Surgery Offers Hope for Lymphedema

Cancer Newsline - 06/01/09

Method Helps Breast Cancer Treatment Side Effect

A surgical procedure helped reduce upper-arm lymphedema, swelling that is common after surgery or radiation to treat breast cancer, by nearly 30% in a recent study.

The results of the investigation, which looked at the effects of a microsurgical technique known as lymphaticovenular bypass, were reported by M. D. Anderson surgeons at the annual meeting of the American Association of Plastic Surgeons in March.

Significance of study

Lymphedema results when the lymph nodes are removed or blocked due to treatment, and lymph fluid accumulates and causes chronic swelling in the upper arm. According to the National Cancer Institute, 25% to 30% of patients who have breast cancer surgery with lymph node removal and radiation therapy develop lymphedema.

There is no cure or preventive measure for the condition, and it is difficult to manage. Common recommendations to cope with lymphedema include compression bandages and a special type of massage.

"Options brought forward to reduce lymphedema haven't proven effective," says lead author David W. Chang, M.D., professor in the Department of Plastic Surgery and director of the Plastic Surgery Clinic at M. D. Anderson.

"Surgical techniques, in particular, have been limited and therefore have been met with skepticism by surgeons, making it extremely important to determine which new techniques promise to bring real benefits to patients."

Background

In lymphaticovenular bypass surgery, surgeons use tiny microsurgical tools to make two or three small incisions measuring an inch or less in the patient's arm. Lymphatic fluid is then redirected to microscopic blood vessels to promote drainage and alleviate lymphedema.

The procedure is minimally invasive and generally is completed in less than four hours under general anesthesia, allowing patients to leave the hospital within 24 hours.

M. D. Anderson is among a few institutions in the United States to offer this technically complex surgery.

Research methods

Researchers looked at the records of 20 breast cancer patients with stage II and III treatment-related lymphedema of the upper arm who had lymphaticovenular bypasses at M. D. Anderson from December 2005 to September 2008.

Primary results

Of these 20 patients, 19 reported initial significant clinical improvement in the year following the procedure.

"Lymphedema is like a massive traffic jam with no exit," Chang says. "This procedure does a lot to help relieve lymphedema by giving the fluid a way out. While it does not totally eliminate the condition, there is little downside for the patient, and we may see significant improvement in the lymphedema’s severity."

Additional results

Chang notes the surgery is most effective in lymphedema’s earlier stages. However, he says almost any breast cancer patient suffering from lymphedema is a candidate.

Though breast cancer was the focus of this study, the surgery also can be performed on patients who have lymphedema in the leg resulting from cancers involving the pelvic regions.

What’s next?

Long-term follow-up with patients who have received lymphaticovenular bypass surgery is necessary to determine if the procedure continues to promote drainage after one year.

Chang and his team of surgeons at M. D. Anderson believe fluid volume will continue to decrease over time. They suggest the surgery might be used in the future as a preventive measure for lymphedema.

"Working toward a definitive technique to cure this encumbering side effect of cancer and improve a patient's quality of life is a priority for us," he says.

 

Adapted by Dawn Dorsey from an M. D. Anderson news release.