POSTMASTECTOMY LYMPHORRHEA: CURRENT METHODS OF TREATMENT AND OUTCOMES | Issues of reconstructive and plastic surgery. 2020. № 4 (75). DOI: 10.17223/1814147/75/02

POSTMASTECTOMY LYMPHORRHEA: CURRENT METHODS OF TREATMENT AND OUTCOMES

The objectives of the study were analyze of recent scientific data concerning the causes of postmastectomy lymphorrhea after J.L. Madden surgery and its effects on the lymphatic system of the anterior chest wall and upper limb; investigate contemporary view regarding causes of postmastectomy lymphorrhea and treatment management. We searched the MEDLINE database for the past 20 years with keywords “lymphedema”, “breast cancer-associated lymphedema”, “lymphatic complications”, “lymphatic mapping”, “lymphorrhea”, “lymphatic drainage collector”, “upper limb”. We also searched list of references from eligible papers. In total, we have identified about 120 relevant papers. The found methods of prevention and treatment of lymphorrhea can be divided into several groups: surgical interventions, wound obliteration, sclerotherapy and absorbents, compression hosiery, wound drainage, late activation of the ipsilateral limb, use of somatostatin analogues. These methods don’t affect on cause of lymphorrhea and trying to eliminate lymphorrhea by itself. Therefore, it doesn’t have a stable effect in patients and found no significant effects compared with conventional lymphocele puncture. Taking into account the pathogenesis of postmastectomy lymphorrhea, in particular, that lymphatic drainage pathways running from the upper limb are cut during radical mastectomy and the lymph of the upper extremity begins to drain into the “empty” axillary fossa, that’s why the lymphovenous bypass is the most promising way of treatment.

Download file

Counter downloads: 127

Keywords

lymphatic complications, lymphatic mapping, lymphorrhea, lymphatic drainage collector

Authors

Name	Organization	E-mail
Garkusha V.M.	Tomsk Regional Oncology Center	v.m.garkusha@gmail.com

Всего: 1

References

Малая медицинская энциклопедия. М.: Медицинская энциклопедия, 1991-1996 гг. [Malaya Medicinskaya Encyclopedia [Small Medical Encyclopedia]. Moscow, Medical Encyclopedia. 1991-1996. (In Russ.)].

Obara A., Dziekiewicz M.A., Maruszynski M., Witkowski A., Dąbrowski M., Chmielak Z. Lymphatic complications after vascular interventions. Wideochir Inne Tech Maloinwazyjne. 2014 Sep; 9(3):420-426. doi: 10.5114/wiitm.2014.43021

Шевченко Ю.Л. (ред.). Ошибки, опасности и осложнения в хирургии вен: руководство для врачей. СПб.: ПитерКом, 1999:320 с. [Shevchenko Yu.L. (ed.) Oshibki, opasnosti i oslozhneniya v hirurgii ven: rukovodstvo dlya vrachey [Errors, dangers and complications in vein surgery: a Guide]. Saint-Petersburg, PiterKom Publ., 1999:320 p. (In Russ.)].

Ayano Shimono, Hisashi Sakuma, Shiho Watanabe, Hikaru Kono. Effective combination of lymphatico-venous anastomosis and negative pressure wound therapy for lymphocyst: A Case Study. J Obstet Gynaecol Res. 2020 Jul; 46(7):1224-1228. doi: 10.1111/jog.14300.

Katsumasa Kuroi, Kojiro Shimozuma, Tetsuya Taguchi, Hirohisa Imai, Hiroyasu Yamashiro, Shozo Ohsumi, Shinya Saito. Pathophysiology of seroma in breast cancer. Breast Cancer. 2005;12(4):288-93. doi: 10.2325/jbcs.12.288

Hiroshi Isozaki, Yasuhisa Yamamoto, Shigeki Murakami, Sasau Matsumoto, Takehiro Takama. Impact of the surgical modality for axillary lymph node dissection on postoperative drainage and seroma formation after total mastectomy. Patient Saf Surg. 2019;13:20.

Divino C.M., Kuerer H.M., Tartter P.I. Drains Prevent Seromas Following Lumpectomy with Axillary Dissection. Breast J. 2000 Jan;6(1):31-33.

TNM: Классификация злокачественных опухолей / под ред. Л.Х. Собина и др.; пер. с англ. и научн. ред. А.И. Щёголев, Е.А. Дубова, К.А. Павлов. М.: Логосфера, 2011:304 с. Перевод. изд. TNM Classification of Malignant Tumours, 7th ed. [TNM: Klassifikatsiya zlokachestvennykh opukholey [TNM: Classification of Malignant Tumors]. Ed. L.Kh. Sobin et al. others; Trans. from English. and scientific. ed. A.I. Shchegolev, E.A. Dubova, K.A. Pavlov. Moscow, Logosfera Publ., 2011. 304 p. (In Russ.)].

Билич Г.Л., Крыжановский В.А. Анатомия человека: атлас. М.: ГЭОТАР-медиа, 2010:824 с. [Bilich G.L., Kryzhanovskiy V.A. Anatomiya cheloveka: atlas [Human Anatomy: Atlas]. Moscow, GEOTAR-media Publ,, 2010:824 p. (In Russ.)].

Földi M., Földi E., Kubik S. (eds). Anatomy of the lymphatic system. Textbook of Lymphology: For Physicians and Lymphoedema Therapists. San Francisco CA, Urban and Fischer, 2003:1-164.

Островерхов Г.Е., Бомаш Ю.М., Лубоцкий Д.Н. Оперативная хирургия и топографическая анатомия. Курск: Курский государственный медицинский университет, 1996:720 с. [Ostroverkhov G.Ye., Bomash Yu.M., Lubotskiy D.N. Operativnaya hirurgiya i topograficheskaya anatomiya [Operative surgery and topographic anatomy]. Kursk: Kursk State Medical University, 1996:720 p. (In Russ.)].

Farias-Cisneros E., Chilton P.M., Palazzo M.D. Infrared imaging of lymphatic function in the upper extremity of normal controls and hand transplant recipients via subcutaneous indocyanine green injection. SAGE Open Med. 2019;7:2050312119862670. Publ. online 2019 Jul 8. doi: 10.1177/2050312119862670

Suami H., Yamashita S., Soto-Miranda M.A., Chang D.W. Lymphatic Territories (Lymphosomes) in a Canine: An Animal Model for Investigation of Postoperative Lymphatic Alterations. PLoS One. 2013; 8(7): e69222. Publ. online 2013 Jul 24. doi: 10.1371/journal.pone.0069222

Singer M., Aliano K., Stavrides S., Davenport T. Lymphatic Mapping in the Treatment of Chronic Seroma: A Case Series. Eplasty. 2015;15:e7. Publ. online 2015 Feb 27.

Collins C.D., Mortimer P.S., D'Ettorre H., A'Hern R.P., Moskovic E.C. Computed tomography in the assessment of response to limb compression in unilateral lymphoedema. Clin Radiol. 1995 Aug;50(8):541-4. doi: 10.1016/s0009-9260(05)83188-5

Suami H., Pan W.R., Taylor G.I. Changes in the lymph structure of the upper limb after axillary dissection: radiographic and anatomical study in a human cadaver. Plastic and Reconstructive Surgery. 2007;120(4):982- 991.21.

Stanton A.W.B., Mellor R.H., Cook G.J., Svensson W.E., Peters A.M., Levick J.R., Mortimer P.S. Impairment of lymph drainage in subfascial compartment of forearm in breast cancer-related lymphedema. Lymphat Res Biol. 2003;1(2):121-32. doi: 10.1089/153968503321642615

Patel K.M., Manrique O., Sosin M., Hashmi M. A., Poysophon P., Henderson R. Lymphatic mapping and lymphedema surgery in the breast cancer patient. Gland Surg. 2015 Jun; 4(3): 244-256. doi: 10.3978/j.issn.2227- 684X.2015.03.02

Жданов Д.А. Хирургическая анатомия грудного протока и главных лимфатических коллекторов и узлов туловища. Горький, 1945.

Suami H., Yamashita S., Soto-Miranda M.A., Chang D.W. Lymphatic territories (lymphosomes) in a canine: an animal model for investigation of postoperative lymphatic alterations. PLoS One. 2013;8(7):69222.

O'Hea B.J., Ho M.N., Petrek J.A. External compression dressing versus standard dressing after axillary lymphadenectomy. Am J Surg. 1999 Jun;177(6):450-453.

Пак Д.Д., Соколов В.В., Ермощенкова М.В. Профилактика лимфореи после радикальных мастэктомий с использованием воздушно-плазменных потоков. В кн.: Материалы II Международной ежегодной конференции «Проблемы диагностики и лечения рака молочной железы», 22-24 июня 2005 г. СПб., 2005:132.

Пак Д.Д., Ермощенкова М.В., Сарибекян Э.К., Паньшина И.В. Миопластика при радикальных мастэктомиях как метод профилактики послеоперационных осложнений. В кн.: III Международная ежегодная конференция «Проблемы диагностики и лечения рака молочной железы» - «Белые ночи Санкт-Петербурга», 21-23 июня 2006 г., СПб, 2006:78.

Plesca M, Bordea C., Houcheimi B.El., Ichim E., Blidaru A. Evolution of radical mastectomy for breast cancer. J Med Life. 2016 Apr-Jun; 9(2):183-186.

Cordelia Shaw Bland. The Halsted Mastectomy: Present Illness and Past History. West J Med. 1981 Jun; 134(6):549-555.

Maddox W.A. A randomized prospective trial of radical (Halsted) mastectomy versus modified radical mastectomy in 311 breast cancer patients. Ann Surg. 1983 Aug;198(2):207-12. doi: 10.1097/00000658-198308000- 00016

Deo S.V., Shukla N.K. Modified radical mastectomy using harmonic scalpel. J Surg Oncol. 2000 Jul;74(3):204-7.

Antonio M., Pietra T., Domenico L.G., Massimo D., Ignazio R., Antonio N., Luigi C. Does LigaSure reduce fluid drainage in axillary dissection? A randomized prospective clinical trial. A Cancer Medical Science. 2007; 1: 61.

Srivastava V., Basu S., Shukla V.K. Seroma Formation after Breast Cancer Surgery: What We Have Learned in the Last Two Decades. J Breast Cancer. 2012 Dec; 15(4): 373-380. doi: 10.4048/jbc.2012.15.4.373

Wyman A., Rogers K. Randomized trial of laser scalpel for modified radical mastectomy. Br J Surg. 1993 Jul;80(7):871-873.

Kerin M.J., O'Hanlon D.M., Kenny P., Kent P.J., Given H.F. Argon-enhanced cutting and coagulation confers advantages over conventional electrocautery for mastectomy. Eur J Surg Oncol. 1996 Dec;22(6): 571-573.

Lorena P. Suarez-Kelly, W. Hampton Pasley, Eric J. Clayton, Stephen P. Povoski, William E. Carson, Ray Rudolph. Effect of topical microporous polysaccharide hemospheres on the duration and amount of fluid drainage following mastectomy: a prospective randomized clinical trial. BMC Cancer. 2019; 19: 99.

Giovanni Docimo, Paolo Limongelli, Giovanni Conzo, Simona Gili, Alfonso Bosco, Antonia Rizzuto, Vincenzo Amoroso, Salvatore Marsico, Nicola Leone, Antonio Esposito, Chiara Vitiello, Landino Fei, Domenico Parmeggiani, Ludovico Docimo. Axillary lymphadenectomy for breast cancer in elderly patients and fibrin glue. BMC Surg. 2013; 13(Suppl 2): S8.

Rice D.C., Morris S.M., Sarr M.G., Farnell M.B., van Heerden J.A., Grant C.S., Rowland C.M., Ilstrup D.M., Donohue J.H. Intraoperative topical tetracycline sclerotherapy following mastectomy: a prospective, randomized trial. J Surg Oncol. 2000 Apr;73(4):224-7.

Campisi C., Boccardo F., Taechella M. Reconstructive microsurgery of lymph vessels: the personal method of lymphaticvenous-lymphatic interpositioned graffed shunt. Microsurgery. 1995; 16(3):161-166.

Абалмасов К.Г., Малинин А.А., Морозов К.М. и др. Микрохирургическое лечение лимфатических осложнений после реконструктивных операций на магистральных сосудах. Вопросы реконструктивной и пластической хирургии. 2002;3(4):27-30.