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. 2023 May 2;4(2):e278.
doi: 10.1097/AS9.0000000000000278. eCollection 2023 Jun.

Prophylactic Lymphovenous Bypass at the Time of Axillary Lymph Node Dissection Decreases Rates of Lymphedema

Romina Deldar  1 , Daisy Spoer  1 , Nisha Gupta  2 , Parhom Towfighi  2 , Marc Boisvert  3 , Patricia Wehner  3 , Ian T Greenwalt  3 , Eric M Wisotzky  4 , Katherine Power  4 , Kenneth L Fan  1 , Laura K Tom  1   5
Affiliations

Prophylactic Lymphovenous Bypass at the Time of Axillary Lymph Node Dissection Decreases Rates of Lymphedema

Romina Deldar et al. Ann Surg Open. .

Abstract

Background: Breast cancer-related lymphedema impacts 30% to 47% of women who undergo axillary lymph node dissection (ALND). Studies evaluating the effectiveness of prophylactic lymphovenous bypass (LVB) at the time of ALND have had small patient populations and/or short follow-up. The aim of this study is to quantitatively and qualitatively evaluate prophylactic LVB in patients with breast cancer.

Methods: A retrospective review of patients who underwent ALND from 2018 to 2022 was performed. Patients were divided into cohorts based on whether they underwent prophylactic LVB at the time of ALND. Primary outcomes included 30-day complications and lymphedema. Lymphedema was quantitatively evaluated by bioimpedance analysis, with L-dex scores >7.1 indicating lymphedema.

Results: One-hundred five patients were identified. Sixty-four patients (61.0%) underwent ALND and 41 patients (39.0%) underwent ALND+LVB. Postoperative complications were similar between the cohorts. At a median follow-up of 13.3 months, lymphedema occurred significantly higher in the ALND only group compared with ALND+LVB group (50.0% vs 12.2%; P < 0.001). ALND without LVB was an independent risk factor for lymphedema development (odds ratio, 4.82; P = 0.003).

Conclusions: Prophylactic LVB decreases lymphedema and is not associated with increased postoperative complications. A multidisciplinary team approach is imperative to decrease lymphedema development in this patient population.

Keywords: lyMPHA; lymphedema; lymphovenous bypass; microsurgery; super-microsurgery.

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Figures

FIGURE 1.
FIGURE 1.
Afferent lymphatics. A, Afferent lymphatic vessel filled with blue dye (arrow) that was transected during axillary lymph node dissection. B, Lymphatic vessel (arrow) is illuminated during reverse axillary lymphatic mapping.
FIGURE 2.
FIGURE 2.
Types of lymphovenous anastamosis. A. Suture end-to-end anastamosis with multiple lymphatics to single vein with blue dye seen within the vein. B. Coupler-assisted lymphovenous anastomosis. C. Lymphovenous anastomosis using vein graft (arrow).
See this image and copyright information in PMC

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