axillary lymphovenous anastomoses simultaneously with lymph node dissection in the treatment of breast cancer for prevention of lymphedema of the upper limb (LYMPHA technique)

Ovchinnikova I.V.

Sigal Republican Clinical Oncology Dispensary

ORCID: 0009-0002-3213-820X

Gimranov A.M.

Sigal Republican Clinical Oncology Dispensary

ORCID: 0009-0007-8330-1536

Tazieva G.R.

Sigal Republican Clinical Oncology Dispensary

ORCID: 0009-0000-6340-9960

Busygin M.A.

Sigal Republican Clinical Oncology Dispensary

ORCID: 0009-0008-9605-3997

Korunova E.G.

Sigal Republican Clinical Oncology Dispensary

ORCID: 0009-0002-9356-0172

Preventive axillary lymphovenous anastomoses simultaneously with lymph node dissection in the treatment of breast cancer for prevention of lymphedema of the upper limb (LYMPHA technique)

Authors:

Ovchinnikova I.V., Gimranov A.M., Tazieva G.R., Busygin M.A., Korunova E.G.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2024;(2‑2): 42‑47

DOI: 10.17116/hirurgia202402242

Read: 1385 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Ovchinnikova IV, Gimranov AM, Tazieva GR, Busygin MA, Korunova EG. Preventive axillary lymphovenous anastomoses simultaneously with lymph node dissection in the treatment of breast cancer for prevention of lymphedema of the upper limb (LYMPHA technique). Pirogov Russian Journal of Surgery. 2024;(2‑2):42‑47. (In Russ.)
https://doi.org/10.17116/hirurgia202402242

Подписка 2025-2 (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

Close metadata

OBJECTIVE

To analyze the effect the LYMPHA technique on the incidence of upper limb lymphedema in patients with breast cancer after complete axillary lymph node dissection.

MATERIAL AND METHODS

There were 89 patients with breast cancer and signs of metastatic lesion of axillary lymph nodes who underwent complete axillary lymph dissection. In group 1 (41 patients), the LYMPHA technique was used simultaneously with lymph node dissection; in group 2 (48 patients) — lymph node dissection alone.

RESULTS

The follow-up period was 1 year. The LYMPHA technique prolonged surgery and decreased duration of postoperative lymphorrhea. The incidence of upper limb lymphedema was 9.8% and 22.9%, respectively.

CONCLUSION

The LYMPHA technique was effective for prevention of upper limb lymphedema after complete axillary lymph node dissection in the treatment of breast cancer.

Keywords:

prevention of lymphedema

lymphovenous anastomoses

LYMPHA

breast cancer

Authors:

Ovchinnikova I.V.

Sigal Republican Clinical Oncology Dispensary

ORCID: 0009-0002-3213-820X

Gimranov A.M.

Sigal Republican Clinical Oncology Dispensary

ORCID: 0009-0007-8330-1536

Tazieva G.R.

Sigal Republican Clinical Oncology Dispensary

ORCID: 0009-0000-6340-9960

Busygin M.A.

Sigal Republican Clinical Oncology Dispensary

ORCID: 0009-0008-9605-3997

Korunova E.G.

Sigal Republican Clinical Oncology Dispensary

ORCID: 0009-0002-9356-0172

Received:

10.10.2023

Accepted:

24.10.2023

List of references:

Kaprin AD, Starinskij VV, Shahzadova AO. Zlokachestvennye novoobrazovaniya v Rossii v 2021 godu (zabolevaemost’ i smertnost’). M.: MNIOI im. P.A. Gercena — filial FGBU «NMIC radiologii» Minzdrava Rossii; 2022. (In Russ.).
DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: A systematic review and meta-analysis. Lancet Oncology. 2013;14(6):500-515. https://doi.org/10.1016/s1470-2045(13)70076-7
Tsai RJ, Dennis LK, Lynch CF, et al. The risk of developing arm lymphedema among breast cancer survivors: A meta-analysis of treatment factors. Annals of Surgical Oncology. 2009;16(7):1959-1972. https://doi.org/10.1245/s10434-009-0452-2
Kim M, Kim SW, Lee SU, Lee NK, Jung SY, Kim TH, Lee ES, Kang HS, Shin KH. A model to estimate the risk of breast cancer-related lymphedema: Combinations of treatment-related factors of the number of dissected axillary nodes, adjuvant chemotherapy, and radiation therapy. International Journal of Radiation Oncology. Biology. Physics. 2013;86(3):498-503. https://doi.org/10.1016/j.ijrobp.2013.02.018
Salinas-Huertas S, Luzardo-González A, Vázquez-Gallego S, Pernas S, Falo C, Pla MJ, Gil-Gil M, Beranuy-Rodriguez M, Pérez-Montero H, Gomila-Sancho M, Manent-Molina N, Arencibia-Domínguez A, Gonzalez-Pineda B, Tormo-Collado F, Ortí-Asencio M, Terra J, Martinez-Perez E, Mestre-Jane A, Campos-Varela I, Jaraba-Armas M, Benítez-Segura A, Campos-Delgado M, Fernández-Montolí ME, Valverde-Alcántara Y, Rodríguez A, Campos G, Guma A, Ponce-Sebastià J, Planas-Balagué R, Catasús-Clavé M, García-Tejedor A. Risk factors for lymphedema after breast surgery: A prospective cohort study in the era of sentinel lymph node biopsy. Breast Diseases. 2022;41(1):97-108.
Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surgical Oncology. 1993;2(6):335-340. https://doi.org/10.1016/0960-7404(93)90064-6
Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M, Costa A, de Cicco C, Geraghty JG, Luini A, Sacchini V, Veronesi P. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997;349(9069):1864-1867. https://doi.org/10.1016/S0140-6736(97)01004-0
Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK, Hess T, Oertli D, Bronz L, Schnarwyler B, Wight E, Uehlinger U, Infanger E, Burger D, Zuber M. Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery. Annals of Surgery. 2007;245(3):452-461. https://doi.org/10.1097/01.sla.0000245472.47748.ec
Klinicheskie rekomendacii. Rak molochnoj zhelezy. 2021. Odobreno na zasedanii nauchno-prakticheskogo soveta Ministerstva zdravoohraneniya Rossijskoj Federacii (protokol ot 25.12.20 №17-4/4884). Accessed July 09, 2023. (In Russ.). https://oncology-association.ru/wp-content/uploads/2021/02/rak-molochnoj-zhelezy-2021.pdf
Land SR, Kopec JA, Julian TB, Brown AM, Anderson SJ, Krag DN, Christian NJ, Costantino JP, Wolmark N, Ganz PA. Patient-reported outcomes in sentinel node-negative adjuvant breast cancer patients receiving sentinel-node biopsy or axillary dissection: National Surgical Adjuvant Breast and Bowel Project phase III protocol B-32. Journal of Clinical Oncology. 2010;28(25):3929-3936. https://doi.org/10.1200/jco.2010.28.2491
Tummel E, Ochoa D, Korourian S, Betzold R, Adkins L, McCarthy M, Hung S, Kalkwarf K, Gallagher K, Lee JY, Klimberg VS. Does Axillary Reverse Mapping Prevent Lymphedema after Lymphadenectomy. Annals of Surgery. 2017;265(5):987-992. https://doi.org/10.1097/sla.0000000000001778
Nos C, Lesieur B, Clough KB, Lecuru F.Blue dye injection in the arm in order to conserve the lymphatic drainage of the arm in breast cancer patients requiring an axillary dissection. Annals of Surgical Oncology. 2007;14(9):2490-2496. https://doi.org/10.1245/s10434-007-9450-4
Thompson M, Korourian S, Henry-Tillman R, Adkins L, Mumford S, Westbrook KC, Klimberg VS. Axillary reverse mapping (ARM): A new concept to identify and enhance lymphatic preservation. Annals of Surgical Oncology. 2007;14(6):1890-1895. https://doi.org/10.1245/s10434-007-9412-x
Noguchi M, Yokoi M, Nakano Y. Axillary reverse mapping with indocyanine fluorescence imaging in patients with breast cancer. Journal of Surgical Oncology. 2010;101(3):217-221. https://doi.org/10.1002/jso.21473
Sakurai T, Endo M, Shimizu K, Yoshimizu N, Nakajima K, Nosaka K, Dai Y, Iwao A, Jinnai Y. Axillary reverse mapping using fluorescence imaging is useful for identifying the risk group of postoperative lymphedema in breast cancer patients undergoing sentinel node biopsies. Journal of Surgical Oncology. 2014;109(6):612-615. https://doi.org/10.1002/jso.23528
Wu JD, Wang Z, Zeng HC, He LF, Zhang YQ, Huang GS, Zhang F, Wei XL, Huang WH, Zhang G. Comparison of indocyanine green and methylene blue use for axillary reverse mapping during axillary lymph node dissection. MedComm. 2020;1(2):211-218. https://doi.org/10.1002/mco2.31
Beek MA, Gobardhan PD, Klompenhouwer EG, Rutten HJ, Voogd AC, Luiten EJ. Axillary reverse mapping (ARM) in clinically node positive breast cancer patients. European Journal of Surgical Oncology. 2015;41(1):59-63. https://doi.org/10.1016/j.ejso.2014.09.012
Yue T, Zhuang D, Zhou P, Zheng L, Fan Z, Zhu J, Hou L, Yu F, Dong X, Xiao L, He Q. A Prospective Study to Assess the Feasibility of Axillary Reverse Mapping and Evaluate Its Effect on Preventing Lymphedema in Breast Cancer Patients. Clinical Breast Cancer. 2015:15(4):301-306. https://doi.org/10.1016/j.clbc.2015.01.010
Noguchi M, Inokuchi M, Noguchi M, Morioka E, Ohno Y, Kurita T. Axillary surgery for breast cancer: past, present, and future. Breast Cancer. 2021;28(1):9-15. https://doi.org/10.1007/s12282-020-01120-0
Chao Han, Ben Yang, Wen-Shu Zuo, Gang Zheng, Li Yang, Mei-Zhu Zheng The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies. PLoS One. 2016;11(2):e0150285. https://doi.org/10.1371/journal.pone.0150285
Boccardo F, Casabona F, De Cian F, Friedman D, Villa G, Bogliolo S, Ferrero S, Murelli F, Campisi C. Lymphedema microsurgical preventive healing approach: A new technique for primary prevention of arm lymphedema after mastectomy. Annals of Surgical Oncology. 2009;16(3):703-708. https://doi.org/10.1245/s10434-008-0270-y
Boccardo F, Casabona F, De Cian F, Friedman D, Murelli F, Puglisi M, Campisi CC, Molinari L, Spinaci S, Dessalvi S, Campisi C. Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: Over 4 years follow-up. Microsurgery. 2014;34(6):421-424. https://doi.org/10.1002/micr.22254
Lipman K, Luan A, Stone K, Wapnir I, Karin M, Nguyen D. Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for Lymphedema Prevention after Axillary Lymph Node Dissection — A Single Institution Experience and Feasibility of Technique. Journal of Clinical Medicine. 2022;11(1):92. https://doi.org/10.3390/jcm11010092
Johnson AR, Kimball S, Epstein S, Recht A, Lin SJ, Lee BT, James TA, Singhal D. Lymphedema Incidence after Axillary Lymph Node Dissection Quantifying the Impact of Radiation and the Lymphatic Microsurgical Preventive Healing Approach. Annals of Plastic Surgery. 2019;82(4S suppl 3):S234-S241. https://doi.org/10.1097/sap.0000000000001864
Suami H, Pan WR, Taylor GI. Changes in the lymph structure of the upper limb after axillary dissection: radiographic and anatomical study in a human cadaver. Plastic and Reconstructive Surgery. 2007;120(4):982- 991.21. https://doi.org/10.1097/01.prs.0000277995.25009.3e

Close metadata