Tweets from ESL (4) – Preventative surgery works for lymphoedema

@Oxford OLP

Sep 26

Boccardo: key to success is early treatment with microsurgery ‪#Lymphedema‬‬ ‪#breastcancer‬‬

Feldman: must make microsurgery available for all breast cancer patients undergoing lymph node dissection ‪#Lymphedema‬‬ ‪#breastcancer‬‬ ‪#ESL2014‬‬

Feldman: Microsurgery very effective in preventing ‪#Lymphedema‬‬ after ‪#breastcancer‬‬ ‪#ESL‬‬ 2014

Feldman (New York): microsurgery is only approach that can prevent ‪#Lymphedema‬‬ ‪#ESL‬‬ 2014 Genoa

For me, these tweets were the most important of the whole meeting. Francesco Boccardo is an eminent surgeon from Genoa. He is thoughtful, intelligent, and highly scientific and realistic in his outlook.

He has studied preventative lymphatic microsurgery in patients having axillary clearance for breast cancer (this is where all of the lymph glands are taken from the armpit). He did a randomized controlled trial of microsurgery versus no microsurgery in these patients. A randomized controlled trial is where the patients are randomly assigned to either have microsurgery or not after their axillary clearance procedure. The surgeon doesn’t decide who gets the microsurgery, it is effectively a toss of the coin for the trial participants. This is really important, because if the surgeon gets to choose, she might introduce bias into the trial (e.g. only picking favourable patients for the microsurgery, and the higher risk patients for no microsurgery, which would bias the results in favour of microsurgery).

In this trial, after 18 months of follow up, 30% of patients who didn’t have microsurgery developed lymphoedema. In contrast, only 4% of patients who had the microsurgery developed lymphoedema.

This is an amazing result.

I think that deserves repeating!

This is an amazing result.

It shows that we can prevent lymphoedema in patients undergoing treatment for breast cancer. Similar results have been reported from Japan in patients undergoing treatment for gynaecological cancer (e.g. womb cancer or cervical cancer).

Sheldon Feldman is a breast surgeon from New York. He has put together a team to provide this treatment to his breast cancer patients. Their team has managed to reproduce these preventative results.

However (there had to be a but……), it could be argued that 70% of the patients who didn’t have microsurgery in Francesco’s trial didn’t get lymphoedema, so they have had an operation they didn’t need. Good point. For me, the key to this problem is identifying patients who will benefit from microsurgery by screening them with ICG lymphography (see my previous post), and only intervening when the patient develops the early changes of lymphoedema, before the swelling occurs.

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4 Replies

  • This is a really interesting development and I wish it had all been known about almost 8 years ago. I had axillary node clearance with mastectomy of left breast, and developed cording in left arm prior to discharge from hospital. As this is also a hiccup in the lymph system I am wondering if this is a sort of 'pre-condition' for lymphoedema so would be a useful pointer for microsurgery? The cording was treated with kinesiotaping and cleared and it was about a month afterwards that I first noted achey feeling in left forearm. Fortunately I was still under care of hospital physio team so got rapid referral to more locally based lymphoedema physio specialist and the rest is part of my personal lymphie journey

  • Cording is a warning sign for lymphedema and so is Mondor's disease.

  • Thanks Athinakay.........but if so, why was I not told about this, maybe now there is more awareness of the connection!

  • Why where you not told? I have no idea as I was not told either. I had to look both up,

    found the info on an american website which is the same place I found my Belisse vest. There is lots of useful info on this website.

    The Mondor's disease I looked up as well...

    That is the problem I am talking about. Either the doctors are not informed ( which is shocking in our age and stage ) or they do not bother ( which would be even more shocking. Either way, it seems that most tend to steer away from post treatment side effects.

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