Evaluation of Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) for the prevention of breast cancer-related lymphedema after axillary lymph node dissection using bioimpedance spectroscopy

BackgroundLymphedema is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 20%. Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) is a safe and relatively simple method, which decreases incidence of lymphedema dramatically. Our initial study showed an 88% decrease in clinical lymphedema rate. In the initial study, we used arm circumference measurement for the diagnosis of lymphedema and median follow up was 15 months. The aim of this study was to confirm these results after a long-term follow up period and by using bioimpedance spectroscopy (L-Dex) technology in detecting lymphedema.Study designAll patients, undergoing ALND with or without SLYMPHA between January 2014 and November 2020 were included in the study. Patients with no postoperative L-Dex measurements were excluded. A L-Dex score outside the normal range (±10 L-Dex unit) or ≥10 L-Dex unit increase above patient's baseline was considered as lymphedema. The incidence of lymphedema was compared between patients with and without SLYMPHA.Results194 patients were included in the study. 57% of cohort underwent SLYMPHA. Mean follow-up time was 47 ± 37 months. Patients, who underwent SLYMPHA, had a significantly lower rate of lymphedema (16% vs 32%; p = 0.01; OR 0.4 [0.2–0.8]).ConclusionSLYMPHA is a safe and relatively simple method, which continued its efficacy after a long-term follow up period. It should be considered as an adjunct procedure to ALND for all patients during initial surgery.     

DIEP flap breast reconstruction combined with vascularized lymph node transfer for patients with breast cancer-related lymphedema

IntroductionLymphedema is a condition which heavily impacts patients QoL. For patients who desire autologous breast reconstruction, lymph nodes can be included in the Deep Inferior Epigastric Artery (DIEP) flap combining vascularized lymph node transfer and autologous breast reconstruction.Material and methodsPatients who received autologous breast reconstruction with a DIEP flap in combination with vascularized lymph nodes were included in this study. Volume measurements pre and post-surgery were analyzed and surveys including two versions of the ULL-27 questionnaire to measure QoL before and after surgery were send.ResultsIn total, 45 out of 64 patients returned the questionnaires. The average follow up was 51 months. The total ULL-27 score increased with 12.6 points on average (p = 0.00). The subdomain scores (physical, psychological and social) also significantly increased (p = 0.00). In addition 69% of patients were able to decrease physiotherapy, 63% of patients were able to decrease compression garment usage and the incidence of skin infections decreased in 6 patients out of 7 patients who had recurrent skin infections prior to surgery. The volume difference between the affected and the healthy arm did not significantly change (407 ml–406 ml, p = 0.988).ConclusionsVascularized lymph node transfer in combination with DIEP flap breast reconstruction can cause a significant improvement on lymphedema related QoL, even when a volume difference decrease is absent. It can also decrease compression garment usage and reduce the need for physiotherapy. Future prospective studies should evaluate these findings and identify patients that benefit most from such procedures.     

Risk factors associated with lymphedema after lymph node dissection in melanoma patients

Background

Secondary lymphedema is a frequent complication after lymphadenectomy in melanoma patients, although few studies in melanoma adequately characterize risk factors for lymphedema, and of these, sample size is limited. This study aims to identify risk factors associated with the lymphedema after axillary lymph node dissection (ALND) and inguinal lymph node dissection (ILND) in a more robust cohort of melanoma patients.

Methods

We identified 269 ALND or ILND melanoma patients treated between 2008 and 2014. Demographic, clinical, and postoperative data were collected by review of the electronic medical record. Univariate and multivariate analysis were used to determine independent predictors of lymphedema.

Results

Fifty-six (20.8%) of the patients developed lymphedema after lymph node dissection with a median staging group of 3. ILND (odds ratio [OR] = 4.506, P < .001, 95% confidence interval [CI]: 2.289 to 8.869) and peripheral vascular disease (PVD; OR = 3.849, P = .020, 95% CI: 1.237 to 11.975) were significant predictors of lymphedema in multivariate analysis. Obese body mass index approached significance (OR = 1.802, P = .069, 95% CI: .955 to 3.399).

Conclusions

PVD and ILND were the 2 factors associated with the highest risk of lymphedema in melanoma surgery with PVD increasing risk 2-fold in ILND patients and 3-fold in ALND patients. These findings may improve surgeon-patient communication of care goals and surgical risk assessment.     

The risks of radiation therapy and lymphedema in shoulder surgery

BackgroundRadiation therapy has proven efficacy for cancer treatment but is not without short- and long-term side effects, including radiation-induced lymphedema. There has been limited evidence on the secondary effects of prior radiation therapy on shoulder surgery. The purpose of this study is to evaluate the short-term outcomes of shoulder arthroplasty and rotator cuff repair (RCR) in patients who have undergone ipsilateral radiation therapy and/or have preoperative upper extremity lymphedema.MethodsDuke Enterprise Data Unified Content Explorer was used to query for patients who underwent RCR at our institution. Patients with radiation therapy for breast or lung cancer prior to ipsilateral RCR or shoulder arthroplasty were included. Patients with less than 2 years of follow-up were excluded. Data variables included primary tumor type, dates of cancer diagnoses, radiation treatment, axillary lymph node dissection (aLND), presence of lymphedema, index shoulder operations, most recent follow-up, and surgical and medical complications within the 90-day postoperative period. Additional oncologic variables included total Gray (Gy) delivered.ResultsTwenty-one patients underwent radiation therapy and subsequent shoulder arthroplasty or RCR (13 RCR, 3 total shoulder arthroplasty, 5 reverse shoulder arthroplasty). There were 20 females and 1 male with an average age of 65.6 years (47-82) and average clinical follow-up of 4.4 years (2.0-7.4). Oncologic diagnoses included lung (4.8%) and breast (95.2%) cancer. Average radiation dose delivered was 53.3 Gy (38.5-64) in the cohort. The average time from last external beam radiation therapy to shoulder surgery was 4.3 years (0.3-18.0). One of 13 (7.7%) 90-day postoperative complications was reported in the RCR cohort: a superficial vein thrombosis. One of 8 (12.5%) 90-day complications was reported in the arthroplasty cohort: a clinically suspected but radiographically absent acromial stress fracture in a reverse shoulder arthroplasty that did not require operative intervention. Overall, there were no revisions, reoperations, or shoulder-related unplanned inpatient 90-day readmissions. Among 10 patients with prior aLND, 3 (30%) (2 RCR, 1 arthroplasty) experienced new or worsening upper extremity lymphedema within the immediate postoperative period.ConclusionA minority of patients having undergone prior radiation therapy and aLND who subsequently underwent ipsilateral shoulder surgery experienced worsening subjective upper extremity lymphedema. Although 10% of these radiation therapy patients experienced minor complications within 90 days of their shoulder surgery, none were severe enough to merit inpatient admission or revision surgery.     

肢体慢性淋巴水肿CDT治疗后低弹力绷带使用时长对远期疗效的影响

目的探讨肢体慢性淋巴水肿CDT(Complex decongestion therapy)治疗后低弹绷带使用时长对于长期疗效的影响。方法2016至今,对57例淋巴水肿患者按治疗结束后自我使用低弹绷带包扎时长(t)分为A(>1年)、B(0.5~1年)、C(<0.5年)3组。采用多频生物电阻人体成分分析仪测量组织水分,卷尺测量肢体周径。比较3组患者复诊时与治疗结束时水分和周径的变化。结果A组在维持肢体周径、水分方面明显优于B组和C组,B组则优于C组(P<0.05)。3组治疗后的丹毒发作频率均有改善,A组改善最为明显(P<0.05)。结论肢体慢性淋巴水肿患者在CDT治疗结束后应继续使用低弹绷带包扎患肢,坚持使用越久的患者长期疗效越好。     

Prevalence and Risk Factors of Adhesive Capsulitis in Asian Breast Cancer Patients Undergoing an Outpatient Community Cancer Rehabilitation Program

ObjectivesTo investigate the prevalence and risk factors for adhesive capsulitis in postoperative breast cancer patients up to 5 years after surgery who were attending an outpatient community cancer rehabilitation program, and to determine whether any significant relationship exists between arm lymphedema and adhesive capsulitis.DesignCross-sectional observational study.SettingNational cancer rehabilitation center.ParticipantsAsian women (N=135) who underwent breast surgery and were referred for an outpatient community cancer rehabilitation program.InterventionsNot applicable.Main Outcome MeasuresPresence of adhesive capsulitis, lymphedema.ResultsThe prevalence of adhesive capsulitis and lymphedema in this population was 22.2% and 33.3%, respectively. A history of mastectomy (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.23-12.63; P=.021), mastectomy with reconstruction (OR, 2.72; 95% CI, 1.27-30.54; P=.024), and lymphedema (OR, 7.92; 95% CI, 2.73-22.95; P<.001) were found to be significantly associated with adhesive capsulitis on multivariate analysis.ConclusionsAdhesive capsulitis and lymphedema are common in breast cancer survivors. The design of cancer rehabilitation programs for breast cancer survivors should include surveillance and management of adhesive capsulitis, especially in the presence of lymphedema.     

干细胞移植治疗肢体淋巴肿29例临床研究

目的：探讨自体骨髓基质干细胞移植术治疗肢体淋巴水肿。方法：回顾性分析山东大学附属省立医院血管外科2008年8月—2011年6月采用自体骨髓基质干细胞移植术治疗的29例淋巴肿患者的临床资料。结果：抽取骨髓过程中2例出现乏力症状,第2天好转,其余患者均无异常。分离的单个核细胞计数为（110～820）×108mL-1,干细胞移植过程顺利。术后有3例患者自述患肢局部注射部位发热、胀痛感,后逐渐缓解,无其他明显并发症。平均随访18.3个月,10例患者肢围较术前无明显改善,但肢体皮质硬化程度有所下降;19例患者患肢与健肢周径之差明显减小,未发现明显并发症。结论：骨髓间充质干细胞移植治疗淋巴水肿在理论上具有可行性,但远期安全问题需密切关注。     

肌内效贴治疗乳腺癌根治术患者放疗后上肢肿胀的疗效观察

目的观察肌内效贴治疗乳腺癌根治术患者放疗后上肢肿胀的疗效。 方法选取乳腺癌根治术接受放疗后出现上肢淋巴水肿的患者68例,按照随机数字表法将其分为实验组和对照组,每组34例。2组均采用常规手法康复治疗,实验组在此基础上行肌内效贴贴扎,对照组接受相同形状和颜色的无弹性肌内效贴贴扎,共治疗3周。治疗前、治疗3周后（治疗后）,采用上肢周径测量法、上肢功能评定量表（DASH）、世界卫生组织生活质量量表-100（WHOQOL-100）对2组患者的淋巴水肿程度、上肢肢体功能及生活质量进行评价。 结果2组患者淋巴水肿的程度及DASH评分均较治疗前有所改善（P<0.05）,且观察组优于对照组（P<0.05）。 结论在常规手法康复基础上辅以肌内效贴治疗,能进一步减轻乳腺癌术后淋巴水肿,改善上肢功能。     

Intra- and Interrater Reliability and Concurrent Validity of a New Tool for Assessment of Breast Cancer–Related Lymphedema of the Upper Extremity

Objective

The goal of this study was to develop and assess intra- and interrater reliability and validity of a clinical evaluation tool for breast cancer–related lymphedema, for use in the context of outcome evaluation in clinical trials.