Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Lymphological Liposculpture for Secondary Lymphedema after Breast Cancer and Gynecological Tumors: Long-Term Results after 15 Years

  • Manuel E. Cornely ( LY.SEARCH)
  • Received : 2022.08.18
  • Accepted : 2022.11.27
  • Published : 2023.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Untreated lymphedema of an extremity leads to an increase in volume. The therapy of this condition can be conservative or surgical. Methods "Lymphological liposculpture" is a two-part procedure consisting of resection and conservative follow-up treatment to achieve curative volume adjustment of the extremities in secondary lymphedema. This treatment significantly reduces the need for complex decongestive therapy (CDT). From 2005 to 2020, 3,184 patients with secondary lymphedema after breast cancer and gynecological tumors were treated in our practice and clinic. "Lymphological liposculpture" was applied to 65 patients, and the data were recorded and evaluated by means of perometry and questionnaires. Results The alignment of the sick to the healthy side was achieved in all patients. In 58.42% (n = 38), the CDT treatment could be completely stopped postoperatively; in another 33.82% (n = 22) of the patients, a permanent reduction of the CDT was achieved. In 7.69% (n = 5) patients, the postoperative CDT could not be reduced. A total of 92.30% (n = 60) of the patients described a lasting significant improvement in their quality of life. Conclusion "Lymphological liposculpture" is a standardized curative sustainable procedure for secondary lymphedema for volume adjustment of the extremities and reduction of postoperative CDT with eminent improvement of the quality of life.

Keywords

References

  1. Mortimer P, Levine G. Let's Talk Lymphoedema. The Essential Guide to Everything You Need to Know. London: Elliott and Thompson; 2017:210
  2. Cornely M, Angewandte Lymphologie. Grundlagen - Alltag - PerspektivenCornely M, Marsch W, Brenner E, eds. Cham: Springer; 2022
  3. Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg 2018;7(04):379-403 https://doi.org/10.21037/gs.2017.11.04
  4. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 2013;14(06):500-515 https://doi.org/10.1016/S1470-2045(13)70076-7
  5. Frost JA, Webster KE, Bryant A, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev 2017;10(10):CD007585
  6. Lindqvist E, Wedin M, Fredrikson M, Kjolhede P. Lymphedema after treatment for endometrial cancer - a review of prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol 2017;211:112-121 https://doi.org/10.1016/j.ejogrb.2017.02.021
  7. Biglia N, Zanfagnin V, Daniele A, Robba E, Bounous VE. Lower body lymphedema in patients with gynecologic cancer. Anticancer Res 2017;37(08):4005-4015 https://doi.org/10.21873/anticanres.11785
  8. Lim MC, Lee JS, Nam BH, Seo SS, Kang S, Park SY. Lower extremity edema in patients with early ovarian cancer. J Ovarian Res 2014;7:28
  9. Cornely ME. [Fatter through lipids or water. Lipohyperplasia dolorosa versus lymphedema]. Hautarzt 2010;61(10):873-879 https://doi.org/10.1007/s00105-010-1987-7
  10. Kasseroller R. The LVF measurement system - a way of classifying lymphoedema. Lymphol Res Pract 1999;3:11-16
  11. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013;46(01):1-11
  12. Brenner E. Anatomy and physiology of the lymphatic system. In: Hoffmann U, Weiss N, Czihal M, Linnemann BF E, eds. Clinical Angiology. Cham: Springer; 2021:1-7
  13. Sayegh HE, Asdourian MS, Swaroop MN, et al. Diagnostic methods, risk factors, prevention, and management of breast cancer-related lymphedema: past, present, and future directions. Curr Breast Cancer Rep 2017;9(02):111-121 https://doi.org/10.1007/s12609-017-0237-8
  14. Shaitelman SF, Chiang YJ, Griffin KD, et al. Radiation therapy targets and the risk of breast cancer-related lymphedema: a systematic review and network meta-analysis. Breast Cancer Res Treat 2017;162(02):201-215 https://doi.org/10.1007/s10549-016-4089-0
  15. Swaroop MN, Ferguson CM, Horick NK, et al. Impact of adjuvant taxane-based chemotherapy on development of breast cancer-related lymphedema: results from a large prospective cohort. Breast Cancer Res Treat 2015;151(02):393-403 https://doi.org/10.1007/s10549-015-3408-1
  16. Specht MC, Miller CL, Russell TA, et al. Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression? Breast Cancer Res Treat 2013;140(03):485-494 https://doi.org/10.1007/s10549-013-2655-2
  17. Blum KS, Karaman S, Proulx ST, et al. Chronic high-fat diet impairs collecting lymphatic vessel function in mice. PLoS One 2014;9(04):e94713
  18. Greene AK, Grant FD, Slavin SA, Maclellan RA. Obesity-induced lymphedema: clinical and lymphoscintigraphic features. Plast Reconstr Surg 2015;135(06):1715-1719 https://doi.org/10.1097/PRS.0000000000001271
  19. GDL Wilting J, Bartkowski R, Baumeister R, Foldi E, Stohr S, et al. S2k Leitlinie, Diagnostik und Therapie der Lymphodeme [S2k Leitlinie]. Germany2017 [94]. http://www.awmf.org/leitlinien/detail/ll/058-001.html
  20. Onorato A, Rossitti P, Lovati L. Le problematiche della spalla nella donna operata al seno. Atti del Convegno Interregionale "Spalla - Approfondimenti multidisciplinari nella prospettiva riabilitativa". Udine, November; 1996
  21. Rogan S, Taeymans J, Luginbuehl H, Aebi M, Mahnig S, Gebruers N. Therapy modalities to reduce lymphoedema in female breast cancer patients: a systematic review and meta-analysis. Breast Cancer Res Treat 2016;159(01):1-14 https://doi.org/10.1007/s10549-016-3919-4
  22. Rossitti P, Onorato A, Anania G, Pinat F. Trattamento riabilitativo precoce della donna operata al seno. In: Bresadola F, Anania G, Gnocchi E, eds. La mammella operata per carcinoma - aspetti multidisciplinary. Gnocchi Ed.; 1998
  23. Schuchhardt C. Diagnostic-therapy-long term observation of lymphedema following cancer treatment. J Exp Clin Hematol 1985;51:175
  24. Reich-Schupke S, Mohren E, Stucker M. Befragung zur Diagnostik und Therapie bei Patienten mit Lymphodem und Lipodem. Hautarzt 2018;69(06):471-477 https://doi.org/10.1007/s00105-018-4151-4
  25. Rogge H, Breuer E. Die Technik der Komplexen Physikalischen Entstauungstherapie. In: Cornely ME, Marsch W, Brenner E, eds. Angewandte Lymphologie Grundlagen - Alltag - Perspektiven. Springer; 2022:549-563
  26. Torres Lacomba M, Yuste Sanchez MJ, Zapico Goni A, et al. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ 2010;340:b5396
  27. Schumacher C. Gynakologie: Brustkrebs und Karzinome von Endometrium, Ovar, Zervix und Vulva. In: Cornely ME, Marsch W, Brenner E, eds. Angewandte Lymphologie Grundlagen - Alltag - Perspektiven. Cham: Springer; 2022:241-263
  28. Tzou CJ, Steinbacher J, Czedik-Eysenberg M, et al. Institutionalization of reconstructive lymphedema surgery in Austria-single center experience. J Surg Oncol 2020;121(01):91-99 https://doi.org/10.1002/jso.25740
  29. Visconti G, Bianchi A, Salgarello M, et al. Lymphatic tissue transfer: ultrasound-guided description and preoperative planning of vascularised lymph nodes, lymphatic units, and lymphatic vessels transfers. J Pers Med 2022;12(08):1346
  30. Visconti G, Hayashi A, Bianchi A, Tartaglione G, Bartoletti R, Salgarello M. Lymphaticovenular anastomosis for advanced-stage peripheral lymphedema: expanding indication and introducing the hand/foot sign. J Plast Reconstr Aesthet Surg 2022;75(07):2153-2163 https://doi.org/10.1016/j.bjps.2022.02.012
  31. Yamamoto T, Yamamoto N, Hayashi A, Koshima I. Supermicrosurgical deep lymphatic vessel-to-venous anastomosis for a breast cancer-related arm lymphedema with severe sclerosis of superficial lymphatic vessels. Microsurgery 2017;37(02):156-159 https://doi.org/10.1002/micr.22382
  32. Schaverien MV, Asaad M, Selber JC, et al. Outcomes of vascularized lymph node transplantation for treatment of lymphedema. J Am Coll Surg 2021;232(06):982-994 https://doi.org/10.1016/j.jamcollsurg.2021.03.002
  33. Cha HG, Oh TM, Cho MJ, et al. Changing the paradigm: lympho-venous anastomosis in advanced stage lower extremity lymphedema. Plast Reconstr Surg 2021;147(01):199-207 https://doi.org/10.1097/PRS.0000000000007507
  34. Brorson H. Liposuction combined with controlled compression therapy reduces arm lymphedema more effectively than controlled compression therapy alone. Plast Reconstr Surg 1998;102(04):1058-1067; discussion 1068 https://doi.org/10.1097/00006534-199809020-00021
  35. Schaverien MV, Munnoch DA, Brorson H. Liposuction treatment of lymphedema. Semin Plast Surg 2018;32(01):42-47 https://doi.org/10.1055/s-0038-1635116
  36. Cornely M. Liposuction (Liposculpture). In: Weissleder H, Schuchhardt C, eds. Erkrankungen des Lymphgefasssystems. 3rd ed. Koln: Viavital; 2000:384-397
  37. Cornely ME, Hettenhausen C. The addition of hyaluronidase to tumescent local anesthesia supports lymphological liposculpture of secondary lymphedema. Plast Reconstr Surg Glob Open 2021;9(12):e3995
  38. Yamamoto T, Yamamoto N, Kageyama T, Sakai H, Fuse Y, Tsukuura R. Lymph-interpositional-flap transfer (LIFT) based on lymphaxiality concept: Simultaneous soft tissue and lymphatic reconstruction without lymph node transfer or lymphatic anastomosis. J Plast Reconstr Aesthet Surg 2021;74(10):2604-2612 https://doi.org/10.1016/j.bjps.2021.03.014
  39. Brenner E. Plasma-interstitielle Flussigkeit-Lymphe. LymphForsch 2009;13(01):25-27
  40. Brenner E. Initial lymphatic vessels - myths and truths. Lymphol Res Pract 2014;18:31-40
  41. Zhu Y, Kruglikov IL, Akgul Y, Scherer PE. Hyaluronan in adipogenesis, adipose tissue physiology and systemic metabolism. Matrix Biol 2019;78-79:284-291 https://doi.org/10.1016/j.matbio.2018.02.012
  42. Cornely ME. Lipedema and lymphatic edema. In: Shiffman M, Di Guiseppe A, eds. Liposuction Principles and Practice. Berlin: Springer; 2006:547-549
  43. Jacobson JH II, Suarez EL. Microvascular surgery. Dis Chest 1962;41:220-224 https://doi.org/10.1378/chest.41.2.220
  44. Yamada Y. The studies on lymphatic venous anastomosis in lvmphedema. Nagoya J Med Sci 1969;32:1-21
  45. Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000;16(06):437-442 https://doi.org/10.1055/s-2006-947150
  46. Baumeister RG, Seifert J, Wiebecke B, Hahn D. Experimental basis and first application of clinical lymph vessel transplantation of secondary lymphedema. World J Surg 1981;5(03):401-407 https://doi.org/10.1007/BF01658013
  47. Becker C, Hidden G, Godart S, Maurage H, Pecking A. Free lymphatic transplant. Eur J Lymphol Rel Prob 1991;6:25-77
  48. Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer. Scand J Plast Reconstr Surg Hand Surg 1997;31(02):137-143 https://doi.org/10.3109/02844319709085480
  49. Cornely M. Inventor Lymphological Liposculpture According to Dr. Cornely. Deutsches Patent- und Markenamt, Munchen: Germany; 2006
  50. Cornely ME. Lymphologische liposkulptur. Hautarzt 2007;58(08):653-654, 656-658 https://doi.org/10.1007/s00105-007-1367-0
  51. Cornely M. Fragebogen zur Lebensqualitat nach operativer Behandlung eines sekundaren Lymphodem. Koln; 2022 https://www.lysearch.de/home/evaluation-op-sek-lymphoedem/
  52. Klein JA. Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction. Mosby; 2000
  53. Cornely M. Lymphologische Liposculptur. In: Cornely M, Marsch W, Brenner E, eds. Angewandte Lymphologie Grundlagen - Alltag - Perspektiven. Cham: Springer; 2022:661-682
  54. Brenner E. Lymphoedema in ultrasound - a literature review. Phlebology 2005;34(03):143-145 https://doi.org/10.1055/s-0037-1621478
  55. Cavezzi A. Duplex ultrasonography. In: Lee B, Rockson SG, eds. Lymphedema: A Concise Compendium of Theory and Practice. Cham: Springer; 2018:316-26
  56. Iker E, Mayfield CK, Gould DJ, Patel KM. Characterizing lower extremity lymphedema and lipedema with cutaneous ultrasonography and an objective computer-assisted measurement of dermal echogenicity. Lymphat Res Biol 2019;17(05):525-530 https://doi.org/10.1089/lrb.2017.0090
  57. Krackowizer P, Brenner E. Thickness of the human skin. Phlebologie 2008;37(02):83-92 https://doi.org/10.1055/s-0037-1622218
  58. Marshall M. Duplex sonographic criteria for lymphoedema and lipoedema. Phlebology 2005;6:325-326
  59. Cornely M, Gensior M. Complications and their management in the surgical treatment of lipohyperplasia dolorosa. Dermatologie (Heidelb) 2022(e-pub ahead of print). Doi: 10.1007/s00105-022-05075-5
  60. Kocak Z, Overgaard J. Risk factors of arm lymphedema in breast cancer patients. Acta Oncol 2000;39(03):389-392 https://doi.org/10.1080/028418600750013168
  61. Arrault M, Vignes S. [Risk factors for developing upper limb lymphedema after breast cancer treatment]. Bull Cancer 2006;93(10):1001-1006
  62. Steinbacher J, Tzou CJ. Surgical aspects in the treatment of lymphoedema using lymphovenous anastomoses and vascularised lymph node transfer. Lymphol Res Pract 2019;23(01):41-44
  63. Mohos B, Czedik-Eysenberg M, Steinbacher J, Tinhofer I, Meng S, Tzou CJ. Long-term use of ultrasound for locating optimal LVA sites: a descriptive data analysis. J Reconstr Microsurg 2021;38(03):238-244
  64. Brorson H, Svensson H. Liposuction combined with controlled compression therapy reduces arm lymphedema more effectively than controlled compression therapy alone. Plast Reconstr Surg 1998;102(04):1058-1067, discussion 1068 https://doi.org/10.1097/00006534-199809020-00021
  65. Cornely ME. Fatter through lipids or water: lipohyperplasia dolorosa versus lymphedema. Am J Cosmet Surg 2014;31(03):189-195 https://doi.org/10.5992/AJCS-D-12-00026.1
  66. Felmerer G, Sattler T, Lohrmann C, Tobbia D. Treatment of various secondary lymphedemas by microsurgical lymph vessel transplantation. Microsurgery 2012;32(03):171-177 https://doi.org/10.1002/micr.20968
  67. Tzou CH, Meng S, Ines T, et al. Surgical anatomy of the vascularized submental lymph node flap: anatomic study of correlation of submental artery perforators and quantity of submental lymph node. J Surg Oncol 2017;115(01):54-59 https://doi.org/10.1002/jso.24336
  68. Kuhnke E. Volume determination of out-of-round extremities from circumferential measurements. Lymphology 1978;1:35-44