V16: Prophylactic Lymphovenous Bypass in Reduction of Breast Cancer-related Lymphedema

Tuesday, March 1, 2022

5:52 PM – 5:55 PM CST

Location: Zoom Meeting

Virtual Poster Presenter(s)

GK

Gyulnara Kasumova, MD

GCSO Fellow
Ohio State University/ James Cancer Hospital, United States

Disclosure: Disclosure information not submitted.

Participants should be aware of the following financial/non-financial relationships:

Gyulnara Kasumova, MD: Disclosure information not submitted.

Introduction: Breast cancer-related lymphedema (BCRL) occurs in up to 40% of patients undergoing axillary lymph node dissection (ALND). Lymphovenous bypasses have shown promise in the treatment of BCRL, but research is lacking regarding effectiveness in the preventative setting. Prophylactic lymphovenous bypass (PLVB) was performed at the time of ALND using microsurgical technique to evaluate the effectiveness of PLVB in BCRL reduction.

Methods:

Retrospective review of patients undergoing ALND with or without PLVB between May 2011 to November 2020 at a tertiary academic comprehensive cancer center. Patient demographics, treatment, and surgical characteristics were assessed to determine rates of BCRL. Physical therapy (PT) assessments were reviewed for circumferential limb measurements at multiple sites on the arm and hand. BCRL was defined as an increase in circumference ≥2cm at 3 months post op. P-values were calculated using chi-squared test.

Results: Total of 503 patients were identified, with 383 (76.1%) undergoing ALND and 120 (23.9%) undergoing ALND + PLVB. Patients who underwent PLVB were younger, less likely to have a mastectomy, and more likely to receive neoadjuvant chemotherapy (Table). 293 patients had PT assessments. Significantly more ALND + PLVB underwent preoperative PT assessment compared to ALND alone (83.3% vs 31.6%, p< 0.0001). Overall, the rate of BCRL at 3 months post operatively was 20.4%, with similar rates between ALND vs ALND + PLVB (17.6% vs 20.0%; p=0.605). Patient undergoing ALND + PLVB had fewer number of affected limb sites (67% 1 site, 33% 2 sites), compared to ALND (48% 1 site, 18% 2 sites, 18% 3 sites, 12% 4 sites, 3% 5 sites). Among ALND + PLVB, the average number of LVB performed did not vary significantly by BCRL status (2.2±1.4 no BCRL vs 1.9±0.7 BCRL).

Conclusions: The rate of BCRL 3 months post operatively did not differ significantly in ALND+PLVB vs ALND only, however, PT assessment rates were significantly lower in non-PLVB patients. There was a trend towards lower number of affected sites by BCRL in ALND + PLVB. PLVB may play a critical role in mitigating the severity of lymphedema. Future studies will focus on long-term follow up and correlation with patient reported outcomes.

Learning Objectives:

Upon completion, participant will be able to describe the benefit of prophylactic lymphovenous bypass during ALND.
Upon completion, participant will be able to define the role of PLVB in reducing severity of symptoms following ALND.
Upon completion, participant will be able to define the understand the importance of PT referral following ALND.