KEY TAKEAWAYS
- The study aimed to determine risk factors for truncal and upper extremity lymphedema using alternative drainage, guiding medical and surgical interventions.
- The study identified lymphedema risk factors and drainage patterns, guiding postoperative management and lymphovenous bypass surgery eligibility.
The emerging understanding of trunk and breast lymphedema following breast cancer treatment highlights the importance of assessing lymphatic dysfunction. Utilizing indocyanine green-lymphangiography has been crucial in characterizing this dysfunction in the extremity and can be extended to other regions.
Previous research has introduced a validated Pittsburgh Trunk Lymphedema Staging System to characterize the affected areas, particularly in breast cancer-related lymphedema.
Meeti Mehta and her team conducted a study that aimed to discern risk and protective factors for truncal and upper extremity lymphedema via alternative lymphatic drainage, informing medical and surgical interventions.
Patients undergoing revisional breast surgery and suspected of upper extremity lymphedema were provided the option of lymphangiography. Visualization of the breast and lateral/anterior trunks was conducted, with blind evaluation for axillary and inguinal lymphatic flow.
A linear-weighted Cohen’s kappa statistic was employed to compare alternative drainage assessments. Relative risks (RRs) were computed using binomial regression, with significance set at alpha = 0.05.
About 86 sides (46 patients) were included, with 12 sides serving as controls without treatment. Among non-control sides, 88% exhibited alternative lymphatic flow to various locations, including ipsilateral axillae (64%), ipsilateral groins (57%), contralateral axillae (20.3%), and contralateral groins (9.3%).
The Cohen’s kappa for alternative drainage assessment was 0.631 ± 0.043. Ipsilateral axillary and contralateral inguinal drainage were associated with a reduced risk of truncal lymphedema (RR 0.78, CI 0.63-0.97, P = 0.04; RR 0.32, CI 0.13-0.79, P = 0.01, respectively).
Radiation therapy increased the risk of both truncal and upper extremity lymphedema (RR 3.69, CI 0.96-14.15, P = 0.02; RR 1.92, CI 1.09-3.39, P = 0.03, respectively). Contralateral axillary drainage and axillary lymph node dissection were associated with an increased risk of upper extremity lymphedema (RR 4.25, CI 1.09-16.61, P = 0.01; RR 2.83, CI 1.23-6.52, P = 0.01, respectively).
Expanding on prior research, this study identified risk and protective factors linked to truncal and upper extremity lymphedema. Predominant alternative drainage routes are towards the ipsilateral axilla and groin. Ipsilateral axillary and contralateral inguinal drainage were correlated with decreased risk of truncal lymphedema.
Conversely, radiation, axillary dissection, and contralateral axillary drainage elevate the risk of upper extremity lymphedema. These insights hold significance for postoperative lymphatic management and determining suitability for lymphovenous bypass surgery.
No funding information was available.
Source: https://pubmed.ncbi.nlm.nih.gov/38556685/
Mehta M, Sarrami S, Moroni E, et al. (2024) “Alternative Lymphatic Drainage Pathways in the Trunk Following Oncologic Therapy.” Ann Plast Surg. 2024 Apr 1;92(4S Suppl 2):S258-S261. doi: 10.1097/SAP.0000000000003861. PMID: 38556685.
