Lymphoedema Surgery
New treatment regimes for Lymphoedema mean patients are not only surviving their initial cancer – they are literally outliving any expectations!
A big swollen arm with a compression garment has long been the tell-tale sign of a patient who had survived breast cancer. Less commonly, it was a result of metastatic skin cancer like Melanoma or Squamous Cell Carcinoma. In days gone by, these patients were rare, as the survival rates for these awful diseases were so low at 5 yrs. Nowadays however, advances in treatment regimes mean patients are not only surviving their initial cancer – they are literally outliving any expectations!
In the 1970s, Melbourne Plastic Surgeon Bernie O’Brien developed trailblazing techniques for lymphoedema surgery that would not be mastered for another 50years, due to inadequate microscopes, tools and techniques that would require time and patience to perfect. Since then, Lymphoedema patients have relied upon the hard work of therapists (usually Physiotherapists or Occupational Therapists) to compress and manually decongest lymphoedema through massage techniques. While our solution wasn’t developing quickly, our problems for causing lymphoedema (radical surgery) and our ability to then cure patients meant the number of patients with lymphoedema greatly increased.
It wasn’t until the early 2000’s when surgeons in Japan and Italy began pushing the limits of lymphatic microsurgery to perform Lymphovenous Implantation (LVI) wherein lymph vessels are shoved en masse into a low flow draining vein. This yielded excellent results in primary preventative procedures (at the time of mastectomy / axillary clearance) and reduced the rates from 30-40% down to 3%.
Further work from South East Asia and in particular Chang Gung Memorial Hospital (Taiwan) and Japan (Koshima) led to the development of Lymphovenous Anastomosis – wherein a single lymph vessel is reconnected to a draining vein. Work done by Sydney local Professor Hiroo Suami on the mapping of lymphatics using near-infrared fluorescence has helped identify blocked lymphatics and target which patients are likely to benefit from super-microsurgical intervention.
These techniques have been slow to be taken up in Australia due to early failures and quick criticism of the scientific methods used to report on them. But perseverance from dedicated surgeons across the world has led to Lymphatic Super microsurgery becoming more and more accepted as a reasonable surgical option to treat lymphoedema.
Nowadays the common pathway for surgical treatment involves either prophylactic (at the time of lymph node resection) or secondary workup.
Prophylactic lymphatic surgery involves coming into your operation at the end of the resection of lymph nodes from the axilla or groin, and using super microsurgery techniques, reconnecting lymphatic vessels into tiny veins to bypass this fluid drainage.
Secondary lymphatic reconstruction involves workup by Lymphoedema Practitioners, staging the lymphoedema disease. By ‘mapping’ your limb using indocyanine green dye into the skin, to show us where your lymphatic vessels run, and gives us a target for lymphovenous bypass. The alternative options to this procedure may include Lymph Node Venous Anastomosis, Lymph Node Flap Surgery, or liposuction.
Whatever your stage of lymphoedema, it is essential to talk to your lymphoedema practitioner about whether surgery may be an option – and if you have questions, please reach out to the team at Queensland Lymphoedema Specialists (info@lymphoedemaqld.com) for more information or to make an appointment.
