Lymphovenous Anastomosis at the Time of Axillary Lymph Node Dissection: A Systematic Review of Risk and Outcomes
Julia A. Cook, MD1, Sarah E. Sasor, MD2, Aladdin H. Hassanein, MD, MMSc1.
1Indiana University, Indianapolis, IN, USA, 2University of Michigan, Ann Arbor, MI, USA.
PURPOSE: Lymphedema is a significant cause of morbidity in patients who undergo axillary lymph node dissection. Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) has been proposed as a prophylactic surgical intervention for lymphedema prevention following lymph node dissection. The purpose of this systematic review is to assess the efficacy of LYMPHA on lymphedema prevention in axillary lymph node dissection patients.
METHODS: A MEDLINE, PubMed, and EBSCO Host search of articles regarding use of LYMPHA in preventing lymphedema following axillary lymph node dissection was performed. Data points of interest included patient demographics, number of lymph nodes dissected, number of nodal micro-metastases, and presence of post-operative lymphedema.
RESULTS: Six studies were included in the analysis. 573 patients underwent axillary lymph node dissection; 221 underwent LYMPHA. Of the patients who underwent LYMPHA: average age was 56.2±5.6 years; average BMI was 26.4±2.2 kg/m2; an average 17.4±2.0 lymph nodes were dissected with an average 3.7±1.5 positive lymph nodes. There were no significant differences in patient characteristics and nodal dissection between treatment and control groups. Eight patients (3.6%) who underwent LYMPHA had upper extremity lymphedema at one year. Sixty-six of the 324 control patients (20.4%) with one year follow up had upper extremity lymphedema.
CONCLUSIONS: The rate of upper extremity lymphedema is reduced from 20.4% to 3.6% in patients who undergo LYMPHA at the time of axillary lymph node dissection. This surgical technique demonstrates promising results in preventing upper extremity lymphedema after axillary lymph node dissection.
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