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

Autor: H. G. J. Voesten, W. D. van Schelven, R. J. Damstra, van der Berend Lei
Přispěvatelé: Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Department of Surgery, Department of Nuclear Medicine, Medical Centre Leeuwarden, Department of Plastic Reconstructive, Aesthetic and Hand Surgery, University Medical Centre Groningen
Rok vydání: 2008
Předmět:
Cancer Research
Microsurgery
medicine.medical_treatment
Review
030230 surgery
Breast cancer related lymphedema
THERAPY
0302 clinical medicine
PERIPHERAL LYMPHEDEMA
Recurrence
Lymphedema
Prospective Studies
Treatment Failure
Prospective cohort study
Mastectomy
Massage
Evidence-Based Medicine
Anastomosis
Surgical
Middle Aged
Combined Modality Therapy
3. Good health
Oncology
Inverse water volumetry
030220 oncology & carcinogenesis
Female
Breast disease
Lymphoscintigraphy
Stockings
Compression
Adult
medicine.medical_specialty
Breast Neoplasms
Anastomosis
Lympho-venous anastomosis (LVA)
VALIDATION
Veins
03 medical and health sciences
Breast cancer
medicine
Humans
Radionuclide Imaging
Physical Therapy Modalities
Aged
Lymphatic Vessels
business.industry
Retrospective cohort study
medicine.disease
Bandages
Surgery
Clinical trial
EXTREMITY LYMPHEDEMA
Quality of Life
Lymph Node Excision
FOLLOW-UP
business
Follow-Up Studies
Zdroj: Breast Cancer Research and Treatment
Breast Cancer Research and Treatment, Springer Verlag, 2008, 113 (2), pp.199-206. ⟨10.1007/s10549-008-9932-5⟩
ISSN: 1573-7217
0167-6806
DOI: 10.1007/s10549-008-9932-5⟩
Popis: Objective The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic, this study was undertaken to prospectively determine the effect of Lympho Venous Anastomosis (LVA) on BCRL and to review the current literature. Study design and methods Ten patients who were previously treated for breast cancer by surgery, radiotherapy, and chemotherapy, and were unresponsive to 12-weeks of non-operative treatment, underwent an LVA procedure (Degni-Cordeiro). Objective measurements were gathered for circumferential measurement and water volumetry, and quality of life. Various types of lymphoscintigraphy were carried out pre-operatively and post-operatively at 3 and 12 months. Treatment was embedded in a multidisciplinary setting. Results Post-operative volume measurements initially showed a 4.8% reduction of lymphedema at 3 months and a 2% reduction after one year. Various scintigraphic parameters showed some improvement. Quality of life questionnaires reported minimal improvement. Reviewing the literature, only retrospective studies were found; these reported varying results for LVA procedures. The selection of patients, classification of lymphedema, indications and types of LVA, and additional therapeutic options were heterogeneous, not comparable, and lacked a validated method of effect-assessment. Conclusions Our results showed a minimal reduction in volume of lymphedema following LVA; in the literature, there was no convincing evidence of the success of LVA. Non-operative treatment and elastic stockings are still preferred by most patients with lymphedema, especially in early stages with few irreversible changes.
Databáze: OpenAIRE
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