Lymphedema Prevention Surgery: Improved Operating Efficiency Over Time
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ORIGINAL ARTICLE – BREAST ONCOLOGY
Lymphedema Prevention Surgery: Improved Operating Efficiency Over Time Kristina Shaffer, MD1, Cagri Cakmakoglu, MD2, Graham S. Schwarz, MD2, Ayat ElSherif, MD1, Zahraa Al-Hilli, MD1, Risal Djohan, MD2, Diane M. Radford, MD1, Stephen Grobmyer, MD3, Steven Bernard, MD2, Andrea Moreira, MD2, Alicia Fanning, MD1, Chao Tu, MS4, and Stephanie A. Valente, DO1 1
Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH ; 2Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH; 3Oncology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; 4Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
ABSTRACT Background. Lymphedema prevention surgery (LPS), which identifies, preserves, and restores lymphatic flow via lymphaticovenous bypasses (LVB), has demonstrated potential to decrease lymphedema in breast cancer patients requiring axillary lymph node dissection. Implementing this new operating technique requires additional operating room (OR) time and coordination. This study sought to evaluate the improvement of LPS technique and OR duration over time. Methods. A prospective database of patients who underwent LPS at our institution from 2016 to 2019 was queried. Type of breast and reconstruction surgery, number of LVB performed, and OR times were collected. LPS details were compared by surgical group and year performed. Results. Ninety-four patients underwent LPS, and 88 had complete OR time data available for analysis. Average age was 51 years, body mass index of 28, with an average of 15 lymph nodes removed. Reconstructive treatment groups included prosthetic reconstruction 56% (49), oncoplastic reduction 10% (9), and no reconstruction 34% (30). The number of patients undergoing LPS increased significantly from 2016 to 2019, and average number of LVB per patient doubled. In patients without reconstruction, the average
Ó Society of Surgical Oncology 2020 First Received: 12 May 2020 Accepted: 30 June 2020 S. A. Valente, DO e-mail: [email protected]
time for LPS improved significantly from 212 to 87 min from 2016 to 2019 (p = 0.015) and similarly in patients undergoing LPS with prosthetic reconstruction from 238 to 160 min (p = 0.022). Conclusions. LVB is an emerging surgical lymphedema prevention technique. While requiring additional surgical time, our results show that with refinement of technique, over 4 years, we were able to perform double the number of LVB per patient in half the OR time.
Lymphedema can be a progressive and potentially devastating condition affecting up to one in five breast cancer patients undergoing axillary lymph node dissection (ALND).1 Sequelae of lymphedema, such as pain, limited range of motion, infections, malignancy, and body image issues, can negatively impact patients’ quality of life. Additionally, patients may suffer higher rates of depression and anxiety, and incur more medical expenses coupled with decreased productivity in the long-term treatm
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