Prophylactic Multidisciplinary Treatment to Reduce the Risk of Lymphedema after Axillary Lymph Node Dissection
Julia A. Cook, MD1, Sarah E. Sasor, MD2, Scott N. Loewenstein, MD1, Will DeBrock, BS1, Mary Lester, MD1, Juan Socas, MD1, Carla S. Fisher, MD1, Aladdin H. Hassanein, MD, MMSc1.
1Indiana University, Indianapolis, IN, USA, 2University of Michigan, Ann Arbor, MI, USA.
PURPOSE: Lymphedema Microsurgical Preventing Healing Approach (LYMPHA) is a technique where lymphovenous anastomosis (LVA) is performed immediately following lymph node dissection to decrease the risk of lymphedema. This technique has demonstrated a significant decrease in incidence of lymphedema, but outpatient therapy has been proposed as an adjuvant to lymphedema prophylaxis. The purpose of this study is to evaluate the combined efficacy of multi-disciplinary outpatient therapy and the LYMPHA microsurgical technique.
METHODS: All patients with a breast cancer diagnosis over a 6-month period were referred to physical and occupational therapy for pre-operative limb measurements and education regarding arm exercises and self-lymphatic stimulation. All patients undergoing axillary lymph node dissection (ALND) were offered LYMPHA. Patient demographics, operative and pathologic findings, number of LVAs, timing of chemoradiation therapy, and pre-operative and follow-up limb measurements were collected and analyzed.
RESULTS: Ten patients were included in the analysis. Average age was 52.1 ± 8.9 years; average body mass index was 30.2 ± 6.3 kg/m2. An average 17.2 (range 5-26) nodes were excised at the time of ALND with a mean 3.6 (range 1-12) nodes with micro-metastases. Average time since dissection was 124.0 (range 31-220) days. There were 1.6 (range 1-4) LVAs performed per patient. One patient (10%) had early post-operative arm swelling, which resolved following compression therapy. There was an average decrease of 1.1 cm at the proximal upper arm, 0.4 cm at the elbow, 0.2 cm at the distal forearm, and 0.3 cm at the palm. To date, no patient has been demonstrated early signs of lymphedema.
CONCLUSIONS: A multidisciplinary approach using LYMPHA, pre-operative therapy, and post-operative therapy exhibits potential to reduce the risk of breast cancer related lymphedema in patients undergoing axillary lymph node dissection.
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