New procedure might help prevent lymphedema

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Posted on 21 January 2014

Lymphedema

Lymphedema — typically, swelling of the arm and hand — can be a lifelong problem for women who have undergone surgery for advanced-stage breast cancer.
As part of treatment, surgeons often remove many lymph nodes from the arm and underarm to try to limit the spread of cancer. The cancer would most likely be found there first, because underarm lymph nodes drain lymph — a clean liquid that transports waste and bacteria out of soft tissue — from the breast.

But the lymph-node removal — along with the build-up of fibrous connective tissue following radiation therapy — can result in fluid retention. If not treated with compressive wrapping and massage, this fluid build-up can lead to inflammation, severe swelling and skin infection.

is halfway through a small clinical trial testing the effectiveness and safety of a new technique that could spare patients the discomfort and inconvenience of lymphedema.

Dr. Sheldon Marc Feldman, breast surgery division chief, and colleagues at Columbia University have performed the LYMPHA technique (lymphatic microsurgical preventive healing approach) on a dozen patients. They plan to use the procedure on 30 patients in all before initiating a large-scale study with several other major medical institutions.

Feldman estimates his team should complete its trial by the end of 2014. He expects the technique to become standard protocol for treating patients who would otherwise be at greater risk of developing lymphedema.

Developed by Drs. Francesco Boccardo and Corradino Campisi at the University of Genoa in Italy, the technique involves creating a bypass to restore lymphatic flow by connecting lymph vessels to a branch of the axillary vein, according to Feldman, who visited Italy to watch surgeons use the technique.

“The good news is that even with patients with advanced disease, most of these patients are being cured of breast cancer,” Feldman said. “We are curing them of their cancer, but if they develop lymphedema, they have serious quality-of-life issues.”

Because most women are diagnosed with breast cancer at an early stage, they don’t need aggressive lymph-node removal, Feldman said. This technique is for the 20 percent to 25 percent of patients who are diagnosed in later stages, he said.

For people diagnosed with advanced breast cancer who undergo radiation therapy in addition to complete lymph-node dissection, 40 percent are at risk of developing lymphedema, according to Feldman.

For the first time, physicians have a way to help that group of patients avoid lymphedema, he said: “We think this is a big deal.”

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