por Lynn Shapiro
, Writer | March 23, 2009
Breast cancer patients with lymphedema in their upper arm experienced reduced fluid in the swollen arm by up to 39 percent after undergoing a super-microsurgical technique known as lymphaticovenular bypass, report researchers at The University of Texas M. D. Anderson Cancer Center.
The results from the prospective analysis, presented at the 88th Annual Meeting of the American Association of Plastic Surgeons, suggest a new option for breast cancer patients considering ways to manage lymphedema, a common and debilitating condition following surgery and/or radiation therapy for breast cancer.
Lymphedema results when the lymph nodes are removed or blocked due to treatment and lymph fluid accumulates causing chronic swelling in the upper arm or other portion of the arm or hand. Currently, there is no cure or preventive measure for lymphedema and it is difficult to manage; the use of compression bandages, massage and other forms of lymphatic therapy are commonly recommended options for patients. According to the National Cancer Institute, 25 percent to 30 percent of women who have breast cancer surgery with lymph node removal and radiation therapy develop lymphedema.
"Patients often resort to lymphatic therapy because other options brought forward to reduce lymphedema haven't proved effective," said lead author of the study, David W. Chang, M.D., professor in the Department of Plastic Surgery and Director of the Plastic Surgery Clinic at M. D. Anderson.
In lymphaticovenular bypass surgery, surgeons use tiny microsurgical tools to make two to three small incisions measuring an inch or less in the patient's arm. Lymphatic fluid is then redirected to microscopic vessels--approximately 0.3 - 0.8 millimeters in diameter--to promote drainage and alleviate lymphedema. The procedure is minimally invasive and is generally completed in less than four hours under general anesthesia, allowing patients to return home from the hospital within 24 hours. M. D. Anderson is among a few institutions in the United States to offer this technically complex surgery.
"Lymphedema is like a massive traffic jam with no exit," Chang said. "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 very little downside for the patient and we may see significant improvement in its severity."
Researchers evaluated 20 breast cancer patients with stage II and III treatment-related lymphedema of the upper arm who underwent a lymphaticovenular bypass at M. D. Anderson from December 2005 to September 2008. Due to lymphedema, the patients' affected arm was an average of 34 percent larger compared to the unaffected arm prior to the surgery. Of these 20 patients, 19 reported initial significant clinical improvement following the procedure. In those patients, total reduction in the volume differential at one month was 29 percent, at three months 33 percent, at six months 39 percent and 25 percent at one year.