Dual procedures offer relief from lymphedema

Cancer patients who have undergone lymph node removal or radiation therapy as part of cancer treatment know all too well the pain and discomfort of lymphedema. The condition occurs when the body, with its missing or damaged lymph nodes, can no longer drain lymph fluid from the arms or legs. Fluid accumulates and chronic swelling occurs.
Typically the condition is managed by drainage-inducing massage, exercise, and compression garments to keep lymph fluid moving. However, these techniques are time consuming and do not restore function for all patients.

MD Anderson surgeons are combining two treatments to reduce limb swelling and improve quality of life for patients with severe lymphedema.

In the first procedure, called lymphovenous bypass, surgeons peer through a microscope and use minute instruments to connect blocked lymphatic vessels as small as 0.3 millimeters in diameter to a nearby vein. The bypass allows excess lymph fluid to flow more freely.

In the second procedure, called lymph node transfer, surgeons microsurgically transplant healthy lymph nodes that have a rich blood supply to an area of lymphatic injury to re-establish lymphatic connections.

“Lymphovenous bypass surgery alone provides immediate relief by improving drainage. But in some patients, its effectiveness begins to decrease around 12 months after surgery. In contrast, vascularized lymph node transfer can provide permanent new lymphatic drainage, but these new lymphatic channels do not begin functioning until six to nine months after surgery,” said Matthew Hanasono, M.D., professor of Plastic Surgery.

Hanasono and colleagues have found that performing both procedures during the same operation can provide immediate and long-lasting relief.

“After these dual surgeries, we’ve seen a significant reduction in the amount of time patients have to spend on massage and compression garments to remove fluid from their limbs,” said Edward Chang, M.D., associate professor of Plastic Surgery. “Moreover, I’ve had patients who had multiple infections in their affected limbs before surgery, but after the double-procedure they no longer get infections.”

Read more about lymphedema treatment in the April issue of Oncolog.