Page 15 - VOL 26 N. 72 - 2015

LYMPHATIC MICROSURGERY (LYMPHA) FOR CANCER-RELATED LYMPHOEDEMA PREVENTION
BOCCARDO F., CAMPISI C.C., MOLINARI L., SPINACI S., DESSALVI S., CAMPISI C.
Unit of Lymphatic Surgery (Chief: Prof. C. Campisi), Department of Surgery, IRCCS S. Martino – IST National Cancer Institute, University of Genoa, Italy
Introduction: The purpose of this manuscript is to assess the efficacy of direct multiple lymphatic-venous anastomoses (MLVA) in the prevention of peripheral lymphedema following axillary and groin lymph nodal dissection.
Materials and Methods: Authors report their clinical experience in treating patients with operable breast cancer, skin melanoma of the trunk and vulvar cancer requiring axillary and/or nodal dissection by carrying out MLVA between the blue lymphatics (from the arm or the leg) and a vein branch (collateral of the axillary or the great saphenous vein) simultaneously. Short and long term follow-up included circumferential measurements in all cases, lymphangitic attacks and lymphangioscintigraphy.
Results: Blue nodes in relation to lymphatic arm or leg drainage were identified. All blue nodes were resected anyhow and 2-4 main afferent lymphatics from the extremity could be prepared and used for anastomoses. Multiple lymphatic-venous anastomosis allowed to prevent secondary lymphedema. Lymphangioscintigraphy demonstrated the patency of microvascular anastomoses.
Conclusions: Disruption of the blue nodes and closure of arm lymphatics can explain the significantly high risk of lymphedema after axillary and groin dissection. MLVA proved to be a safe procedure for risk patients in order to prevent lymphedema of extremities.
LYMPHATIC MAPPING PRIOR TO SENTINEL NODE BIOPSY
M. MATTER
Switzerland
June 5, 2015 - Auditoire C. Roux
PLENARY SESSION 5
PATIENT EDUCATION AND LYMPHOEDEMA IN PARTICULAR SITUATIONS
EFFECTIVENESS OF PATIENT EDUCATION
M. SNEDDON
United Kingdom
INTERACTIONS BETWEEN OBESITY AND LYMPHEDEMA
Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares (Lymphoedèmes Primaires), Hôpital Cognacq-Jay, Paris, France
Obesity is defined as body mass index (BMI) exceeding 30 kg/m2. Interactions between lymphedema and weight were mostly studied in women after breast-cancer treatment and involve several fields. Among physiopathological mechanisms, which remain partially unelucidated, lymph accumulation leads to adipocyte and fibroblast activation, and subsequently to fibrosis and excess adipose tissue. Notably, obesity increases 3.6-fold the risk of developing upper limb lymphedema after breast-cancer therapy. Post-treatment weight variations (gain/loss) are also a risk factor and weight gain may also be considered a risk factor. For women with lymphedema, increasing BMI corresponded to lymphedema volume, i.e., its severity. Lymphedema management is essentially based on complex decongestive physiotherapy. During the first intensive phase, obesity is a factor negatively influencing lymphedema-volume reduction. During the maintenance phase, re-increasing lymphedema volume is associated to BMI independently of compliance (wearing an elastic sleeve, low-stretch bandage). For obese women with breast cancer-related lymphedema, weight loss had a demonstrated positive impact on decreased lymphedema volume. In conclusion, preventing obesity is essential to limiting lymphedema in women with breast cancer. Lymphedema management should also include weight control and weight loss, if necessary, with adapted diet. Further studies are needed to confirm these results for primary and secondary lower limb lymphedema, after pelvic cancer treatment.
Key words: obesity, lymphedema, breast cancer.
S. VIGNES
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015