CLO20-051: LYMPHA: Eliminating the Burden of Lymphedema in Cancer Patients Requiring Nodal Dissections. A Pilot Study

Background: Lymphedema is a form of soft tissue swelling from interstitial accumulation of fluid due to disruption of the lymphatic system. In melanoma patients, the incidence of lymphedema ranges from 5-10% in upper extremity and 28-40% in lower extremity disease; leaving countless with chronic, debilitating swelling significantly impacting their health and quality of life. Current treatment options for lymphedema have proven themselves to be of poor efficacy, time consuming and expensive. The Lymphatic Microsurgical Preventive Healing Approach (LYMPHA), is a microsurgical technique where lymphatic vessels are connected to the venous circulation by surgically creating lymphatic-venous shunts. Despite its reported benefits and immense potential, the LYMPHA technique requires more preliminary evidence in patients affected with cutaneous malignancies before it can be widely used. Methods: This case report study includes findings on patients from The Ottawa Hospital with cutaneous malignancies requiring node dissections. Consenting patients underwent LYMPHA at the time of either upper or lower extremity node dissection for primary prevention of lymphedema. Patients were followed clinically for up to 2 years. Circumferential measurements of both operated and non-operated limbs as well as lymphedema-specific quality of life questionnaire (LYMQOL) results were collected at the time of follow-up appointments. The International Society of Lymphology (ISL) grading system was used to quantify lymphedema. Results: A total of 8 patients with a mean age of 69 (25% women) were included in this study. Of these patients, 2 had squamous cell carcinoma and 6 had melanoma. Five patients underwent node dissections of the upper extremity and 3 of the lower. The number of anastomosis performed at the time of surgery ranged between 1 and 3 and a total of 3 patients developed mild lymphedema. Of these 3, 2 had an ISL of 1 and the other an ISL of 2. Four of 8 patients completed the LYMQOL and all of them reported being very satisfied with their quality of life in the post-operative periods. None of the patients included in this study experience adverse outcome directly associated with LYMPHA. Conclusion: The findings of this pilot study have shown favorable outcomes with the LYMPHA technique and should be used to guide studies to further elucidate the efficacy of LYMPHA in comparison to current standards for primary prevention of lymphedema in this patient population.

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Corresponding Author: Maria Cassandre Medor, HBSc
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