New surgical approach Immediate Lymphatic Reconstruction might prevent lymphedema from starting

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Monday, February 26, 2024
New surgical approach might prevent lymphedema from starting
Fox Chase Cancer Center doctors say a new approach can offer the possibility of not developing lymphedema after cancer surgery.

Lymphedema is one of the most feared complications after cancer surgery.

The swelling in a limb can be life-altering.

However, a new approach can offer the possibility of not developing lymphedema at all.

It's the network running alongside blood vessels, delivering nutrients and disease-fighting cells, and cleaning up dead cells.

Dr. Michael Tecce, a reconstructive plastic surgeon at Fox Chase Cancer Center, says when lymph nodes are removed during surgery or damaged by radiation, the impact can be like a crash on the Schuylkill Expressway - big backups.

That's lymphedema.

"You're sitting there thinking, how can I find an exit route to get away from the traffic," says Dr. Tecce.

Lymph channels have dead ends, with nowhere for the fluid to go.

While swelling from surgery usually goes away within weeks after an operation, lymphedema doesn't.

It is a common concern in breast cancer and for melanoma in the lower body.

Lymph nodes are removed in a sentinel node biopsy, checking the extent of the cancer as well as during the cancer surgery itself.

However, there's no way yet to predict who will or won't develop it.

"They might have surgery on both breasts for breast cancer. And we'll see swelling in one arm," says Dr. Tecce.

Heaviness in the arm," is another sign of lymphedema, as is numbness or tingling.

"It's very important to catch it early on," he says.

Otherwise, fluid keeps building, creating more pressure inside the affected area.

"The fluid causes a lot of inflammation, and that inflammation turns into fibro-fatty tissue," says Dr. Tecce.

In recent years, lymphatic bypass surgery has been used to reduce fluid pressure.

However, limbs may not go completely back to normal size

And liposuction may be needed to reduce the fibro-fatty tissue.

Dr. Tecce says a new approach called Immediate Lymphatic Reconstruction changes the timing on a bypass by creating detours for disrupted lymph channels at the same time the lymph nodes are removed during reconstructive surgery.

Trials are also underway to do the bypass procedure at the time of the initial cancer surgery.

The super microsurgery is aimed at preventing lymphedema, rather than waiting to see if it develops.

"We take that lymphatic channel, we bypass it into a neighboring vein so that way the fluid has somewhere to go," he says

Bypasses done after lymphedema starts are an outpatient minimally invasive procedure.

"The downtime is not too significant. The incision that we make is about maybe an inch or so," he says, noting that patients go home the same day.

Done early, a bypass can prevent a major disability.

"It's really hard to get back to a normal-sized limb with normal function, once that happens," he says.

Dr Tecce says Fox Chase is the only center in the Philadelphia area offering Immediate Lymphatic Reconstruction.

In fact, it is only available at a few centers nationwide.

However, it is gaining support, as are all lymphatic bypass procedures.