Evaluation of Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) for the prevention of breast cancer-related lymphedema after axillary lymph node dissection using bioimpedance spectroscopy |
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| Affiliation: | 1. Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan;2. Department of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Japan;3. Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan;4. Department of Plastic and Reconstructive Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan;5. Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan;6. Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan;7. Department of Plastic and Reconstructive Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe City, Japan;8. Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College, Tokyo, Japan;9. Department of Plastic and Reconstructive Surgery, Osaka Medical College, Takatsuki, Japan;10. Clinical Research Center, Chiba University Hospital, Chiba, Japan;1. Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China;2. Department of Gastroenterology, Lishui City People''s Hospital, Lishui, 323000, Zhejiang, China;1. Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;2. Department of Pathology, Complejo Hospitalario Metropolitano CSS, Panama, Panama;3. Department of Pathology, Azienda Ospedaliera di Padova, Padua, Italy;4. Department of Biomedical and Neuromotor Sciences (DIBINEM)-Surgical Pathology Section-Alma Mater Studiorum, University of Bologna, Italy;5. IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;6. Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;1. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway;2. Department of Clinical Medicine K1, University of Bergen, Bergen, Norway;3. Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway;4. Department of Oncology, Oslo University Hospital, Oslo, Norway;5. Institute of Clinical Medicine, University of Oslo, Oslo, Norway;6. Department of Registration, Cancer Registry of Norway, Oslo, Norway;7. University of Bergen, Bergen, Norway;1. Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China;2. Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China;3. Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, China;4. Department of General Surgery (Thyroid Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China;5. Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, China;1. Plastic and Reconstructive Surgeon and Fellow at “L''Institut Du Sein-The Paris Breast Centre”, Paris, France;2. Oncoplastic Breast Surgeon at “L''Institut Du Sein-The Paris Breast Centre”, Paris, France;3. General Surgeon and Fellow at “L''Institut Du Sein-The Paris Breast Centre”, Paris, France |
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| Abstract: | BackgroundLymphedema is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 20%. Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) is a safe and relatively simple method, which decreases incidence of lymphedema dramatically. Our initial study showed an 88% decrease in clinical lymphedema rate. In the initial study, we used arm circumference measurement for the diagnosis of lymphedema and median follow up was 15 months. The aim of this study was to confirm these results after a long-term follow up period and by using bioimpedance spectroscopy (L-Dex) technology in detecting lymphedema.Study designAll patients, undergoing ALND with or without SLYMPHA between January 2014 and November 2020 were included in the study. Patients with no postoperative L-Dex measurements were excluded. A L-Dex score outside the normal range (±10 L-Dex unit) or ≥10 L-Dex unit increase above patient's baseline was considered as lymphedema. The incidence of lymphedema was compared between patients with and without SLYMPHA.Results194 patients were included in the study. 57% of cohort underwent SLYMPHA. Mean follow-up time was 47 ± 37 months. Patients, who underwent SLYMPHA, had a significantly lower rate of lymphedema (16% vs 32%; p = 0.01; OR 0.4 0.2–0.8]).ConclusionSLYMPHA is a safe and relatively simple method, which continued its efficacy after a long-term follow up period. It should be considered as an adjunct procedure to ALND for all patients during initial surgery. |
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| Keywords: | Lymphedema Breast cancer SLYMPHA Prevention Bioimpedance spectroscopy |
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