Supermicrosurgical lymphaticovenous anastomosis for breast cancer related lymphedema in low resources settings.

[BACKGROUND] Supermicrosurgical lymphaticovenous anastomosis (LVA)is becoming popular for the management of breast cancer-related lymphedema (BCRL), but mainly provided in well-developed countries. Little is known on possibility of LVA with limited resources. This study aimed to evaluate feasibility of LVA in Egypt, where latest devices are not available.

[METHODS] Medical records of patients who underwent LVA for progressive BCRL were reviewed. All patients were refractory to conservative treatment for 6 months or longer. As devices for near-infrared fluorescent lymphography was not available, a conventional high-frequency (18-MHz) ultrasound was used to localize the lymph vessels and veins for LVA. LVA was done using conventional microsurgery sets and 10 - 0 nylon sutures under an operating microscope with 40 times magnification. One-year postoperative results were evaluated based on upper extremity lymphedema index (UEL index), cellulitis frequency, and subjective symptoms.

[RESULTS] Twenty-three patients were included. The number of LVAs per limb ranged from 2 to 3 (average, 2). Lymph vessel detection rate was 92.6% (50/54). Ten (43.5%) patients with dermal backflow (DB) showed 19.2% postoperative volume reduction based on UEL index after one year. Thirteen (56.5%) patients without dermal backflow showed only 2% reduction. Postoperative UEL index was significantly lower than preoperative UEL index (123.5 ± 7.3 ml vs. 136.4 ± 9.4 ml, P = 0.017). Postoperative cellulitis frequency was decreased compared to preoperative one (2.15 ± 0.85 vs. 0.09 ± 0.18 attack/year, P ˂ 0.001). 13(56.5%) patients reported improvement in all subjective symptoms; limb tension improvement in 18 (78.3%) patients, limb heaviness in 15 (65.2%), and overall limb mobility in 13 (56.5%).

[CONCLUSIONS] LVA could be safely and effectively performed in limited resources settings without latest device for lymphatic mapping nor supermicrosurgery instruments. A conventional high-frequency ultrasound allows lymphatic and venous mapping useful for LVA. LVA should not be given up even with limited resources.