LYMPHA Trial Seeks to Prevent Lymphedema in Breast Cancer Patients

Attention breast cancer patients: a new protocol is available to help prevent lymphedema, a debilitating condition that can occur after lymph node dissection.

The Clinical Breast Cancer Program is enrolling patients in a two-year pilot study to evaluate Lymphatic Microsurgical Preventive Healing Approach, or LYMPHA, This innovative protocol combines microsurgery with advanced imaging in order to prevent, detect, and treat lymphedema.

Lymphedema is the accumulation of lymph fluid and painful swelling in the arm due to blocked lymph drainage. It occurs in up to 13 percent of breast cancer patients after sentinel node biopsy and external-beam radiation, and up to 40 percent of patients after axillary lymph node dissection and radiation. Treatment for lymphedema is difficult, and the condition can significantly compromise both quality and length of life.

Lymphedema in the left arm of patients at stage 0, stage 1, stage 2 and stage 3. Images courtesy of Dr. Charles McGarvey of CLM Consulting, and Guenter Klose of Klose Training and Consulting, LLC.

How LYMPHA Works

The LYMPHA protocol entails several steps.

Before undergoing breast surgery, patients undergo a painless, noninvasive imaging test known as bioimpedance spectroscopy (with a device called the L-Dex) to determine the patient’s normal volume of lymphatic fluid. This measurement will be used as a comparative baseline after surgery to see whether fluid in the arms has increased, and if so, by how much.

Before the patient undergoes axillary lymph node dissection (removal and examination of the nodes under the arms), a blue dye is injected into the upper arm to map the lymphatic circulation from the arm. During the node dissection, the surgical team preserves a branch of the axillary vein and keeps a suitable length for reaching the lymphatic vessels.

The team of plastic reconstructive microvascular surgeons then performs the vein connection, or anastomosis, using a sleeve technique in which the lymphatic vessels are inserted into the cut end of the vein to restore normal lymph flow. A mastectomy is performed at the same time as the node removal and LYMPHA procedure.

In addition to the regular follow-up visits normally scheduled after surgery, patients receive postoperative monitoring for lymphedema to confirm that the LYMPHA bypass is open and functioning.

According to Dr. Feldman, “We can now help patients maintain a normal quality of life by effectively preventing and treating lymphedema without compromising their cancer treatment.”

To be considered for the study, breast cancer patients needing lymph node dissection should contact Amiya Vaz at 212-305-1317 or by email at: av2454@columbia.edu.

Learn about options in breast cancer treatment at www.breastmd.org.

For more information about the LYMPHA protocol, see http://nyp.org/news/hospital/lymphedema-cancer-patients.html

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