Lymphatic venous anastomosis (LVA) for 2ndary arm lymphedema

[patoco]

Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema.

A prospective study of 11 LVA procedures in 10 patients
with breast cancer related lymphedema and a critical review of the
literature.

Breast Cancer Res Treat. 2008 Feb 13

Abstract

Objective

The incidence of breast cancer related lymphedema (BCRL) varies
between 7-35% depending on the combination of treatment modalities.
Early detection of BCRL is crucial in order to start an effective non-
operative treatment program. Because of the lack of prospective
research on this topic, this study was undertaken to prospectively
determine the effect of Lympho Venous Anastomosis (LVA) on BCRL and to review the current literature.

Study design and methods

Ten patients who were previously treated for breast cancer by surgery,
radiotherapy, and chemotherapy, and were unresponsive to 12-weeks of
non-operative treatment, underwent an LVA procedure (Degni-Cordeiro).
Objective measurements were gathered for circumferential measurement
and water volumetry, and quality of life. Various types of
lymphoscintigraphy were carried out pre-operatively and post-
operatively at 3 and 12 months. Treatment was embedded in a
multidisciplinary setting.

Results

Post-operative volume measurements initially showed a 4.8% reduction
of lymphedema at 3 months and a 2% reduction after one year. Various
scintigraphic parameters showed some improvement. Quality of life
questionnaires reported minimal improvement. Reviewing the literature,
only retrospective studies were found; these reported varying results
for LVA procedures. The selection of patients, classification of
lymphedema, indications and types of LVA, and additional therapeutic
options were heterogeneous, not comparable, and lacked a validated
method of effect-assessment.

Conclusions

Our results showed a minimal reduction in volume of lymphedema
following LVA; in the literature, there was no convincing evidence of
the success of LVA. Non-operative treatment and elastic stockings are
still preferred by most patients with lymphedema, especially in early
stages with few irreversible changes.

Keywords Lympho-venous anastomosis (LVA) - Microsurgery - Evidence-
based medicine - Lymphoscintigraphy - Inverse water volumetry - Review
- Breast cancer related lymphedema

Springerlink

http://www.springerlink.com/content/00016731188426w5/

* * * * * *

For additional information:

Arm Lymphedema

http://www.lymphedemapeople.com/wiki/do ... lymphedema

Complications of Breast Cancer Radiotherapy

http://www.lymphedemapeople.com/wiki/do ... diotherapy

Lymphedema Therapy and the Quality of Life for Breast Cancer Patients

http://www.lymphedemapeople.com/wiki/do ... r_patients

Arm and Leg Swelling After Cancer

http://www.lymphedemapeople.com/wiki/do ... ter_cancer

Lymphedema After Cancer - How Serious Is It?

http://www.lymphedemapeople.com/wiki/do ... ious_is_it

* * * * * *

Pat O'Connor
Lymphedema People
http://www.lymphedemapeople.com