The Role of Surgery in the Treatment of Lymphoedema
Friday, May 3, 2:00pm – 2:50pm
It is well known that lymphoedema affects quality of life (QoL). However, there is very little published on the impact of surgical management of lymphoedema on QoL. This presentation will review various QoL questionnaires and data on the variability of QoL perception by patients. Also discussed will be the different types of surgical management of lymphoedema, changes experienced following surgical intervention, and the impairment experienced despite maximal conservative therapy. Dr. Munnoch will also describe his own experience of managing lymphoedema with liposuction and compression.
- Participants will be able to discuss the various surgical approaches to the management of lymphoedema.
- Participants will be able to list the different Quality of Life questionnaires and summarize the differences between them.
Brorson, H., Ohlin, K., Olsson, G., Langstrom, G., Wiklund, I., & Svensson, H. (2006). Quality of life following liposuction and conservative treatment of arm lymphedema. Lymphology, 39(1), 8-25.
Cemal, Y., Jewell, S., Albornoz, C. R., Pusic, A., & Mehrara, B. J. (2013). Systematic review of quality of life and patient reported outcomes in patients with oncologic related lower extremity lymphedema. Lymphat Res Biol, 11(1), 14-19.
Cheng MH, Loh CYY, Lin CY. Outcomes of Vascularized Lymph Node Transfer and Lymphovenous Anastomosis for Treatment of Primary Lymphedema. Plast Reconstr Surg Glob Open. 2018;6:e2056.
Ciudad, P., Maruccia, M., Socas, J., Lee, M. H., Chung, K. P., Constantinescu, T., Chen, H. C. (2015). The laparoscopic right gastroepiploic lymph node flap transfer for upper and lower limb lymphedema: Technique and outcomes. Microsurgery. doi:10.1002/micr.22450
Cornelissen, A. J., Kool, M., Lopez Penha, T. R., Keuter, X. H., Piatkowski, A. A., Heuts, E., Qiu, S. S. (2017). Lymphatico-venous anastomosis as treatment for breast cancer-related lymphedema: a prospective study on quality of life. Breast Cancer Res Treat. doi:10.1007/s10549-017-4180-1
Cornelissen AJM, Kool M, Keuter XHA et al. Quality of Life Questionnaires in Breast Cancer-Related Lymphedema Patients: Review of the Literature. Lymphat Res Biol. 2018
Devoogdt, N., De Groef, A., Hendrickx, A., Damstra, R., Christiaansen, A., Geraerts, I., Van Kampen, M. (2014). Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL): reliability and validity. Phys Ther, 94(5), 705-721.
Finnane, A., Hayes, S. C., Obermair, A., & Janda, M. (2011). Quality of life of women with lower-limb lymphedema following gynecological cancer. Expert Rev Pharmacoecon Outcomes Res, 11(3), 287-297.
Gratzon, A., Schultz, J., Secrest, K., Lee, K., Feiner, J., & Klein, R. D. (2016). Clinical and Psychosocial Outcomes of Vascularized Lymph Node Transfer for the Treatment of Upper Extremity Lymphedema After Breast Cancer Therapy. Ann Surg Oncol, 24(6), 1475-1481.
Greene, A., Meskell, P. (2017). The impact of lower limb chronic oedema on patients’ quality of life. Int Wound J, 14(3), 561-568.
Hoffner, M., Bagheri, S., Hansson, E., Manjer, J., Troëng, T., & Brorson, H. (2017). SF-36 Shows Increased Quality of Life Following Complete Reduction of Postmastectomy Lymphedema with Liposuction. Lymphat Res Biol. doi:10.1089/lrb.2016.0035
Huggenberger, K., Wagner, S., Lehmann, S., Aeschlimann, A., Amann-Vesti, B., & Angst, F. (2015). Health and quality of life in patients with primary and secondary lymphedema of the lower extremity. Vasa, 44(2), 129-137.
Klernas, P., Johnsson, A., Horstmann, V., Kristjanson, L. J., & Johansson, K. (2015). Lymphedema Quality of Life Inventory (LyQLI)-Development and investigation of validity and reliability. Qual Life Res, 24(2), 427-439.
Klernäs P, Johnsson A, Boyages J, Brorson H, Munnoch A, Johansson K. Test of Responsiveness and Sensitivity of the Questionnaire “Lymphedema Quality of Life Inventory”. Lymphat Res Biol. 2018
Lee, T. S., Morris, C. M., Czerniec, S. A., & Mangion, A. J. (2017). Does Lymphedema Severity Affect Quality of Life? Simple Question. Challenging Answers. Lymphat Res Biol. doi:10.1089/lrb.2016.0049
Modolin, M., Mitre, A. I., da Silva, J. C., Cintra, W., Quagliano, A. P., Arap, S., & Ferreira, M. C. (2006). Surgical treatment of lymphedema of the penis and scrotum. Clinics (Sao Paulo), 61(4), 289-294.
Patel, K. M., Lin, C. Y., & Cheng, M. H. (2015). A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. Ann Surg Oncol, 22(7), 2424-2430.
Pusic, A. L., Cemal, Y., Albornoz, C., Klassen, A., Cano, S., Sulimanoff, I., . . . Mehrara, B. (2013). Quality of life among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv, 7(1), 83-92.
Ridner SH, Dietrich MS. Development and validation of the Lymphedema Symptom and Intensity Survey-Arm. Support Care Cancer. 2015;23:3103-3112.
Ridner SH, Doersam JK, Stolldorf DP, Dietrich MS. Development and Validation of the Lymphedema Symptom Intensity and Distress Survey-Lower Limb. Lymphat Res Biol. 2018;16:538-546.
Salgarello M, Mangialardi ML, Pino V, Gentileschi S, Visconti G. A Prospective Evaluation of Health-Related Quality of Life following Lymphaticovenular Anastomosis for Upper and Lower Extremities Lymphedema. J Reconstr Microsurg. 2018;34:701-707.
Springer, S., Koller, M., Baumeister, R. G., & Frick, A. (2011). Changes in quality of life of patients with lymphedema after lymphatic vessel transplantation. Lymphology, 44(2), 65-71.
Williams AE, Rapport F, Russell IT, Hutchings HA. Psychometric development of the Upper Limb Lymphedema Quality of Life Questionnaire demonstrated the patient-reported outcome measure to be a robust measure for breast cancer-related lymphedema. J Clin Epidemiol. 2018;100:61-70.
Venous Congestion in Lymphedema
Saturday, May 4, 11:30am – 12:00pm
Lymphedema usually occurs as a result of impaired lymphatic drainage. However, venous congestion can overload a functioning/struggling lymphatic system which can then cause peripheral oedema. The most common reason for venous congestion is venous incompetence. Other causes include thrombosis, anatomical variation, and external compression, the latter which may be caused by fibrosis and scarring subsequent to lymph node dissection and associated radiotherapy for cancer management. The effect of cancer treatments on the venous system is often overlooked. This presentation will review the anatomy of the axillary and iliac veins, the various aetiologies and the current therapeutic strategies for venous congestion.
- List causes of lymphoedema secondary to venous obstruction.
Raju S, Owen S, Neglen P. Reversal of abnormal lymphoscintigraphy after placement of venous stents for correction of associated venous obstruction. J Vasc Surg. 2001;34:779-784.
Garrie A, Jones LE, Chen JF et al. New Vein Compression Entities in Patients with Unexplained Leg Swelling. Ann Vasc Surg. 2017;45:173-178.
Davidovic LB, Kostic DM, Jakovljevic NS, Kuzmanovic IL, Simic TM. Vascular thoracic outlet syndrome. World J Surg. 2003;27:545-550.
Raju S, Ward M. Utility of iliac vein stenting in elderly population older than 80 years. J Vasc Surg Venous Lymphat Disord. 2015;3:58-63.
Takai N, Miyazaki T, Yoshimatsu J, Miyakawa I. Treatment with a metallic endovascular stent in a patient with iliac venous stenosis due to endometrial cancer. Arch Gynecol Obstet. 2000;264:51-53.
Szuba A, Razavi M, Rockson SG. Diagnosis and treatment of concomitant venous obstruction in patients with secondary lymphedema. J Vasc Interv Radiol. 2002;13:799-803.
Sanders RJ, Rao NM. Pectoralis minor obstruction of the axillary vein: report of six patients. J Vasc Surg. 2007;45:1206-1211.
Rosengarten AM, Wong J, Gibbons S. Endometriosis causing cyclic compression of the right external iliac vein with cyclic edema of the right leg and thigh. J Obstet Gynaecol Can. 2002;24:33-35.
Naramore S, Aziz F, Alexander CP, Methratta S, Cilley R, Rocourt D. Fecal Impaction Causing Pelvic Venous Compression and Edema. Pediatr Rep. 2015;7:5999.
Ikegami A, Kondo T, Tsukamoto T, Ohira Y, Ikusaka M. Iliac Vein Compression Syndrome due to Bladder Distention Caused by Urethral Calculi. Case Rep Urol. 2015;2015:743270.
Liu Z, Gao N, Shen L et al. Endovascular treatment for symptomatic iliac vein compression syndrome: a prospective consecutive series of 48 patients. Ann Vasc Surg. 2014;28:695-704.
Larson NE, Crampton AR. A surgical procedure for postmastectomy edema. Arch Surg. 1973;106:475-481.
Segerstrom K, Bjerle P, Henriksson TG, Nystrom A. Decompression of the axillary vein for oedema of the arm caused by axillary dissection and irradiation. Scand J Plast Reconstr Surg Hand Surg. 1991;25:245-248.
Abboud G, Midulla M, Lions C et al. Right-sided” May-Thurner syndrome. Cardiovasc Intervent Radiol. 2010;33:1056-1059.
For the past 14 years, Dr. Munnoch has provided a surgical treatment option for lymphoedema patients. He has presented his results at numerous national & international conferences.
Dr. Munnoch’s areas of interest are breast reconstruction, microsurgery, vascular malformations, lymphoedema, and lipoedema.