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All TopicsForum: Lymphedema → Topic: Microsurgery after breast cancer treatment

Topic: Microsurgery after breast cancer treatment

Forum: Lymphedema — Risks, tips for prevention, and info about products that can address the symptoms of lymphedema.

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Apr 23, 2009 09:44AM - edited Apr 23, 2009 09:45AM by kira

We've looked into this surgery, and bc.org has evaluated the study as well, and unfortunately it is not a cure, and is considered experimental and not covered by insurance: I recently spoke to Dr. Chang's office and here's our info from StepupSpeakout:Lymphaticovenular Bypass for Management of Lymphedema in Breast Cancer Patients: A Prospective Analysis

David W. Chang, M.D.; MD Anderson Cancer Center, Houston TX

"Purpose: Lymphedema is a common and debilitating condition following surgical and/or radiation therapy for breast cancer. However, lymphedema is difficult to manage and surgical options have been limited and controversial. The purpose of this prospective study is to provide preliminary analysis of lymphaticovenular bypass for upper limb lymphedema in patients with breast cancer.

Methods: Twenty consecutive patients with lymphedema of upper extremity secondary to treatment of breast cancer who underwent lymphaticovenular bypass using "super-microsurgical" approach from December 2005 to September 2008 were evaluated. Mean age was 54 years. Of 20 patients 16 patients had received preoperative XRT and all patients had received axillary lymph node dissection. All patients presented with stage 2 or 3 lymphedema with mean duration of 4.8 years and the mean volume differential of lymphedema arm compared to unaffected arm of 34%. Evaluation included qualitative assessment and quantitative volumetric analysis prior to surgery, at 1 month, 3 months, 6 months and at 1 year following the procedure. All data were collected prospectively.

Results: Mean number of bypasses performed on each patient was 3.5 and the size of bypasses ranged from 0.3 mm to 0.8 mm. Mean operative time was 3.3 hours (2 to 5 hours). Hospital stay was < 24 hours in all patients. Mean follow up was 18 months. Of 20 patients, 19 patients reported significant clinical improvement following the procedure. Mean volume reduction at 1 month was 29%, at 3 months 36%, at 6 month 39%, and at 1 year was 35% (Fig 1). In 3 patients with clinical improvement, no significant quantitative improvement was noted. There were no postoperative complications or exacerbation of lymphedema.

Conclusion: Lymphaticovenular bypass using "super-microsurgical" approach appear to be effective in improving the severity of lymphedema in patients with breast cancer. Long term analysis is needed."
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Here's a link to the abstract: http://www.ncbi.nlm.nih.gov/pubmed/19052859

Comments by the StepUp-SpeakOut Editorial Board:

Note the small number of patients on whom this technique was performed: 20 women with LE following BC treatment. Of those 20 patients, 19 reported "clinical" improvement (presumably qualitative assessment of some sort) after the bypass surgery. Sixteen of the 19 patients who reported a "clinical" improvement also had a significant "quantitative" improvement (presumably a reduction in arm volume measurement); but the other 3 who had a "clinical" improvement did not have a significant improvement in quantitative measurements. The patients were followed for 18 months after their bypass surgeries, but data are only reported for 1 year post-bypass surgery.

It's an interesting but preliminary study. They need greater numbers of patients and more follow-up time (and perhaps a more comprehensive assessment) to see if this really works. Also, there is no mention whether other, conventional LE therapy was provided to those women while they were recovering from their bypass surgery. (For a fuller explanation, see the analysis of an article about this procedure at BreastCancer.org from which we quote:

"Lymphaticovenular bypass surgery is difficult to do and requires special surgical training. This may be one reason why it's not a common lymphedema treatment. While the women in this study did receive some benefit from the surgery, the decrease in arm size didn't last and none of the women were considered cured of lymphedema. More, larger studies are needed to see if the results last over time, as well to figure out if the surgery works for a variety of women. " [Emphasis supplied]

We have written to Dr. Chang and he was quick to respond and interested in conveying information. This is what we learned:

They measure by volume displacement;
The surgery is not curative;
The surgery is currently considered experimental and not covered by Medicare or insurance;
Dr. Chang is committed to helping women with LE:

 http://www.stepup-speakout.org/otheruntestedmodalities.htm

 Here's the review of the literature from bc.org

www.breastcancer.org/tips/new_... 

It's interesting that the link above is to an injury lawyer. LE is collateral damage, but I'm not aware of people initiating lawsuits around it.

Kira 

Knowledge is the antidote to fear, Ralph Waldo Emerson Dx 5/10/2008, IDC, 1cm, Stage IB, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Sep 13, 2017 04:29PM hugz4u wrote:

Bumping. BTW that's a interesting post above. Anyone with experiences. Please give us an update. Much th

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Sep 14, 2017 04:09AM MRock wrote:

Likewise interested. I'll have my first evaluative appointment for this procedure in early December and I'd love to hear any reports.

I'll of course post here or wherever members prefer, if I do go ahead.

Hugs to all

Dx 7/2015, ILC, Left, 4cm, Stage IIIC, 32/33 nodes, ER+/PR+, HER2- Radiation Therapy External: Lymph nodes, Chest wall Chemotherapy Cytoxan (cyclophosphamide), Ellence (epirubicin), Taxol (paclitaxel) Surgery Mastectomy: Left Hormonal Therapy Femara (letrozole)
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Sep 14, 2017 04:59AM AussieElaine wrote:

Hello all, I haven't been on here for a while, lots of family issues, never the less here I am. I had LVA surgery in June 2015 in Oxford UK. it was explained to me that as I was stage 3 my lymphoedema could not be cured but I was a good candidate for the surgery and decided to go ahead. I was awake for the surgery and had 16 anastomoses (bypasses). I was asked to wear my compression garments and to continue with the MLD and also to exercise especially swimming for a year afterwards. Have had a fantastic outcome, my arm is very soft and the measurement for the amount of lymph fluid dropped dramatically. I had follow up through Skype as I am in Australia but see my therapist occasionally. The only thing that bothers it is extreme humidity. I wear my sleeve when flying and exercising and have had no problems. Regardless of whatever the outcome was, I felt that I had to try everything as I was utterly distraught and felt that my life was not worth living being such a freak. Good luck to anyone considering this surgery.

Oncotype 15.She needed a hero so she became one...seen on a t-shirt Dx 6/4/2014, ILC, <1cm, Stage IIB, Grade 2, 0/2 nodes, ER+/PR-, HER2- Dx 6/4/2014, IDC, 2cm, Stage IIB, Grade 2, 1/13 nodes, ER+/PR+, HER2- Surgery 6/20/2014 Lumpectomy: Right; Lymph node removal: Right, Underarm/Axillary Surgery 6/20/2014 Lumpectomy: Left; Lymph node removal: Left, Sentinel Chemotherapy 8/15/2014 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 11/10/2014 Breast, Lymph nodes Hormonal Therapy 12/26/2014 Arimidex (anastrozole)
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Sep 14, 2017 11:53AM hugz4u wrote:

Aussie Extremely happy for you. Thx for encouraging post. Will the docs still follow you for a while. Do they have a study going to show success and failures over a long time period. If they don't we will never know the outcomes except by people posting. Many thanks to you!

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