Preventing Breast Cancer-Related Lymphedema: A Comprehensive Analysis of a 9-Year Single-Center Experience of Prophylactic Lymphovenous Bypass

Abstract

Background: Prophylactic lymphovenous bypass (pLVB) is a microsurgical technique aimed to prevent breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND) by redirecting lymphatic flow from the ligated lymphatics into neighboring veins. This report describes the authors' 9-year institutional experience of pLVB in patients undergoing ALND to prevent BCRL.

Methods: Patients who underwent ALND were reviewed. Demographic and oncologic data were analyzed. The primary outcomes included limb circumference and perometry. The secondary outcomes included patient-reported outcomes, incidence of cellulitis, and need for therapeutic lymphovenous bypass (LVB). Furthermore, the study identified risk factors for the development of BCRL within the ALND plus pLVB population.

Results: Of the 370 patients, 25% underwent ALND plus pLVB. Demographic and oncologic features were similar between the two cohorts, and the average follow-up time was 23 months. The rate of BCRL was 8.7% in the ALND plus pLVB group and 20.1% in the no-pLVB group (p < 0.05), whereas the postoperative circumferential measurements were significantly improved among the ALND plus pLVB patients. In addition, the patients treated with ALND plus pLVB had a lower incidence of positive symptoms of lymphedema (pain, tightness, heaviness) and were less likely to require therapeutic LVB. The medical history of cardiac arrythmia was identified as a risk factor for the development of lymphedema in the ALND plus pLVB cohort.

Conclusions: Prophylactic lymphovenous bypass contributes to a decreased incidence of lymphedema as well as improved patient symptoms and limb functionality. Furthermore, pLVB modulates disease severity for patients who experience BCRL. The authors advocate that pLVBs should be routinely offered to breast cancer patients undergoing ALND.

Keywords: ALND; Axillary lymph node dissection; BCRL; Breast cancer related lymphedema; Lymphedema; Lymphovenous bypass.