Lymphedema is an accumulation of fluid due to disruption of lymphatic drainage. Lymphedema can be caused by congenital or inherited abnormalities in the lymphatic system (primary lymphedema) but is most often caused by acquired damage to the lymphatic system (secondary lymphedema). Breast cancer treatment is one of the most common causes of secondary lymphedema. Both the surgical removal of lymph nodes and radiotherapy are associated with the development of lymphedema in individuals with breast cancer.
Physiological microsurgical techniques have been developed in an effort to improve lymphatic circulation and thereby decrease symptoms and risk of infection. These surgical interventions can be broadly grouped into two procedures:
Reconstruct or bypass the obstructed lymphatic vessels to improve lymphatic drainage (lymphatico-lymphatic bypass, lymphovenous bypass and lymphaticovenular anastomosis)
Preventative lymphaticovenular anastomosis is performed during nodal dissection or reconstructive surgery and involves anastomosing arm lymphatics to a collateral branch of an axillary vein. This procedure is also known as the Lymphatic Microsurgical Preventing Healing Approach (LYMPHA).
Transfer lymph tissue into an obstructed area to reestablish lymphatic flow (autologous lymph node transplantation and vascularized lymph node transfer).
Lymphatic physiologic microsurgery for the treatment of breast cancer-related lymphedema, including, but not limited to, the following is considered investigational:
Autologous lymph node transplantation
Vascularized lymph node transfer
Lymphatic physiologic microsurgery performed during nodal dissection or breast reconstruction for the prevention of breast cancer-related lymphedema, including, but not limited to, lymphaticovenular anastomosis (Lymphatic Microsurgical Preventing Healing Approach [LYMPHA]) is considered investigational.
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There is a lack of high-quality evidence published in peer-reviewed journals to evaluate the effectiveness of this technology on health outcomes.
BlueCross BlueShield Association. Evidence Positioning System. (10:2020). Surgical treatments for breast cancer-related lymphedema (7.01.162). Retrieved July 7, 2021 from https://www.evidencepositioningsystem.com/. (22 articles and/or guidelines reviewed)
Cornelissen, A.J.M., Beugels, J., Ewalds, L., Heuts, E.M., Keuter, X.H.A., Piatkowski, A., et al. (2018). The effect of lymphaticovenous anastomosis in breast cancer-related lymphedema: a review of the literature. Lymphatic Research and Biology, 16 (5), 426-434. Abstract retrieved October 16, 2018 from PubMed database.
Demiri, E., Dionyssiou, D., Tsimponis, A., Goula, O.C., Milothridis, P., Pavilidis, L., et al. (2018). Donor-site lymphedema following lymph node transfer for breast cancer-related lymphedema: a systematic review of the literature. Lymphatic Research and Biology, 16 (1), 2-8. Abstract retrieved October 16, 2018 from PubMed database.
Dionyssiou, D., Demiri, E., Tsimponis, A., Sarafis, A., Mpalaris, V., Tatsidou, G., & Arsos, G. (2016). A randomized control study of treating secondary stage II breast cancer-related lymphoedema with free lymph node transfer. Breast Cancer Research and Treatment, 156 (1), 73-79. Abstract retrieved October 16, 2018 from PubMed database.
Jørgensen, M.G., Touserkani, N.M., & Sørensen, J.A. (2018). The effect of prophylactic lymphovenous anastomosis and shunts for preventing cancer-related lymphedema: a systematic review and meta-analysis. Microsurgery, 38 (5), 576-585. Abstract retrieved October 16, 2018 from PubMed database.
Nguyen, A.T., Suami, H., Hanasono, M.M., Womack, V.A., Wong, F.C., & Chang, E.I. (2017). Long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema. Journal of Surgical Oncology, 115 (1), 84-89. Abstract retrieved October 16, 2018 from PubMed database.
Rosian, K., & Stanak, M. (2019). Efficacy and safety assessment of lymphovenous anastomosis in patients with primary and secondary lymphoedema: A systematic review of prospective evidence. Microsurgery, 39 (8), 763- 772. (Level 2 evidence)
Scaglioni, M.F., Arvanitakis, M., Chen, Y.C., Giovanoli, P., Chia-Shen Yang, J., & Chang, E. (2018). Comprehensive review of vascularized lymph node transfers for lymphedema: outcomes and complications. Microsurgery, 38 (2), 222-229. Abstract retrieved October 16, 2018 from PubMed database.
Scaglioni, M.F., Fontein, D.B.Y., Arvanitakis, M., & Giovanoli, P. (2017). Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema. Microsurgery, 37 (8), 947-953. Abstract retrieved October 16, 2018 from PubMed database.
Winifred S. Hayes, Inc. Health Technology Assessment. (2019, October; last update search February 2021). Microsurgery for primary prevention of breast cancer related lymphedema. Retrieved June 7, 2021 from www.Hayesinc.com/subscribers. (40 articles and/or guidelines reviewed)
Winifred S. Hayes, Inc. Health Technology Assessment. (2020, August). Lymph tissue transfer for the physiological microsurgical treatment of lymphedema. Retrieved August 26, 2020 from www.Hayesinc.com/subscribers. (42 articles and/or guidelines reviewed)
Winifred S. Hayes, Inc. Health Technology Assessment. (2020, June). Lymphovenous anastomosis for the physiological microsurgery treatment of lymphedema. Retrieved August 26, 2020 from www.Hayesinc.com/subscribers. (34 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 3/2/2019
MOST RECENT REVIEW DATE: 8/12/2021
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