Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema.

BACKGROUND: As many as 40 % of breast cancer patients undergoing axillary lymph node dissection (ALND) and radiotherapy develop lymphedema. We report our experience performing lymphatic-venous anastomosis using the lymphatic microsurgical preventive healing approach (LYMPHA) at the time of ALND. This technique was described by Boccardo, Campisi in 2009. METHODS: LYMPHA was offered to node-positive women with breast cancer requiring ALND. Afferent lymphatic vessels, identified by injection of blue dye in the ipsilateral arm, were sutured into a branch of the axillary vein distal to a competent valve. Follow-up was with pre- and postoperative lymphoscintigraphy, arm measurements, and (L-Dex®) bioimpedance spectroscopy. RESULTS: Over 26 months, 37 women underwent attempted LYMPHA, with successful completion in 27. Unsuccessful attempts were due to lack of a suitable vein (n = 3) and lymphatic (n = 5) or extensive axillary disease (n = 1). There were no LYMPHA-related complications. Mean follow-up time was 6 months (range 3-24 months). Among completed patients, 10 (37%) had a body mass index of ≥30 kg/m(2) (mean 27.9 ± 6.8 kg/m(2), range 17.4-47.6 kg/m(2)), and 17 (63%) received axillary radiotherapy. Excluding two patients with preoperative lymphedema and those with less than 3-month follow-up, the lymphedema rate was 3 (12.5%) of 24 in successfully completed and 4 (50 %) of 8 in unsuccessfully treated patients. CONCLUSIONS: Our transient lymphedema rate in this high-risk cohort of patients was 12.5%. Early data show that LYMPHA is feasible, safe, and effective for the primary prevention of breast cancer-related lymphedema.

Radiofrequency ablation after breast lumpectomy added to extend intraoperative margins in the treatment of breast cancer (ABLATE): a single-institution experience.

BACKGROUND: Breast-conserving surgery is often preferred to treat early-stage breast cancer. This method aims to minimize repeat excision and local recurrence rates. The ABLATE Registry expands this to multiple centers with a total accrual goal of 250. This video illustrates an intraoperative radiofrequency ablation (RFA) technique. METHODS: Sixteen women with a mean age of 65 years underwent RFA after lumpectomy. The RFA probe was deployed 1 cm circumferentially in the cavity and maintained at 100°C for 15 min. The ablation zone was monitored with color-flow ultrasound. Patients returned 2 weeks later to complete the Subjective Cosmetic Scale and the European Organisation for Research and Treatment of Cancer Body Image Scale. RESULTS: At a mean follow-up of 3.9 months, there were no local recurrences. Two-week cosmesis scores were excellent (n = 9) or good (n = 5). CONCLUSIONS: Our initial experience is encouraging. Continued national accrual will permit evaluation of reduction in repeat excision and local recurrence rate, as well as potentially reduce requirements for adjuvant radiation.