Sylvester Breast Cancer Surgeon Finds Simple Procedure Sharply Reduces Lymphedema

A surgical oncologist at Sylvester Comprehensive Cancer Center of the University of Miami Miller School of Medicine has found that a simple procedure dramatically reduces lymphedema, a long-term swelling of the arm, after the removal of lymph nodes in breast cancer patients.

Eli Avisar, M.D.

“Different techniques have been tried to lower the risk of lymphedema, including compression sleeves, radiation and surgery,” said Eli Avisar, M.D., professor of clinical surgery and director of the breast surgical oncology fellowship. “We have developed a simplified surgical technique that lowers the rate of lymphedema from nearly one in five patients to just 3 percent.”

Avisar presented the findings of a three-year study of Sylvester breast cancer patients at a poster session of the San Antonio Breast Cancer Symposium, December 8-12 in San Antonio, Texas. Launched in 1977, the symposium provides state-of-the-art information on breast cancer research to an international audience of researchers and physicians in all breast cancer subspecialties from more than 90 countries.

“During most breast cancer surgeries, the lymph nodes under the arm are examined to determine if the cancer has spread beyond the breast,” Avisar said, noting that axillary lymph node dissection (ALND) is the standard initial approach for breast cancer patients whose lymph notes are clinically positive for cancer after a mastectomy or a lumpectomy.

However, lymphedema, caused by a lymphatic system blockage, is a serious complication of ALND with an incidence rate of 16 percent. In recent years, Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) has been introduced as a technique to prevent the blockage. However, this procedure typically involves bringing in a plastic surgeon to reconnect on the lymph nodes using advanced microsurgery techniques alongside the oncology surgeon, Avisar said.

“We have simplified this complicated procedure,” he said. “After the surgeon removes the nodes, we inject blue dye into the arm to identify the lymph channels and connect them to the appropriate veins without using a microscope or involving a second surgeon.”

Avisar’s poster is titled, “Evaluation of Simplified Lymphatic Microsurgical Preventing Healing Approach (S-LYMPHA) for the Prevention of Breast Cancer-Related Clinical Lymphedema After Axillary Lymph Node Dissection.”  Miller School contributors to the paper were Tolga Ozmen, M.D.; Yan Zhou, M.D.; Alicia Vinyard, M.D.; and Lazaro Mesa, a Miller School medical student.

From December 2014 to December 2016, Avisar and his team studied 406 Sylvester patients. The S-LYMPHA procedure was attempted in 81 patients and was completed successfully in 90 percent of those cases. “We found that S-LYMPHA is a safe and relatively simple method, which decreases incidence of clinical lymphedema dramatically,” Avisar said. “It should be considered as an adjunct procedure to ALND for all patients during initial surgery.”

Tags: breast cancer, Dr. Eli Avisar, lymphedema, Sylvester Comprehensive Cancer Center