Boccardo, F.M., Casabona, F., Friedman, D., Puglisi, M., De Cian, F., Ansaldi, F., & Campisi, C. (2011). Surgical prevention of arm lymphedema after breast cancer treatment. Annals of Surgical Oncology, 18, 2500–2505.

To assess the efficacy of lymphactic venous anastomosis (LVA) during surgery for prevention of lymphedema in women having surgery for breast cancer

Patients who consented to participation prior to surgery were randomly assigned to the intervention group or usual care.  Those in the intervention group underwent the LVA microsurgical technique. Specifics of the surgery were described. In the treatment group, 16 patients had lymph node metastasis and underwent the LVA during primary surgery and axillary dissection. In those patients assigned to the intervention who did not have lymph node metastasis with intraoperative frozen section, the procedure was planned after finding micrometastasis after immunohistochemical analysis, and the LVA could be done during lymph node dissection at a second surgery. All patients had volume measurement done by the Kuhnke method and by lymphoscintigraphy. Follow-up included these measures at 1, 3, 6, 12, and 18 months after surgery.

• The study reported on 46 patients with breast cancer.
• Mean age was 67.5 years with a range of 52–74 years.
• The sample was 100% female.

The study was conducted in Italy. The site was not specified.

• Patients were undergoing the transition phase after initial treatment.
• The study has clinical applicability for late effects and survivorship.

This was a randomized clinical trial.

• Limb volume was measured.    
• Lymphoscintigraphy (LS) was used.

Beginning at month three, the proportion of patients with lymphedema was higher in the control group (p = 0.047). No significant differences were reported between volume measures at baseline, one, and six months in the intervention group. By comparison, a significantly higher arm volume was reported at one and six months in the control group (p < 0.01). Postoperatively, LS demonstrated a patency rate of 95.6% for LVAs. 

This trial demonstrated that intraoperative LVA microsurgery was effective in reducing arm lymphedema during the first six months after surgery in women with breast cancer.

• The sample size was small with fewer than 100 patients.
• No information was provided regarding any other interventions during the study period to combat development of lymphedema. 
• Although the mean follow-up time for the study was reported to be 18 months, only analysis of 6 months was provided. 
• No information was provided regarding use of adjuvant treatment during the study follow-up period or differences in body mass index (BMI) that could have influenced findings.

Study findings suggested that operative LVA with breast surgery can be effective in reducing development of secondary lymphedema. More research in this area is needed to further strengthen these findings. Nurses can advocate for patients to ask about the availability and potential use of this surgical technique.