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Donahue PMC, MacKenzie A, Filipovic A, Koelmeyer L. Advances in the prevention and treatment of breast cancer-related lymphedema. Breast Cancer Res Treat 2023; 200:1-14. [PMID: 37103598 DOI: 10.1007/s10549-023-06947-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) represents a lifelong risk for breast cancer survivors and once acquired becomes a lifelong burden. This review summarizes current BCRL prevention and treatment strategies. FINDINGS Risk factors for BCRL have been extensively studied and their identification has affected breast cancer treatment practice, with sentinel lymph node removal now standard of care for patients with early stage breast cancer without sentinel lymph node metastases. Early surveillance and timely management aim to reduce BCRL incidence and progression, and are further facilitated by patient education, which many breast cancer survivors report not having adequately received. Surgical approaches to BCRL prevention include axillary reverse mapping, lymphatic microsurgical preventative healing (LYMPHA) and Simplified LYMPHA (SLYMPHA). Complete decongestive therapy (CDT) remains the standard of care for patients with BCRL. Among CDT components, facilitating manual lymphatic drainage (MLD) using indocyanine green fluorescence lymphography has been proposed. Intermittent pneumatic compression, nonpneumatic active compression devices, and low-level laser therapy appear promising in lymphedema management. Reconstructive microsurgical techniques such as lymphovenous anastomosis and vascular lymph node transfer are growing surgical considerations for patients as well as liposuction-based procedures for addressing fatty fibrosis formation from chronic lymphedema. Long-term self-management adherence remains problematic, and lack of diagnosis and measurement consensus precludes a comparison of outcomes. Currently, no pharmacological approaches have proven successful. CONCLUSION Progress in prevention and treatment of BCRL continues, requiring advances in early diagnosis, patient education, expert consensus and novel treatments designed for lymphatic rehabilitation following insults.
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Affiliation(s)
- Paula M C Donahue
- Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 21St Children's Way, Suite 1218, Nashville, TN, 37212, USA.
- Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Adrien MacKenzie
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Louise Koelmeyer
- Faculty of Medicine, Health, and Human Sciences, Australian Lymphoedema Education, Research, and Treatment (ALERT), Macquarie University, Sydney, Australia
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Luzardo González A, Planas Balagué R, Gómez Cuba M, Fernández Mariscal E, Arencibia Domínguez A, Salinas Huertas S. [Rehabilitation in lymphedema surgery]. Rehabilitacion (Madr) 2022; 56:215-225. [PMID: 35527077 DOI: 10.1016/j.rh.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 01/25/2023]
Abstract
Conservative treatment of lymphedema usually includes complex decongestive therapy in order to reduce the volume of the lymphedema, and compression garments in the maintenance phase. Follow-up is carried out in the Rehabilitation Services. Surgical treatment of lymphedema is a therapeutic option, the interest of which has increased in recent years, although there is no current evidence that it can cure lymphedema and it is always accompanied by conservative treatment. Most studies focus on results according to the type of surgery and there is no standardized protocol for conservative treatment before or after surgery. The objective of this work is to prepare a compendium about the most frequent lymphedema surgeries and their indications, focusing on the rehabilitation treatment for each surgery.
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Affiliation(s)
- A Luzardo González
- Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - R Planas Balagué
- Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Universitat de Barcelona, Barcelona, España
| | - M Gómez Cuba
- Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Universitat de Barcelona, Barcelona, España
| | - E Fernández Mariscal
- Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - A Arencibia Domínguez
- Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - S Salinas Huertas
- Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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3
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Lasso JM, Alonso-Farto JC. Indocyanine green-guided liposuction for patients presenting with residual nonpitting edema after lymphovenous anastomosis. J Plast Reconstr Aesthet Surg 2022; 75:2482-2492. [PMID: 35387757 DOI: 10.1016/j.bjps.2022.02.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 12/24/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Lymphovenous anastomoses (LVA) techniques for the treatment of lymphedema are well defined, and results restoring lymph function are reported in the literature. However, unsatisfactory results (poor-responders) are common, leading to persistent nonpitting edema. Blind liposuction eliminates fat and fibrous tissue but may result in inadvertent damage to the lymph vessel system. Indocyanine green imaging of the lymphatic system provides the potential preservation of functioning lymphatics while conducting liposuction to address the excess adipose and fibrous tissue in these patients. Our study reports the results of a prospectively conducted technique in patients with nonpitting edema after failing previous LVA. It consists of indocyanine green-guided liposuction. PATIENTS AND METHOD Twenty poor-responders patients to LVA who presented with persistent nonpitting edema were operated with liposuction. Limb volume measurements, SPECT-CT/lymphoscintigraphy, and ICG lymphography were recorded and complemented with a satisfaction inquiry. RESULTS The overall percentage of volume reduction was 46.2% after liposuction (p = 0.001). None of our patients reported any set back with respect to the improvements they had achieved after LVA nor new infections. Satisfaction showed a mean improvement of 5 points in a 20-point scale. SPECT-CT/lymphoscintigraphy showed further improvements in 17 cases after liposuction, such as dermal back-flow reduction, spots along the lymphatic system, or lymph nodes not described in preoperative reports, without showing significant differences when compared with overall volume reduction (p = 0.12). CONCLUSION Controlled liposuction with ICG seems to be an effective technique for the reduction of residual non-pitting edema in poor responder patients after LVA. Overall, volume excess reduction after liposuction was 42.6%.
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Affiliation(s)
- J M Lasso
- Department of Plastic and Reconstructive Surgery, Hospital Genertal Universitario Gregorio Marañón, Universidad Complutense de Madrid, Spain.
| | - J C Alonso-Farto
- Department of Nuclear Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Surgical Treatment of Lymphedema: A Systematic Review and Meta-Analysis of Controlled Trials. Results of a Consensus Conference. Plast Reconstr Surg 2021; 147:975-993. [PMID: 33761519 DOI: 10.1097/prs.0000000000007783] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The goal of this consensus conference, sponsored by the American Association of Plastic Surgeons, was to perform a systematic review and meta-analysis of controlled trials to examine both the benefits and risks of surgical treatment and surgical prevention of upper and lower extremity lymphedema. METHODS The panel met in Boston for a 3-day, face-to-face meeting in July of 2017. After an exhaustive review of the existing literature, the authors created consensus recommendations using the Grading of Recommendations, Assessment, Development and Evaluation criteria. Important directions for future research were also identified. RESULTS There is evidence to support that lymphovenous anastomosis can be effective in reducing severity of lymphedema (grade 1C). There is evidence to support that vascular lymph node transplantation can be effective in reducing severity of lymphedema (grade 1B). Currently, there is no consensus on which procedure (lymphovenous bypass versus vascular lymph node transplantation) is more effective (grade 2C). A few studies show that prophylactic lymphovenous bypass in patients undergoing extremity lymphadenectomy may reduce the incidence of lymphedema (grade 1B). More studies with longer follow-up are required to confirm this benefit. Debulking procedures such as liposuction are effective in addressing a nonfluid component such as fat involving lymphedema (grade 1C). There is a role for liposuction combined with physiologic procedures although the timing of each procedure is currently unresolved (grade 1C). CONCLUSIONS Many studies seem to support some efficacy of lymphovenous bypass and vascular lymph node transplantation. Many studies show the important role of lymphedema therapy and other procedures such as liposuction and debulking. The management of lymphedema is a challenging field with many promising advances. However, many questions remain unanswered.
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5
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Jimenez RB, Rabinovitch RA. Caring for the Whole Patient After Breast Cancer Therapy: A Survivorship Guide for Radiation Oncologists. Pract Radiat Oncol 2021; 12:e1-e6. [PMID: 34454104 DOI: 10.1016/j.prro.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
With 5-year survival rates after breast cancer therapy exceeding 90%, comprehensive follow-up care is a vital component of the treatment plan for patients who have completed active therapy. Although radiation oncologists are generally comfortable with management of the locoregional toxicities of breast cancer radiation therapy, many may be less familiar with the toxicities and available interventions associated with surgery, chemotherapy, and antihormone therapy. For radiation oncologists to provide the greatest value to their patients and play a meaningful role in patients with breast cancer follow-up care, multisystem assessment and management, beyond the breast/chest and axilla, is key. This guide is intended as an educational and practical tool to assist any oncology caregiver with a thorough multisystem assessment and management of the most common survivorship issues for the treated breast cancer patient. Hyperlinks to published data supporting or summarizing the intervention are provided for further reading in the online version, along with sample "Follow-Up Note and After Visit Summary" templates.
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Affiliation(s)
- Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Rachel A Rabinovitch
- Department of Radiation Oncology, University of Colorado Hospital, Denver, Colorado
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Tang NSJ, Ramakrishnan A, Shayan R. Quality-of-life outcomes after operative management of primary and secondary lymphoedema: a systematic review. ANZ J Surg 2021; 91:2624-2636. [PMID: 33825306 DOI: 10.1111/ans.16764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/27/2021] [Accepted: 03/06/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Lymphoedema is an incurable and progressive disease that affects not only physical function but overall quality of life. Surgical treatment options for the management of lymphoedema are being increasingly performed. This study aims to review post-operative health-related quality of life (HRQOL) following surgical treatment of lymphoedema. METHODS A systematic search of the PubMed and Medline databases was performed from the date of their inception until September 2018 to evaluate HRQOL following different surgical options for the treatment of lymphoedema. RESULTS One hundred and thirteen articles were identified. Twenty-one articles were included in the final review, comprising a total of 736 patients. HRQOL improvements appear to be sustained for at least 6-12 months post-operatively. In particular, major benefits were noted in the domains based around physical functioning. Patient satisfaction similarly mirrors HRQOL improvements, following an initial dip in the immediate post-operative period. CONCLUSION All surgical treatment modalities for the management of lymphoedema confer significant HRQOL improvements across a diverse range of health domains, with this critical outcome of surgery an important pre-operative consideration. Recommendations for ongoing research are suggested.
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Affiliation(s)
- Nicholas S J Tang
- Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ramin Shayan
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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7
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Dey A, Ni Z, Johnson MS, Sedger LM. A multi-colour confocal microscopy method for identifying and enumerating macrophage subtypes and adherent cells in the stromal vascular fraction of human adipose. J Immunol Methods 2021; 491:112988. [PMID: 33587915 DOI: 10.1016/j.jim.2021.112988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 12/29/2022]
Abstract
This study examines leukocytes present in lymphoedema (LE) adipose tissue (AT) by multi-colour confocal microscopy. LE AT, collected by liposuction surgery, was digested with collagenase to separate adipocytes from other tissue cells, comprising blood and lymphatic endothelial cells, fibroblasts, and all vessel- and tissue-resident leukocytes - the stromal vascular fraction (SVF). SVF cells were activated with phorbol 12-myristate 13-acetate (PMA) and ionomycin, adding Brefeldin-A to prevent cytokine secretion during the final 4 hours. Cells were incubated with CD11b-FITC and CD40-APC (M1 MØ)' or CD206-APC (M2 MØ) specific antibodies, fixed, permeabilised, then incubated with either (1) anti-TNF-PE, (2) anti- IL-1β-PE, (3) anti-IL-6-PE, (4) anti-IL-4-PE, (5) anti-TGFβ-PE or (6) isotype-IgG-PE (control), and stained with Hoechst 33342, preserved in permanent mounting media and examined by confocal microscopy. The FITC, PE and APC fluorescence channels were set to achieve minimal cross-channel emission using single-colour controls and voltages set for optimal detection by thresholding on isotype-IgG stained activated cells. Finally, transmission and z-stack images were captured. Cells were analysed as regions of interest (ROI) based on Hoechst-33342 then enumerated as FITC+, FITC+APC+ or FITC+APC+PE+ using an ImageJ script and exported into Excel. This permitted the examination of >9000 SVF cells individually, per LE sample. This method allows for the analysis of a high number of heterogeneous cells defined into any subtype or combination by the investigators' choice of surface and intracellular expression profiles. Fibroblasts, or other cytokine producing cells, can also be analysed by using other antibodies, and the cell count data can be correlated with any clinical or laboratory data.
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Affiliation(s)
- Agnibesh Dey
- School of Life Science, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Zhongran Ni
- School of Life Science, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Michael S Johnson
- School of Life Science, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Lisa M Sedger
- School of Life Science, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia.
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Eaton LH, Narkthong N, Hulett JM. Psychosocial Issues Associated with Breast Cancer-Related Lymphedema: a Literature Review. CURRENT BREAST CANCER REPORTS 2020; 12:216-224. [PMID: 32864036 PMCID: PMC7445072 DOI: 10.1007/s12609-020-00376-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Breast cancer-related lymphedema (BCRL) is a chronic disease affecting breast cancer survivors. The purpose of this article is to update the scientific literature regarding psychosocial issues associated with BCRL. RECENT FINDINGS Reports describe economic burdens, social support, sexuality, BCRL patient-education needs, and interventions to reduce BCRL symptoms and improve QOL among women with breast cancer. The psychosocial impact of BCRL may differ between younger and older women which has implications for age-related interventions to reduce the adverse psychosocial experiences of women with BCRL. We did not locate studies reporting the psychosocial impact of BCRL on male breast cancer survivors. SUMMARY More psychosocial-based interventions are needed that target the concerns of those with BCRL, including age-related needs, sexual concerns, body image, and social support. Future research is indicated to study the psychosocial impact of BCRL among men. Researchers may consider how pandemic-driven health care policies affect the psychosocial needs of those with BCRL.
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Affiliation(s)
- L. H. Eaton
- School of Nursing & Health Studies, University of Washington Bothell, Box 358531, Bothell, WA 98011 USA
| | - N. Narkthong
- Sinclair School of Nursing, University of Missouri, 115 Business Loop 70W, Mizzou North, Room 408C, Columbia, MO 65211-6000 USA
| | - J. M. Hulett
- Sinclair School of Nursing, University of Missouri, 115 Business Loop 70W, Mizzou North, Room 408C, Columbia, MO 65211-6000 USA
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9
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Jeon BJ, Chang DW. Breast cancer related lymphedema and surgical treatment. PRECISION AND FUTURE MEDICINE 2020. [DOI: 10.23838/pfm.2020.00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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He L, Qu H, Wu Q, Song Y. Lymphedema in survivors of breast cancer. Oncol Lett 2020; 19:2085-2096. [PMID: 32194706 PMCID: PMC7039097 DOI: 10.3892/ol.2020.11307] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 11/07/2019] [Indexed: 12/16/2022] Open
Abstract
The tremendous improvement of survival in patients with breast cancer can be attributed to several treatment strategies, but these strategies also lead to the occurrence of breast cancer-related lymphedema (BCRL). BRCL is regularly associated with factors such as axillary lymph node dissection and local lymph node radiotherapy and manifests as an increase of >10% in the volume of affected limbs. Being overweight or having obesity (body mass index ≥25 kg/m2), an excessive number of positive lymph nodes (>8) and capsular invasion by a tumor are additional risk factors for lymphedema. It is worth assessing the risk before surgery as this can prevent the occurrence of BCRL at the initial stage of breast cancer management. The clinical utility of many diagnostic tools and lymphedema surveillance allows early stage and even subclinical BCRL to be diagnosed, and allows real-time monitoring of the disease. The early diagnosis of BRCL allows treatment at an early stage, which is beneficial to the reduction of excess limb volume and the improvement of quality of life. At present, the major therapeutic methods of BCRL include complex decongestive therapy, pneumatic compression devices, participating in exercise, microsurgery and liposuction, each of which alleviates lymphedema effectively. No medications for treatment of BRCL have yet been developed. However, the recent findings on the success of molecular therapy in animal models may remedy this deficiency. Furthermore, the volume reduction of swollen limbs without swelling rebound by transplanting autologous stem cells has been successfully reported in some pilot studies, which may provide a new technique for treating BCRL. This review aimed to discuss the pathogenesis, clinical manifestation, risk factors, advantages and disadvantages of diagnostic tools, lymphedema surveillance and the characteristics of traditional and newly emerging BCRL treatments.
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Affiliation(s)
- Lin He
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Huili Qu
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Qian Wu
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Yuhua Song
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
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Klernäs P, Johnsson A, Boyages J, Brorson H, Munnoch A, Johansson K. Quality of Life Improvements in Patients with Lymphedema After Surgical or Nonsurgical Interventions with 1-Year Follow-Up. Lymphat Res Biol 2019; 18:340-350. [PMID: 31808720 DOI: 10.1089/lrb.2018.0065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lymphedema may impact patients' health-related quality of life (HRQoL). The purpose of this study was to evaluate HRQoL after two different treatments to the 12-month follow-up point. Methods and Results: Study participants were patients with moderate lymphedema in the upper or lower limb who attended a Swedish rehabilitation program (RP) undergoing conservative treatment, or those with severe, chronic lymphedema dominated by excess adipose tissue, who underwent liposuction (LS) combined with controlled compression therapy (CCT) in Australia, Scotland, or Sweden. The patients completed the Lymphedema Quality of Life Inventory (LyQLI) before intervention and after 1, 3, 6, and 12 months. Mean values and standard deviations were calculated for total limb volume and excess limb volume. Mean values were also calculated for the three LyQLI domains (physical, psychosocial, and practical). To detect and analyze differences in LyQLI responses in the three domains, the Wilcoxon signed rank test was performed. In the RP, 18 eligible patients completed the LyQLI. The results show improvements in HRQoL in physical (p = 0.003) and psychosocial domains (p = 0.002) at 1 month after the RP, with results remaining steady for 12 months for the physical domain (p = 0.024). Fifty-seven eligible LS patients completed the LyQLI. The results show improvements in HRQoL in all three domains (p < 0.001), with results remaining steady up to the 12-month follow-up (p < 0.001). The total volume in affected limb and the excess volume decreased significantly in both patient groups 1 month after intervention (p < 0.001). Conclusions: Treatment with a conservative RP in moderate lymphedema or with LS combined with CCT in severe lymphedema improves HRQoL.
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Affiliation(s)
- Pia Klernäs
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.,Bräcke Diakoni, Rehabcenter Sfären, Solna, Sweden
| | - Aina Johnsson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.,Neurobiology, Care Science and Society, Division of Family Medicine, Karolinska Institutet, Huddinge, Sweden
| | - John Boyages
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Håkan Brorson
- Lymphedema Center, Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Alex Munnoch
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Department of Plastic Surgery, Ninewells Hospital, Dundee, Scotland
| | - Karin Johansson
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
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Forte AJ, Huayllani MT, Boczar D, Cinotto G, McLaughlin SA. Lipoaspiration and Controlled Compressive Therapy in Lymphedema of the Upper Extremity: A Comprehensive Systematic Review. Cureus 2019; 11:e5787. [PMID: 31728234 PMCID: PMC6827846 DOI: 10.7759/cureus.5787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Lipoaspiration followed by controlled compression therapy has been used to treat lymphedema of the upper extremity. We aimed to describe the studies reporting on outcomes of this procedure, in addition to reporting the differences with patients that were treated only with compressive therapy. The PubMed database was queried for studies that evaluated the use of lipoaspiration for upper extremity lymphedema. The keywords “aspiration lipectomy” AND “lymphedema” and synonyms in different combinations were used for the search. From a total of 129 articles, 13 met inclusion criteria. Ten studies reported outcomes of patients treated with lipoaspiration followed by compressive therapy, and three studies compared this procedure with patients that had only compressive therapy. A complete reduction of the edema in the affected limb was found in all the studies. Better results were found in patients who had undergone both procedures. This systematic review suggests that lipoaspiration is recommended for patients with upper extremity lymphedema of any cause in stage two after a long period of compressive therapy that did not produce additional edema reduction.
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Affiliation(s)
- Antonio J Forte
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Maria T Huayllani
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Daniel Boczar
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Gabriela Cinotto
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Sarah A McLaughlin
- Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
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14
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Tyker A, Franco J, Massa ST, Desai SC, Walen SG. Treatment for lymphedema following head and neck cancer therapy: A systematic review. Am J Otolaryngol 2019; 40:761-769. [PMID: 31174933 DOI: 10.1016/j.amjoto.2019.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To perform the first systematic review evaluating all established treatment modalities of head and neck lymphedema resulting from head and neck cancer therapy. Since craniofacial lymphedema treatment represents unique challenges not addressed by extremity lymphedema therapies, a systematic review and evaluation of treatment modalities specific to this area is needed to guide clinical management and further research. DATA SOURCES Four electronic databases were searches from inception to September 2018. These included Scopus (Embase), PubMed (Medline), Clinicaltrials.gov, and Cochrane Databases. REVIEW METHODS A search string was developed, and all databases queried for keywords on three subjects: head and neck cancer, lymphedema, and therapy. Results were uploaded to an EndNote database where relevant items were identified by hand-searching all titles and abstracts. Subsequently results were combined, duplicates removed, and full papers screened according to eligibility criteria. RESULTS Of a total 492 search results, twenty-six items met eligibility criteria for this review. These included fourteen cohort studies, seven case reports, two randomized controlled trials, two systematic reviews, and one narrative review totaling 1018 study subjects. The manual lymph drainage group had the largest number of studies and participants, with fewer studies investigating selenium, liposuction, and lymphaticovenular anastomosis. CONCLUSION Evidence for the efficacy of all types of lymphedema therapy is limited by paucity of large randomized controlled trials. While manual lymph drainage is best studied, liposuction and surgical treatments have also been effective in a small number of patients.
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15
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Hoffner M, Ohlin K, Svensson B, Manjer J, Hansson E, Troëng T, Brorson H. Liposuction Gives Complete Reduction of Arm Lymphedema following Breast Cancer Treatment-A 5-year Prospective Study in 105 Patients without Recurrence. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1912. [PMID: 30324078 PMCID: PMC6181505 DOI: 10.1097/gox.0000000000001912] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/05/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Arm lymphedema is a well-recognized complication after breast cancer surgery that negatively impacts patients' quality of life, both physiologically and psychologically. Lymph stasis and inflammation result in excess formation of adipose tissue, which makes removal of the deposited subcutaneous fat necessary to eliminate the excess volume. Liposuction, combined with postoperative controlled compression therapy (CCT), is the only treatment that gives complete reduction of the excess volume. The aim of this study was to evaluate the 5-year results after liposuction in combination with CCT. METHODS Patients consecutively operated on between 1993 and 2012 were identified from the lymphedema registry, comprising all patients with nonpitting lymphedema treated with liposuction and CCT in our department. Standardized forms were used to collect pre-, peri-, and postoperative data. RESULTS One hundred five women with nonpitting edema were treated. The mean interval between the breast cancer operation and lymphedema start was 2.9 ± 5.0 years, the mean duration of lymphedema was 10 ± 7.4 years, and the preoperative mean excess volume was 1,573 ± 645 ml. The mean volume aspirated was 1,831 ± 599 ml. Postoperative mean reduction 5 years postoperatively was 117% ± 26% as compared with the healthy arm. CONCLUSION Liposuction is an effective method for the treatment of chronic, nonpitting, arm lymphedema resistant to conservative treatment. The volume reduction remains complete after 5 years.
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Affiliation(s)
- Mattias Hoffner
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Surgery, Blekinge Hospital, Karlskrona, Sweden
| | - Karin Ohlin
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Barbro Svensson
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Jonas Manjer
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Emma Hansson
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Troëng
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden
- Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Håkan Brorson
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
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Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg 2018; 7:379-403. [PMID: 30175055 DOI: 10.21037/gs.2017.11.04] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Breast cancer-related lymphedema (BCRL) is a negative sequela of breast cancer treatment, and well-established risk factors include axillary lymph node dissection (ALND) and regional lymph node radiation (RLNR). BCRL affects approximately 1 in 5 patients treated for breast cancer, and it has a significant negative impact on patients' quality of life after breast cancer treatment, serving as a reminder of previous illness. This paper is a comprehensive review of the current evidence regarding BCRL risk factors, precautionary guidelines, prospective screening, early intervention, and surgical and non-surgical treatment techniques. Through establishing evidence-based BCRL risk factors, researchers and clinicians are better able to prevent, anticipate, and provide early intervention for BCRL. Clinicians can identify patients at high risk and utilize prospective screening programs, which incorporate objective measurements, patient reported outcome measures (PROM), and clinical examination, thereby creating opportunities for early intervention and, accordingly, improving BCRL prognosis. Innovative surgical techniques that minimize and/or prophylactically correct lymphatic disruption, such as axillary reverse mapping (ARM) and lymphatic-venous anastomoses (LVAs), are promising avenues for reducing BCRL incidence. Nonetheless, for those patients with BCRL who remain unresponsive to conservative methods like complete decongestive therapy (CDT), surgical treatment options aiming to reduce limb volume or restore lymphatic flow may prove to be palliative or corrective. It is only through a strong team-based approach that such a continuum of care can exist, and a multidisciplinary approach to BCRL screening, intervention, and research is therefore strongly encouraged.
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Affiliation(s)
- Tessa C Gillespie
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Hoda E Sayegh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Cheryl L Brunelle
- Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Kayla M Daniell
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
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17
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Lymphedema surgery: the current state of the art. Clin Exp Metastasis 2018; 35:553-558. [DOI: 10.1007/s10585-018-9897-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/09/2018] [Indexed: 11/26/2022]
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18
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Alexander A, Arnold TL, Bishnoi S, Ballinger C, Shaitelman SF, Schaverien MV, Cohen L, Dev M, Ueno NT. Survivorship and Advocacy in Inflammatory Breast Cancer. J Cancer 2018; 9:1430-1436. [PMID: 29721053 PMCID: PMC5929088 DOI: 10.7150/jca.21281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 03/04/2018] [Indexed: 01/30/2023] Open
Abstract
In February 2017, the Morgan Welch Inflammatory Breast Cancer (IBC) Research Program and Clinic hosted a scientific conference in Houston to commemorate the tenth anniversary of the opening of the first IBC-dedicated clinic in the world. Attendees included basic science researchers, clinicians who treat IBC, as well as patients and their caregivers. Several US-based and international IBC-focused nonprofit organizations were also represented. In this third paper from the conference, we report on the breakout session regarding survivorship and advocacy issues related to IBC, sharing an overview of the educational content presented and discussions regarding the future of IBC advocacy. Panelists focused on lymphedema research and clinical solutions, integrative medicine, and social work, with time provided for questions in small groups. IBC nonprofits that are leading advocacy efforts were introduced, and ways to become involved in these initiatives were discussed. Priorities for future advocacy and clinical care needs were also highlighted. In addition to summarizing these topics, we provide a suggested integrated IBC-specific plan of care that could be provided to the patient at the beginning of care and referred to throughout treatment and follow-up.
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Affiliation(s)
- Angela Alexander
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston TX
| | | | - Sandra Bishnoi
- Rice 360 Program, Rice University, Houston TX.,Metastatic Breast Cancer Network
| | | | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Mark V Schaverien
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Lorenzo Cohen
- Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Mary Dev
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston TX
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Abstract
In the Western world, lymphedema most commonly occurs following treatment of cancer. Limb reductions have been reported utilizing various conservative therapies including manual lymph and pressure therapy, as well as by microsurgical reconstruction involving lymphovenous shunts and transplantation of lymph vessels or nodes. Failure of these conservative and surgical treatments to provide complete reduction in patients with long-standing pronounced lymphedema is due to the persistence of excess newly formed subcutaneous adipose tissue in response to slow or absent lymph flow, which is not removed in patients with chronic non-pitting lymphedema. Traditional surgical regimes utilizing bridging procedures, total excision with skin grafting, or reduction plasty seldom achieved acceptable cosmetic and functional results. Liposuction removes the hypertrophied adipose tissue and is a prerequisite to achieve complete reduction, and this reduction is maintained long-term through constant (24 h) use of compression garments postoperatively. This article describes the techniques and evidence basis for the use of liposuction for treatment of lymphedema.
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Affiliation(s)
- Mark V Schaverien
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - D Alex Munnoch
- Department of Plastic and Reconstructive Surgery, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Håkan Brorson
- Department of Clinical Sciences, Lund University, Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
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20
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Stewart C, Munnoch D. Liposuction as an effective treatment for lower extremity lymphoedema: A single surgeon's experience over nine years. J Plast Reconstr Aesthet Surg 2018; 71:239-245. [DOI: 10.1016/j.bjps.2017.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/08/2017] [Accepted: 11/07/2017] [Indexed: 01/21/2023]
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22
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Sen Y, Qian Y, Koelmeyer L, Borotkanics R, Ricketts R, Mackie H, Lam TC, Shon KH, Suami H, Boyages J. Breast Cancer-Related Lymphedema: Differentiating Fat from Fluid Using Magnetic Resonance Imaging Segmentation. Lymphat Res Biol 2017; 16:20-27. [PMID: 28346854 DOI: 10.1089/lrb.2016.0047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lymphedema is an iatrogenic complication after breast cancer treatment in which lymph fluid in the affected limb progresses to fat deposition and fibrosis that are amenable to liposuction treatment. Magnetic resonance imaging (MRI) for lymphedema can differentiate fat tissue from fluid, but estimating relative volumes remains problematic. METHODS AND RESULTS Patients underwent routine bilateral arm MRI both before and after liposuction for advanced lymphedema. The threshold-based level set (TLS) segmentation method was applied to segment the geometric image data and to measure volumes of soft tissue (fat, muscle, and lymph fluid) and bone. Bioimpedance testing (L-Dex®) to detect extracellular fluid was also used. Volumes derived by using TLS or girth measurement were evaluated and showed consistent agreement, whereas L-Dex showed no significant reduction between pre- and postoperative measures. The percentage median volume difference between the affected and unaffected sides was 132.4% for girth measures compared with 137.2% for TLS (p = 0.175) preoperatively, and 99.8% and 98.5%, respectively (p = 0.600), postoperatively. MRI segmentation detected reductions in fat (median 52.6%, p = 0.0163) and lymph fluid (median 66%, p = 0.094), but the volumes of muscle and bone were relatively constant. CONCLUSIONS MRI imaging with TLS technology may be a useful tool to quantitatively measure fat tissue and fluid for patients with advanced lymphedema and may assist in the selection of eligible liposuction candidates at initial assessment and follow-up of patients who proceed with surgery.
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Affiliation(s)
- Yuka Sen
- 1 Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia
| | - Yi Qian
- 1 Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia
| | - Louise Koelmeyer
- 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia
| | - Robert Borotkanics
- 3 Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology , Auckland, New Zealand
| | - Robyn Ricketts
- 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia
| | - Helen Mackie
- 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia
| | - Thomas C Lam
- 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia
| | - Kevin Ho Shon
- 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia
- 4 Macquarie Medical Imaging, Macquarie University Hospital, Macquarie University , Sydney, Australia
| | - Hiroo Suami
- 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia
| | - John Boyages
- 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia
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23
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Fibro-Lipo-Lymph-Aspiration With a Lymph Vessel Sparing Procedure to Treat Advanced Lymphedema After Multiple Lymphatic-Venous Anastomoses. Ann Plast Surg 2017; 78:184-190. [DOI: 10.1097/sap.0000000000000853] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Abstract
The amount of physical pressure plays an important role in complex decongestive therapy (CDT). As a function of pressure, microcirculation takes place between blood vessels and tissue. As part of the total lymphatic system, lymphatic vessels transport the lymphatic load from the interstitial space to the blood stream. The lymphatic vessel system, characterized by specific anatomical conditions like initial lymphatic vessels, precollectors, collectors, and lymphatic strains, is the therapeutic target of complex decongestive therapy. Components of CDT include manual lymphatic drainage, compression therapy, decongestive kinesitherapy, and good skin care, which increase the transport capacity of the lymphatic vessel system. Currently, CDT is acknowledged as the main conservative treatment of lymphedema of primary and secondary genesis, lipolymphedema, and phlebolymphedema. In clinical practice, we are increasingly confronted with edema of multifactorial genesis requiring a critical discussion and stocktaking of comprehensive clinical findings in terms of the indication for CDT. Therapeutic success depends on a joint application of all CDT components and patient compliance. To an increasing extent, medical research tries to combine successfully CDT with adjunct treatment options.
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Affiliation(s)
- B Heinig
- Zentrum für Physikalische und Rehabilitative Medizin, Krankenhaus Dresden-Friedrichstadt, Städtisches Klinikum, Akademisches Lehrkrankenhaus der Technischen Universität Dresden, Friedrichstr. 41, 01067, Dresden, Deutschland.
| | - U Wollina
- Klinik für Dermatologie & Allergologie, Krankenhaus Dresden-Friedrichstadt, Städtisches Klinikum, Akademisches Lehrkrankenhaus der Technischen Universität Dresden, Dresden, Deutschland
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26
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Doscher ME, Schreiber JE, Weichman KE, Garfein ES. Update on Post-mastectomy Lymphedema Management. Breast J 2016; 22:553-60. [DOI: 10.1111/tbj.12625] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Matthew E. Doscher
- Division of Plastic and Reconstructive Surgery; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York
| | - Jillian E. Schreiber
- Division of Plastic and Reconstructive Surgery; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York
| | - Katie E. Weichman
- Division of Plastic and Reconstructive Surgery; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York
| | - Evan S. Garfein
- Division of Plastic and Reconstructive Surgery; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York
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27
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Multisite Lymphaticovenular Bypass Using Supermicrosurgery Technique for Lymphedema Management in Lower Lymphedema Cases. Plast Reconstr Surg 2016; 138:262-272. [DOI: 10.1097/prs.0000000000002254] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Sedger LM, Tull DL, McConville MJ, De Souza DP, Rupasinghe TWT, Williams SJ, Dayalan S, Lanzer D, Mackie H, Lam TC, Boyages J. Lipidomic Profiling of Adipose Tissue Reveals an Inflammatory Signature in Cancer-Related and Primary Lymphedema. PLoS One 2016; 11:e0154650. [PMID: 27182733 PMCID: PMC4868287 DOI: 10.1371/journal.pone.0154650] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/15/2016] [Indexed: 12/12/2022] Open
Abstract
Cancer-related and primary lymphedema (LE) are associated with the production of adipose tissue (AT). Nothing is known, however, about the lipid-based molecules that comprise LE AT. We therefore analyzed lipid molecules in lipoaspirates and serum obtained from LE patients, and compared them to lipoaspirates from cosmetic surgery patients and healthy control cohort serum. LE patient serum analysis demonstrated that triglycerides, HDL- and LDL-cholesterol and lipid transport molecules remained within the normal range, with no alterations in individual fatty acids. The lipidomic analysis also identified 275 lipid-based molecules, including triacylglycerides, diacylglycerides, fatty acids and phospholipids in AT oil and fat. Although the majority of lipid molecules were present in a similar abundance in LE and non-LE samples, there were several small changes: increased C20:5-containing triacylglycerides, reduced C10:0 caprinic and C24:1 nervonic acids. LE AT oil also contained a signature of increased cyclopropane-type fatty acids and inflammatory mediators arachidonic acid and ceramides. Interestingly C20:5 and C22:6 omega-3-type lipids are increased in LE AT, correlating with LE years. Hence, LE AT has a normal lipid profile containing a signature of inflammation and omega-3-lipids. It remains unclear, however, whether these differences reflect a small-scale global metabolic disturbance or effects within localised inflammatory foci.
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Affiliation(s)
- Lisa M. Sedger
- Department of Clinical Medicine, Faculty of Medicine & Health Science, Macquarie University, Sydney, NSW, Australia
- * E-mail:
| | - Dedreia L. Tull
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Malcolm J. McConville
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - David P. De Souza
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Spencer J. Williams
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, VIC, Australia
- School of Chemistry, The University of Melbourne, Melbourne, VIC, Australia
| | - Saravanan Dayalan
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Daniel Lanzer
- Daniel Lanzer Clinic, Malvern, Melbourne, VIC, Australia
| | - Helen Mackie
- Macquarie University Hospital, North Ryde, Sydney, NSW, Australia
| | - Thomas C. Lam
- Macquarie University Hospital, North Ryde, Sydney, NSW, Australia
| | - John Boyages
- Department of Clinical Medicine, Faculty of Medicine & Health Science, Macquarie University, Sydney, NSW, Australia
- Macquarie University Hospital, North Ryde, Sydney, NSW, Australia
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29
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Functional and Therapeutic Indications of Liposuction: Personal Experience and Review of the Literature. Ann Plast Surg 2016; 75:231-45. [PMID: 25695452 DOI: 10.1097/sap.0000000000000055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Liposuction is the most common cosmetic surgical procedure worldwide. It has evolved from being designed primarily for body contouring to becoming essential adjunct to various other aesthetic procedures, greatly enhancing their outcome. Despite its hard clear differentiation between an aesthetic and therapeutic indication for some pathologic conditions, liposuction has been increasingly applied to a gamut of disorders as a therapeutic tool or to improve function. In fact, liposuction has ceased to define a specific procedure and became synonymous to a surgical technique or tool same as the surgical knife, laser, electrocautery, suture material, or even wound-dressing products. At present, there seems to be an enormous potential for the application of the basic liposuction technique in ablative and reconstructive surgery outside the realm of purely aesthetic procedures. The present review contemplates the various nonaesthetic applications of liposuction, displaying the enormous potentials of what should be considered a basic surgical technique rather than a specific aesthetic procedure. Implications of this new definition of liposuction should induce third-party public payers and insurance companies to reconsider their remuneration and reimbursement policies.
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31
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Teo I, Munnoch D. Referral patterns to a surgical lymphoedema service: 10 years of experience. J Plast Reconstr Aesthet Surg 2015; 68:1395-401. [DOI: 10.1016/j.bjps.2015.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 05/02/2015] [Accepted: 05/18/2015] [Indexed: 12/01/2022]
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32
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Fu MR, Deng J, Armer JM. Putting evidence into practice: cancer-related lymphedema. Clin J Oncol Nurs 2015; 18 Suppl:68-79. [PMID: 25427610 DOI: 10.1188/14.cjon.s3.68-79] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer-related lymphedema is a progressive and chronic syndrome of abnormal swelling and multiple symptoms resulting from cancer treatment. Even with modern medical advances, lymphedema remains a major health problem affecting thousands of cancer survivors. To provide healthcare professionals with evidence-based clinical practice guidelines for lymphedema treatment and management, a systematic review was conducted to evaluate 75 selected articles from 2009-2014 by the Oncology Nursing Society Putting Evidence Into Practice lymphedema team. Findings of the systematic review support complete decongestive therapy, compression bandages, and compression garments with highest evidence for best clinical practice. Weight management, full-body exercise, information provision, prevention, and early intervention protocols are likely to be effective for clinical practice. Historic recommendations for activity restriction and avoidance of aerobic and resistive exercises that limit cancer survivors' daily lives have been challenged with more evidence. Cancer survivors may not need to restrict activities such as resistive or aerobic exercises and weightlifting with gradual exercise progression. Future research should focus on providing high-level evidence using randomized clinical trials with larger samples and studying lymphedema beyond breast cancer.
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Affiliation(s)
- Mei R Fu
- College of Nursing, New York University, New York
| | - Jie Deng
- School of Nursing, Vanderbilt University, Nashville, TN
| | - Jane M Armer
- School of Nursing, University of Missouri, Columbia
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Boyages J, Kastanias K, Koelmeyer LA, Winch CJ, Lam TC, Sherman KA, Munnoch DA, Brorson H, Ngo QD, Heydon-White A, Magnussen JS, Mackie H. Liposuction for Advanced Lymphedema: A Multidisciplinary Approach for Complete Reduction of Arm and Leg Swelling. Ann Surg Oncol 2015; 22 Suppl 3:S1263-70. [PMID: 26122375 PMCID: PMC4686553 DOI: 10.1245/s10434-015-4700-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Indexed: 12/28/2022]
Abstract
Purpose This research describes and evaluates a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities. Methods A prospective clinical study was conducted at an Advanced Lymphedema Assessment Clinic (ALAC) comprised of specialists in plastic surgery, rehabilitation, imaging, oncology, and allied health, at Macquarie University, Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the ALAC. Eligibility criteria for liposuction included (i) unilateral, non-pitting, International Society of Lymphology stage II/III lymphedema; (ii) limb volume difference greater than 25 %; and (iii) previously ineffective conservative therapies. Of 55 eligible patients, 21 underwent liposuction (15 arm, 6 leg) and had at least 3 months postsurgical follow-up (85.7 % cancer-related lymphedema). Liposuction was performed under general anesthesia using a published technique, and compression garments were applied intraoperatively and advised to be worn continuously thereafter. Limb volume differences, bioimpedance spectroscopy (L-Dex), and symptom and functional measurements (using the Patient-Specific Functional Scale) were taken presurgery and 4 weeks postsurgery, and then at 3, 6, 9, and 12 months postsurgery. Results Mean presurgical limb volume difference was 45.1 % (arm 44.2 %; leg 47.3 %). This difference reduced to 3.8 % (arm 3.6 %; leg 4.3 %) by 6 months postsurgery, a mean percentage volume reduction of 89.6 % (arm 90.2 %; leg 88.2 %) [p < 0.001]. All patients had improved symptoms and function. Bioimpedance spectroscopy showed reduced but ongoing extracellular fluid, consistent with the underlying lymphatic pathology. Conclusions Liposuction is a safe and effective option for carefully selected patients with advanced lymphedema. Assessment, treatment, and follow-up by a multidisciplinary team is essential.
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Affiliation(s)
- John Boyages
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia. .,Genesis Cancer Care, Macquarie University Hospital, 3 Technology Place, Macquarie University, Sydney, NSW, Australia.
| | - Katrina Kastanias
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia
| | - Louise A Koelmeyer
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia
| | - Caleb J Winch
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia
| | - Thomas C Lam
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia
| | - Kerry A Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - David Alex Munnoch
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia.,Department of Plastic Surgery, Ninewells Hospital, Dundee, UK
| | - Håkan Brorson
- Plastic and Reconstructive Surgery, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Quan D Ngo
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia
| | - Asha Heydon-White
- The Clinic Physiotherapy, Macquarie University Hospital, 2 Technology Place, Macquarie University, Sydney, NSW, Australia
| | - John S Magnussen
- Macquarie Medical Imaging, Macquarie University Hospital, 3 Technology Place, Macquarie University, Sydney, NSW, Australia
| | - Helen Mackie
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia.,Mt. Wilga Rehabilitation Hospital, Hornsby, NSW, Australia
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Merchant SJ, Chen SL. Prevention and management of lymphedema after breast cancer treatment. Breast J 2015; 21:276-84. [PMID: 25772311 DOI: 10.1111/tbj.12391] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Lymphedema of the arm after breast cancer treatment continues to challenge clinicians worldwide. In this review, we examine the main modalities, both nonsurgical and surgical, to prevent and treat this as yet incurable condition.
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Affiliation(s)
- Shaila J Merchant
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, California
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Leung N, Furniss D, Giele H. Modern surgical management of breast cancer therapy related upper limb and breast lymphoedema. Maturitas 2015; 80:384-90. [PMID: 25747119 DOI: 10.1016/j.maturitas.2015.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 11/27/2022]
Abstract
Breast cancer is the commonest cancer in the UK. Advances in breast cancer treatment means that the sequelae of treatment are affecting more women and for a longer duration. Lymphoedema is one such sequela, with wide-ranging implications, from serious functional and psychological effects at the individual level to wider economic burdens to society. Breast cancer-related lymphoedema is principally managed by conservative therapy comprising compression garments and manual decongestive massage. This approach is effective for early stages of lymphoedema, but it is not curative and the effectiveness depends on patient compliance. Early surgical approaches were ablative, gave significant morbidity and hence, reserved for the most severe cases of refractory lymphoedema. However, recent non-ablative reconstructive surgical approaches have seen a revival of interest in the prevention or surgical management of breast cancer-related lymphoedema. This review examines the modern surgical techniques for the treatment of breast cancer-related lymphoedema. Liposuction reduces the volume and symptoms of lymphedema, but requires continual compressive therapy to avoid recurrence. Lymphatic reconstruction or bypass techniques including lymph node transfer (inguinal nodes are transferred to the affected limb), lymphatico-lymphatic bypass (lymphatics bypass the axilla using a lymph vessel graft reconstructing lymphatic flow from arm to neck) and lymphaticovenous anastomoses (lymphatics in the arm are joined to the venous system aiding lymph drainage) show promise in reducing lymphedema significantly. Further research is required, including into the role of primary lymphaticovenous anastomoses in the prevention of lymphedema at the time of axillary dissection.
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Affiliation(s)
- Nelson Leung
- Foundation Programme, Oxford Deanery, Oxford Radcliffe Hospitals NHS Trust, Oxford OX3 9DU, UK
| | - Dominic Furniss
- Department of Plastic and Reconstructive Surgery, Oxford Radcliffe Hospitals NHS Trust, Oxford OX3 9DU, UK
| | - Henk Giele
- Department of Plastic and Reconstructive Surgery, Oxford Radcliffe Hospitals NHS Trust, Oxford OX3 9DU, UK.
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Shaitelman SF, Cromwell KD, Rasmussen JC, Stout NL, Armer JM, Lasinski BB, Cormier JN. Recent progress in the treatment and prevention of cancer-related lymphedema. CA Cancer J Clin 2015; 65:55-81. [PMID: 25410402 PMCID: PMC4808814 DOI: 10.3322/caac.21253] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overview of important trends in the diagnosis, treatment, and management of cancer-related lymphedema.
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Hadamitzky C, Pabst R, Gordon K, Vogt PM. Surgical procedures in lymphedema management. J Vasc Surg Venous Lymphat Disord 2014; 2:461-8. [DOI: 10.1016/j.jvsv.2014.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 02/06/2014] [Accepted: 02/09/2014] [Indexed: 10/25/2022]
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Simultaneous Breast Reconstruction and Treatment of Breast Cancer–Related Upper Arm Lymphedema With Lymphatic Lower Abdominal Flap. Ann Plast Surg 2014; 73 Suppl 1:S12-7. [DOI: 10.1097/sap.0000000000000322] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Granzow JW, Soderberg JM, Kaji AH, Dauphine C. An Effective System of Surgical Treatment of Lymphedema. Ann Surg Oncol 2014; 21:1189-94. [DOI: 10.1245/s10434-014-3515-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Indexed: 11/18/2022]
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Tiwari P, Coriddi M, Salani R, Povoski SP. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options. World J Surg Oncol 2013; 11:237. [PMID: 24053624 PMCID: PMC3852359 DOI: 10.1186/1477-7819-11-237] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/05/2013] [Indexed: 11/24/2022] Open
Abstract
Lymphedema remains a poorly understood entity that can occur after lymphadenectomy. Herein, we will review the pathogenesis of lymphedema, diagnostic modalities and the natural history of extremity involvement. We will review the incidence of upper extremity lymphedema in patients treated for breast malignancies and lower extremity lymphedema in those treated for gynecologic malignancy. Finally, we will review traditional treatment modalities for lymphedema, as well as introduce new surgical treatment modalities that are under active investigation.
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Affiliation(s)
- Pankaj Tiwari
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Michelle Coriddi
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Abstract
Complex physical therapy is the main treatment for the secondary lymphedema after breast cancer. The low-level laser therapy (LLLT) has been used in order to stimulate lymphangiogenesis, encourage lymphatic motility, and reduce lymphostatic fibrosis. However, these factors could also favor the development of recurrence and metastasis. The objective of this study is to discuss the use of LLLT in the treatment of lymphedema after breast cancer. This study utilized a systematic review on the use of LLLT in the treatment of lymphedema after breast cancer. Evaluating quality of articles was conducted through the PEDro scale. Of the 41 articles identified, four were considered to be of high methodological quality (score ≥ 5). The low-level laser in the axillary region was performed in all studies. The control group was not similar across studies. The results presented showed that there was a reduction in limb volume in the group subjected to low-power laser when compared with other treatments. No studies have evaluated the risk of metastasis or relapse in the irradiated areas. Because no studies have included the complex physical therapy as the comparison group, we cannot claim that laser treatment is the best efficacy or effectiveness in lymphedema treatment after breast cancer. No studies have evaluated the hypothesis that the LLLT can increase the risk of recurrence or metastasis. Therefore, the questions about the safety of this procedure in cancer patients remain.
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