Microsurgical Techniques for the Treatment of Breast Cancer—related Lymphedema: a Systematic Review

 

 Permissions and Reprints

Abstract

Background Upper limb lymphedema is one of the most underestimated and debilitating complications of breast cancer treatment. The aim of this review is to summarize the recent literature for evidence of the effectiveness of lymphatic microsurgery for the treatment of breast cancer–related lymphedema (BCRL).

Methods A search was conducted for articles published from January 2000 until January 2012. Only studies on secondary lymphedema after breast cancer treatment and those examining the effectiveness of microsurgery were included.

Results No randomized clinical trials or comparative studies were available. Ten case-series met inclusion criteria: (composite) tissue transfer (n = 4), lymphatic vessel transfer (n = 2), and derivative microlymphatic surgery (n = 4). Limb volume/circumference reduction varied from 2 to 50% over a follow-up time ranging from 1 to 132 months. Postoperative discontinuation rates of conservative therapy were only reported after composite tissue transfer, ranging from 33 to 100% after 3 to 24 months. Clear selection criteria for lymphatic surgery and lymphatic flow assessment were absent in most studies.

Conclusion We identified important methodological shortcomings of the available literature. Evidence acquired through comparative studies with uniform patient selection is lacking. Consistent positive findings with regards to limb volume reduction and limited complications are reasons to further explore these techniques in methodologically superior studies.

• References

• 1 Kligman L, Wong RK, Johnston M, Laetsch NS. The treatment of lymphedema related to breast cancer: a systematic review and evidence summary. Support Care Cancer 2004; 12: 421-431
  CrossrefPubMedGoogle Scholar
• 2 Moseley AL, Carati CJ, Piller NB. A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Ann Oncol 2007; 18: 639-646
  CrossrefPubMedGoogle Scholar
• 3 McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR. Conservative and dietary interventions for cancer-related lymphedema: a systematic review and meta-analysis. Cancer 2011; 117: 1136-1148
  CrossrefPubMedGoogle Scholar
• 4 International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema. 2009 Concensus Document of the International Society of Lymphology. Lymphology 2009; 42: 51-60
  PubMedGoogle Scholar
• 5 Ji RC. Lymphatic endothelial cells, lymphedematous lymphangiogenesis, and molecular control of edema formation. Lymphat Res Biol 2008; 6: 123-137
  CrossrefPubMedGoogle Scholar
• 6 Rietman JS, Dijkstra PU, Debreczeni R, Geertzen JH, Robinson DP, De Vries J. Impairments, disabilities and health related quality of life after treatment for breast cancer: a follow-up study 2.7 years after surgery. Disabil Rehabil 2004; 26: 78-84
  CrossrefPubMedGoogle Scholar
• 7 Morgan PA, Franks PJ, Moffatt CJ. Health-related quality of life with lymphoedema: a review of the literature. Int Wound J 2005; 2: 47-62
  CrossrefPubMedGoogle Scholar
• 8 Ahmed RL, Prizment A, Lazovich D, Schmitz KH, Folsom AR. Lymphedema and quality of life in breast cancer survivors: the Iowa Women's Health Study. J Clin Oncol 2008; 26: 5689-5696
  CrossrefPubMedGoogle Scholar
• 9 Oliveri JM, Day JM, Alfano CM , et al. Arm/hand swelling and perceived functioning among breast cancer survivors 12 years post-diagnosis: CALGB 79804. J Cancer Surviv 2008; 2: 233-242
  CrossrefPubMedGoogle Scholar
• 10 Nesvold IL, Reinertsen KV, Fosså SD, Dahl AA. The relation between arm/shoulder problems and quality of life in breast cancer survivors: a cross-sectional and longitudinal study. J Cancer Surviv 2011; 5: 62-72
  CrossrefPubMedGoogle Scholar
• 11 O'Brien BM. Replantation and reconstructive microvascular surgery. Part II. Ann R Coll Surg Engl 1976; 58: 171-182
  PubMedGoogle Scholar
• 12 Nagase T, Gonda K, Inoue K , et al. Treatment of lymphedema with lymphaticovenular anastomoses. Int J Clin Oncol 2005; 10: 304-310
  CrossrefPubMedGoogle Scholar
• 13 Koshima I, Kawada S, Moriguchi T, Kajiwara Y. Ultrastructural observations of lymphatic vessels in lymphedema in human extremities. Plast Reconstr Surg 1996; 97: 397-405 , discussion 406–407
  CrossrefPubMedGoogle Scholar
• 14 O'Brien BM, Mellow CG, Khazanchi RK, Dvir E, Kumar V, Pederson WC. Long-term results after microlymphaticovenous anastomoses for the treatment of obstructive lymphedema. Plast Reconstr Surg 1990; 85: 562-572
  CrossrefPubMedGoogle Scholar
• 15 Campisi C, Boccardo F. Role of microsurgery in the management of lymphoedema. Int Angiol 1999; 18: 47-51
  PubMedGoogle Scholar
• 16 Massey MF, Spiegel AJ, Levine JL , et al; Group for the Advancement of Breast Reconstruction. Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions. Plast Reconstr Surg 2009; 124: 737-751
  CrossrefPubMedGoogle Scholar
• 17 Blum KS, Hadamitzky C, Gratz KF, Pabst R. Effects of autotransplanted lymph node fragments on the lymphatic system in the pig model. Breast Cancer Res Treat 2010; 120: 59-66
  CrossrefPubMedGoogle Scholar
• 18 Tobbia D, Semple J, Baker A, Dumont D, Johnston M. Experimental assessment of autologous lymph node transplantation as treatment of postsurgical lymphedema. Plast Reconstr Surg 2009; 124: 777-786
  CrossrefPubMedGoogle Scholar
• 19 Baumeister RG, Siuda S. Treatment of lymphedemas by microsurgical lymphatic grafting: what is proved?. Plast Reconstr Surg 1990; 85: 64-74 , discussion 75–76
  CrossrefPubMedGoogle Scholar
• 20 Rohrich RJ, Eaves III FF. So you want to be an evidence-based plastic surgeon? A lifelong journey. Plast Reconstr Surg 2011; 127: 467-472
  CrossrefPubMedGoogle Scholar
• 21 Sullivan D, Chung KC, Eaves III FF, Rohrich RJ. The level of evidence pyramid: indicating levels of evidence in Plastic and Reconstructive Surgery articles. Plast Reconstr Surg 2011; 128: 311-314
  CrossrefPubMedGoogle Scholar
• 22 Maegawa J, Mikami T, Yamamoto Y, Satake T, Kobayashi S. Types of lymphoscintigraphy and indications for lymphaticovenous anastomosis. Microsurgery 2010; 30: 437-442
  CrossrefPubMedGoogle Scholar
• 23 Demirtas Y, Ozturk N, Yapici O, Topalan M. Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Microsurgery 2009; 29: 609-618
  CrossrefPubMedGoogle Scholar
• 24 Matsubara S, Sakuda H, Nakaema M, Kuniyoshi Y. Long-term results of microscopic lymphatic vessel-isolated vein anastomosis for secondary lymphedema of the lower extremities. Surg Today 2006; 36: 859-864
  CrossrefPubMedGoogle Scholar
• 25 Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S. Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg. J Reconstr Microsurg 2003; 19: 209-215
  Article in Thieme ConnectPubMedGoogle Scholar
• 26 Narushima M, Mihara M, Yamamoto Y, Iida T, Koshima I, Mundinger GS. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg 2010; 125: 935-943
  CrossrefPubMedGoogle Scholar
• 27 Lee BB, Laredo J, Neville R. Reconstructive surgery for chronic lymphedema: a viable option, but. Vascular 2011; 19: 195-205
  CrossrefPubMedGoogle Scholar
• 28 Campisi C, Bellini C, Campisi C, Accogli S, Bonioli E, Boccardo F. Microsurgery for lymphedema: clinical research and long-term results. Microsurgery 2010; 30: 256-260
  PubMedGoogle Scholar
• 29 Auba C, Marre D, Rodríguez-Losada G, Hontanilla B. Lymphaticovenular anastomoses for lymphedema treatment: 18 months postoperative outcomes. Microsurgery 2012; 32: 261-268
  CrossrefPubMedGoogle Scholar
• 30 Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000; 16: 437-442
  Article in Thieme ConnectPubMedGoogle Scholar
• 31 Lin CH, Ali R, Chen SC , et al. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Plast Reconstr Surg 2009; 123: 1265-1275
  CrossrefPubMedGoogle Scholar
• 32 Becker C, Pham DN, Assouad J, Badia A, Foucault C, Riquet M. Postmastectomy neuropathic pain: results of microsurgical lymph nodes transplantation. Breast 2008; 17: 472-476
  CrossrefPubMedGoogle Scholar
• 33 Becker C, Assouad J, Riquet M, Hidden G. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg 2006; 243: 313-315
  CrossrefPubMedGoogle Scholar
• 34 Saaristo AM, Niemi TS, Viitanen TP, Tervala TV, Hartiala P, Suominen EA. Microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients. Ann Surg 2012; 255: 468-473
  CrossrefPubMedGoogle Scholar
• 35 Baumeister RG, Frick A. [The microsurgical lymph vessel transplantation]. Handchir Mikrochir Plast Chir 2003; 35: 202-209
  Article in Thieme ConnectPubMedGoogle Scholar
• 36 Weiss M, Baumeister RG, Hahn K. Post-therapeutic lymphedema: scintigraphy before and after autologous lymph vessel transplantation: 8 years of long-term follow-up. Clin Nucl Med 2002; 27: 788-792
  CrossrefPubMedGoogle Scholar
• 37 Furukawa H, Osawa M, Saito A , et al. Microsurgical lymphaticovenous implantation targeting dermal lymphatic backflow using indocyanine green fluorescence lymphography in the treatment of postmastectomy lymphedema. Plast Reconstr Surg 2011; 127: 1804-1811
  PubMedGoogle Scholar
• 38 Chang DW. Lymphaticovenular bypass for lymphedema management in breast cancer patients: a prospective study. Plast Reconstr Surg 2010; 126: 752-758
  CrossrefPubMedGoogle Scholar
• 39 Damstra RJ, Voesten HG, van Schelven WD, van der Lei B. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Res Treat 2009; 113: 199-206
  CrossrefPubMedGoogle Scholar
• 40 Yamamoto Y, Horiuchi K, Sasaki S , et al. Follow-up study of upper limb lymphedema patients treated by microsurgical lymphaticovenous implantation (MLVI) combined with compression therapy. Microsurgery 2003; 23: 21-26
  CrossrefPubMedGoogle Scholar
• 41 Degni M. New microsurgical technique of lymphatico-venous anastomosis for the treatment of lymphedema. Lymphology 1981; 14: 61-63
  PubMedGoogle Scholar
• 42 Brorson H. From lymph to fat: complete reduction of lymphoedema. Phlebology 2010; 25 (Suppl. 01) 52-63
  CrossrefPubMedGoogle Scholar
• 43 Brorson H, Svensson H. Liposuction combined with controlled compression therapy reduces arm lymphedema more effectively than controlled compression therapy alone. Plast Reconstr Surg 1998; 102: 1058-1067 , discussion 1068
  CrossrefPubMedGoogle Scholar
• 44 Koshima I, Kawada S, Moriguchi T, Kajiwara Y. Ultrastructural observations of lymphatic vessels in lymphedema in human extremities. Plast Reconstr Surg 1996; 97: 397-405 , discussion 406–407
  CrossrefPubMedGoogle Scholar
• 45 Nagase T, Gonda K, Inoue K , et al. Treatment of lymphedema with lymphaticovenular anastomoses. Int J Clin Oncol 2005; 10: 304-310
  CrossrefPubMedGoogle Scholar
• 46 Maegawa J, Yabuki Y, Tomoeda H, Hosono M, Yasumura K. Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema. J Vasc Surg 2012; 55: 753-760
  CrossrefPubMedGoogle Scholar
• 47 Mukenge SM, Catena M, Negrini D , et al. Assessment and follow-up of patency after lymphovenous microsurgery for treatment of secondary lymphedema in external male genital organs. Eur Urol 2011; 60: 1114-1119
  CrossrefPubMedGoogle Scholar