Surgery Can Help Eliminate Chronic Lymphedema

Two different microsurgery techniques could help relieve the painful swelling caused by chronic lymphedema following cancer treatment.

The two procedures, lymphovenous bypass and vascularized lymph node transfer, involve rerouting lymphatic channels to allow for proper fluid drainage. In the lymphovenous bypass procedure, lymphatic channels are rerouted into functioning veins so that lymphatic system blockages can be bypassed to allow fluids to be transported back to the heart via the venous system. The procedure can be performed on vessels less than one millimeter in diameter using supermicrosurgery techniques, which although technically challenging show promising results.

In the vascularized lymph node transfer (VLNTx) procedure, normal lymph nodes and the associated adipose tissues are transferred to a region of the body that suffers from lymphedema as a means to decrease limb size, alleviate subjective discomfort symptoms and early fatigue, potentially reduce daily compression requirements, and slow progression of the disease. Key aspects of the VLNTx approach include patient selection, a no-touch, atraumatic harvesting technique, aggressive adhesionolysis in the area of injury, and meticulous microsurgical technique.

“This is a huge clinical issue that has serious quality-of-life implications for cancers survivors; 40%–60% of all cancer patients who have full lymph node removal are at risk of developing lymphedema; in breast cancer specifically, up to 40% of survivors will develop the condition,” said Roman Skoracki, MD, division chief of oncologic plastic surgery at the Ohio State University (OSU; Columbus, USA) comprehensive cancer center. “This excess fluid can make a person’s limbs feel heavy and cause a physical as well as a psychological burden for the patient that is very troubling.”

“Now we can offer patients a surgical approach to better manage their lymphedema, and in some cases prevent it from occurring entirely,” added Dr. Skoracki. “After lymphedema-relieving surgery, more than 60% of patients will have a significant improvement in their symptoms. Additionally, in more than 50% of patients we are able to measure a very significant decrease in the size of their affected limb.”

Chronic lymphedema is most common in breast cancer patients, but can occur in all cancers that require full lymph node dissection to confirm the extent of disease and determine if chemotherapy or radiation treatments are necessary. If too many lymph fluid channels are removed, the fluid downstream becomes trapped, leading to the development of lymphedema. Traditionally, it has been managed with a combination of physical therapy and compression bandaging, but once the condition occurs it cannot be eliminated entirely.

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