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Five-Year Breast Surgeon Experience in LYMPHA at Time of ALND for Treatment of Clinical T1–4N1–3M0 Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Breast cancer-related lymphedema (BCRL) is a source of postoperative morbidity for breast cancer survivors. Lymphatic microsurgical preventive healing approach (LYMPHA) is a technique used to prevent BCRL at the time of axillary lymph node dissection (ALND). We report the 5-year experience of a breast surgeon trained in LYMPHA and investigate the outcomes of patients who underwent LYMPHA following ALND for treatment of cT1–4N1–3M0 breast cancer.

Methods

A retrospective review of patients with cT1–4N1–3M0 breast cancer was performed in patients who underwent ALND with and without LYMPHA. Diagnosis of BCRL was made by certified lymphedema therapists. Descriptive statistics and lymphedema surveillance data were analyzed using results of Fisher’s exact or Wilcoxon rank-sum tests. Logistic regression and propensity matching were performed to assess the reduction of BCRL occurrence following LYMPHA.

Results

In a 5-year period, 132 patients met inclusion criteria with 76 patients undergoing LYMPHA at the time of ALND and 56 patients undergoing ALND alone. Patients who underwent LYMPHA at the time of ALND were significantly less likely to develop BCRL than those who underwent ALND alone (p = 0.045). Risk factors associated with BCRL development were increased patient age (p = 0.007), body mass index (BMI) (p = 0.003), and, in patients undergoing LYMPHA, number of positive nodes (p = 0.026).

Conclusions

LYMPHA may be successfully employed by breast surgeons trained in lymphatic–venous anastomosis at the time of ALND. While research efforts should continue to focus on prevention and surveillance of BCRL, LYMPHA remains an option to reduce BCRL and improve patient quality of life.

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Acknowledgment

Research is supported by the University of Florida Ann and Ira Horowitz Fund for Breast Cancer Research. Dr. Herremans and Dr. Riner are supported by the National Human Genome Research Institute T32 HG008958. Melany Ailin Vidret assisted in data collection.

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Authors and Affiliations

  1. Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA

    Kelly M. Herremans MD, Morgan P. Cribbin BS, BA, Andrea N. Riner MD, MPH, Dan W. Neal MS, Tracy L. Hollen PA-C, Pamela Clevenger RN, Mark M. Leyngold MD, Sarah S. Virk MD, Christiana M. Shaw MD & Lisa R. Spiguel MD

  2. Department of Physical Therapy, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA

    Derly Munoz PT, CLT, MTC, CFC, ATRIC & Shannon Blewett PT, CLT

  3. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA

    Fantine Giap MD, Paul G. Okunieff MD, Nancy P. Mendenhall MD & William M. Mendenhall MD

  4. Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA

    Julie A. Bradley MD, Raymond B. Mailhot-Vega MD, MPH & Eric Brooks MD, MHS

  5. Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA

    Karen C. Daily DO & Coy D. Heldermon MD, PhD

  6. Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA

    Julia K. Marshall MD & Mariam W. Hanna MD

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  1. Kelly M. Herremans MD
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  23. Lisa R. Spiguel MD
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Corresponding author

Correspondence to Lisa R. Spiguel MD.

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Herremans, K.M., Cribbin, M.P., Riner, A.N. et al. Five-Year Breast Surgeon Experience in LYMPHA at Time of ALND for Treatment of Clinical T1–4N1–3M0 Breast Cancer. Ann Surg Oncol 28, 5775–5787 (2021). https://doi.org/10.1245/s10434-021-10551-8

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