title: Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema.
abstract: BACKGROUND
  As many as 40 % of breast cancer patients undergoing axillary lymph node dissection (ALND) and radiotherapy develop lymphedema. We report our experience performing lymphatic-venous anastomosis using the lymphatic microsurgical preventive healing approach (LYMPHA) at the time of ALND. This technique was described by Boccardo, Campisi in 2009.
  
  
  METHODS
  LYMPHA was offered to node-positive women with breast cancer requiring ALND. Afferent lymphatic vessels, identified by injection of blue dye in the ipsilateral arm, were sutured into a branch of the axillary vein distal to a competent valve. Follow-up was with pre- and postoperative lymphoscintigraphy, arm measurements, and (L-Dex®) bioimpedance spectroscopy.
  
  
  RESULTS
  Over 26 months, 37 women underwent attempted LYMPHA, with successful completion in 27. Unsuccessful attempts were due to lack of a suitable vein (n = 3) and lymphatic (n = 5) or extensive axillary disease (n = 1). There were no LYMPHA-related complications. Mean follow-up time was 6 months (range 3-24 months). Among completed patients, 10 (37%) had a body mass index of ≥30 kg/m(2) (mean 27.9 ± 6.8 kg/m(2), range 17.4-47.6 kg/m(2)), and 17 (63%) received axillary radiotherapy. Excluding two patients with preoperative lymphedema and those with less than 3-month follow-up, the lymphedema rate was 3 (12.5%) of 24 in successfully completed and 4 (50 %) of 8 in unsuccessfully treated patients.
  
  
  CONCLUSIONS
  Our transient lymphedema rate in this high-risk cohort of patients was 12.5%. Early data show that LYMPHA is feasible, safe, and effective for the primary prevention of breast cancer-related lymphedema.
authors.affiliation: Division of Breast Surgery, Columbia University Medical Center, New York-Presbyterian Hospital, Columbia University, New York, NY, USA, sf2388@cumc.columbia.edu.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Feldman
authors.forename: Hannah
authors.initials: H
authors.lastname: Bansil
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ascherman
authors.forename: Robert
authors.initials: R
authors.lastname: Grant
authors.forename: Billie
authors.initials: B
authors.lastname: Borden
authors.forename: Peter
authors.initials: P
authors.lastname: Henderson
authors.forename: Adewuni
authors.initials: A
authors.lastname: Ojo
authors.forename: Bret
authors.initials: B
authors.lastname: Taback
authors.forename: Margaret
authors.initials: M
authors.lastname: Chen
authors.forename: Preya
authors.initials: P
authors.lastname: Ananthakrishnan
authors.forename: Amiya
authors.initials: A
authors.lastname: Vaz
authors.forename: Fatih
authors.initials: F
authors.lastname: Balci
authors.forename: Chaitanya R
authors.initials: CR
authors.lastname: Divgi
authors.forename: David
authors.initials: D
authors.lastname: Leung
authors.forename: Christine
authors.initials: C
authors.lastname: Rohde
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008866:Microsurgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011322:Primary Prevention; D011379:Prognosis; D012189:Retrospective Studies