Looking into secondary lymphedema

Long-term patency of multiple lymphatic-venous anastomoses in cancer-related lymphedema: A single center observational study

OBJECTIVES

Lymphedema is always initially treated by combined decongestive physiotherapy (CDP). Those cases, refractory to CDP, may be managed by surgical therapy. One of the most used microsurgical procedures is represented by the technique of lymphatic-venous anastomosis (LVA). But very few papers report long term results of LVA. The aim of this study is to assess the long-term patency of multiple lymphatic-venous anastomosis (MLVA) for the treatment of secondary lymphedemas.

METHODS

From January 2014 to December 2014, 101 patients (mean age: 56.94 ± 8.98 years; female/male: 86/15) affected by secondary cancer-related lymphedema (38 lower and 63 upper limbs) were treated by MLVA. All lymphedemas had previously been treated by conservative therapy without sustained results. Many patients (78%) had 1-3 episodes of acute lymphangitis/year. Lymphoscintigraphy, venous duplex-ultrasonography, and abdominal or axillary ultrasound investigation were performed preoperatively. MLVA patency was assessed by the lymphatic transport index (LyTI) and lymphoscintigraphic pattern.

RESULTS

At 1 year after surgery, excess volume reduction was 75%-90% in the early stage II secondary lymphedemas, and 60%-75% in the late stage II. The decrease in volume maintained stability in the 5-years follow-up period. Two more advanced lower and one upper limb lymphedemas had 45%-60% reduction. LyTI showed a significant decrease between the preoperative mean value (31.7 ± 9.43) and after 18 months from surgery (11.2 ± 1.91) (p < .001). MLVA patency was shown in 98 (97%) patients. No patients had evidence of postoperative lymphangitis.

CONCLUSIONS

This study demonstrated the long-term patency of MLVA in the treatment of cancer-related lymphedemas.

Lymphedema and Lymphovenous Bypass: Perioperative Nursing Implications

Lymphedema-the accumulation of fluid in tissues, usually in the upper and lower extremities-often results from lymph node dissection or radiation and can cause painful and debilitating swelling that may interfere with a patient's daily living activities and quality of life. The goal of treatment for lymphedema is to reduce the volume of fluid in the affected area. Lymphedema is staged according to presenting characteristics, and interventions may be surgical or nonsurgical, such as complex decongestive therapy. Lymphovenous bypass is a surgical procedure performed for the management of lymphedema and involves rerouting microvascular channels to allow for the drainage of fluid that has accumulated in the lymphatic tissue of the upper or lower extremities. It requires supermicrosurgery techniques because of the small size of the vessels being anastomosed. Perioperative nursing implications for lymphovenous bypass include OR preparation and providing emotional support for patients living with lymphedema.