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Background <p>Supermicrosurgical lymphaticovenous anastomosis (LVA)is becoming popular for the management of breast cancer-related lymphedema (BCRL), but mainly provided in well-developed countries. Little is known on possibility of LVA with limited resources. This study aimed to evaluate feasibility of LVA in Egypt, where latest devices are not available.</p> Methods <p>Medical records of patients who underwent LVA for progressive BCRL were reviewed. All patients were refractory to conservative treatment for 6 months or longer. As devices for near-infrared fluorescent lymphography was not available, a conventional high-frequency (18-MHz) ultrasound was used to localize the lymph vessels and veins for LVA. LVA was done using conventional microsurgery sets and 10 − 0 nylon sutures under an operating microscope with 40 times magnification. One-year postoperative results were evaluated based on upper extremity lymphedema index (UEL index), cellulitis frequency, and subjective symptoms.</p> Results <p>Twenty-three patients were included. The number of LVAs per limb ranged from 2 to 3 (average, 2). Lymph vessel detection rate was 92.6% (50/54). Ten (43.5%) patients with dermal backflow (DB) showed 19.2% postoperative volume reduction based on UEL index after one year. Thirteen (56.5%) patients without dermal backflow showed only 2% reduction. Postoperative UEL index was significantly lower than preoperative UEL index (123.5 ± 7.3&#xa0;ml vs. 136.4 ± 9.4 ml, <i>P</i> = 0.017). Postoperative cellulitis frequency was decreased compared to preoperative one (2.15 ± 0.85 vs. 0.09 ± 0.18 attack/year, <i>P</i> ˂ 0.001). 13(56.5%) patients reported improvement in all subjective symptoms; limb tension improvement in 18 (78.3%) patients, limb heaviness in 15 (65.2%), and overall limb mobility in 13 (56.5%).</p> Conclusions <p>LVA could be safely and effectively performed in limited resources settings without latest device for lymphatic mapping nor supermicrosurgery instruments. A conventional high-frequency ultrasound allows lymphatic and venous mapping useful for LVA. LVA should not be given up even with limited resources.</p>

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Supermicrosurgical lymphaticovenous anastomosis for breast cancer related lymphedema in low resources settings

  • 期刊论文

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  • 发表日期：

    2025年4月24日

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  • Tarek Hashem,
  • Takumi Yamamoto

摘要

Background

Supermicrosurgical lymphaticovenous anastomosis (LVA)is becoming popular for the management of breast cancer-related lymphedema (BCRL), but mainly provided in well-developed countries. Little is known on possibility of LVA with limited resources. This study aimed to evaluate feasibility of LVA in Egypt, where latest devices are not available.

Methods

Medical records of patients who underwent LVA for progressive BCRL were reviewed. All patients were refractory to conservative treatment for 6 months or longer. As devices for near-infrared fluorescent lymphography was not available, a conventional high-frequency (18-MHz) ultrasound was used to localize the lymph vessels and veins for LVA. LVA was done using conventional microsurgery sets and 10 − 0 nylon sutures under an operating microscope with 40 times magnification. One-year postoperative results were evaluated based on upper extremity lymphedema index (UEL index), cellulitis frequency, and subjective symptoms.

Results

Twenty-three patients were included. The number of LVAs per limb ranged from 2 to 3 (average, 2). Lymph vessel detection rate was 92.6% (50/54). Ten (43.5%) patients with dermal backflow (DB) showed 19.2% postoperative volume reduction based on UEL index after one year. Thirteen (56.5%) patients without dermal backflow showed only 2% reduction. Postoperative UEL index was significantly lower than preoperative UEL index (123.5 ± 7.3 ml vs. 136.4 ± 9.4 ml, P = 0.017). Postoperative cellulitis frequency was decreased compared to preoperative one (2.15 ± 0.85 vs. 0.09 ± 0.18 attack/year, P ˂ 0.001). 13(56.5%) patients reported improvement in all subjective symptoms; limb tension improvement in 18 (78.3%) patients, limb heaviness in 15 (65.2%), and overall limb mobility in 13 (56.5%).

Conclusions

LVA could be safely and effectively performed in limited resources settings without latest device for lymphatic mapping nor supermicrosurgery instruments. A conventional high-frequency ultrasound allows lymphatic and venous mapping useful for LVA. LVA should not be given up even with limited resources.