Feasibility study of combined dynamic imaging and lymphaticovenous anastomosis surgery for breast cancer-related lymphoedema.
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Date
2019-01ICR Author
Author
Khan, AA
Hernan, I
Adamthwaite, JA
Ramsey, KWD
Type
Journal Article
Metadata
Show full item recordAbstract
Background Breast cancer-related lymphoedema (BCRL) presents a significant healthcare burden and adversely affects quality of life of breast cancer survivors. A prospective feasibility study was performed on lymphaticovenous anastomosis (LVA) for the treatment of BCRL.Methods Patients with BCRL underwent near-infrared spectroscopy with indocyanine green lymphatic mapping to identify suitable lymphatic channels for LVA. End-to-end anastomoses to subdermal venules were performed and patients recommenced compression garment therapy (CGT) after surgery. Volumetric assessment of the affected limb was performed at regular intervals using infrared perometry to calculate the excess volume reduction.Results Over a 24-month interval, 27 patients with BCRL underwent LVA. The mean duration of lymphoedema was 3·5 (range 0·5-18) years, and the mean number of LVAs performed was 3 (range 2-5). Twenty-four of the 27 patients completed 12-month follow-up. Patients exhibited three patterns of volumetric response following LVA: sustained response (16 patients), transient response (5) or no response (6). Sustained responders showed an excess volume reduction of -33·2 per cent at 12 months, and this correlated positively with the number of LVAs performed (r = -0·56, P = 0·034). Overall, ten patients were able to downgrade CGT after surgery, and two patients were CGT-free at 12 months.Conclusion LVA resulted in a sustained volume reduction in selected patients and may offset the burden of CGT. Further work is required to identify biomarkers that predict a favourable response to LVA surgery.
Collections
Subject
Veins
Lymphatic Vessels
Humans
Breast Neoplasms
Indocyanine Green
Anti-Bacterial Agents
Anastomosis, Surgical
Spectrophotometry, Infrared
Administration, Oral
Infusions, Intravenous
Prospective Studies
Feasibility Studies
Equipment Design
Coloring Agents
Female
Randomized Controlled Trials as Topic
Breast Cancer Lymphedema
Research team
Targeted Therapy
Language
eng
Date accepted
2018-07-22
License start date
2019-01
Citation
The British journal of surgery, 2019, 106 (1), pp. 100 - 110