To Assess the Efficacy of the LYMPHA in the Prevention of Lymphedema Following Axillary Dissection for Breast Cancer

Study Overview
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Brief Summary
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Lymphedema is the Build-up of Lymph Fluid in the Body's Tissue Causing Chronic, Debilitating Swelling. This Commonly Occurs as a Result of a Disruption of the Lymphatic System During Lymph Node Dissection Surgeries. LYMPHA (LYmphatic Microsurgical Preventive Healing Approach) is an Innovative Microsurgical Technique Where Blocked Lymphatic Vessels Are Drained Into the Blood Circulation by Surgically Creating a Shunt Between a Lymphatic Channel and a Blood Vessel Called a Lymphatic-venous Bypass. Recently, LYMPHA Technique Has Been Shown to Prevent Lymphedema When Performed at the Time of Nodal Dissection. We Propose a Prospective Study Evaluating the Effectiveness of LYMPHA Technique Using Objective Clinical Protocol.

Detailed Description
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Consenting patients will have the LYMPHA procedure at the time of planned axillary dissection surgery for the prevention of upper and extremity lymphedema. The node dissection will be performed by Dr. Kang while the LYMPHA technique will be performed by the plastic surgeon, Dr. Kim. The LYMPHA procedure consist of performing LVA at the time of the node dissection. Patent blue dye will be injected in the volar surface of the upper third of the arm in a quantity of about 1-2 ml intradermally, subcutaneously, and under muscular fascia into patient approximately 10 minutes before skin incision. This will allow mapping of the lymphatic channels for identification for bypass. The node dissection will then be performed with preservation of the anterior branch of the axillary vein in the axilla. Afferent lymphatic vessels will be sutured into a branch of the axillary vein distal to a competen valve. The total duration of the surgery is approximately 3 hours. The LYMPHA technique accounts for an additional 30 min to the standard 2-2.5 hours allocated to the node dissection. Pre-surgery, patients will have baseline limb circumference measurements of both the surgery-affected and unaffected arms and by lymphoscintigraphy. Patients will be followed up clinically at every 6 months up to a year. At each follow-up visit, patients will have a physical examination and their circumference of their limbs taken. Patients will also fill out a LyQLI, SF-36, DASH administered by the Clinical Research Coordinator pre-and post-surgery. Each patient will have a total of 1 years of participation time.

Official Title
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A Randomized Controlled Trial to Assess the Efficacy of the Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) to Prevent Lymphedema After Axillary Dissection for Breast Cancer

Conditions
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Lymphedema, Breast Cancer

Intervention / Treatment
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* Procedure: LYMPHA(LYmphatic Microsurgical Preventive Healing Approach) technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Node-positive cancer requiring an axillary or lymphadenectomy Below 30 Body Mass Index Exclusion Criteria: Patients receiving a sentinel lymph node biopsy Patients with established preoperative lymphedema Patients with post-thrombotic syndrome, peripheral vascular disease Pregnant patients

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: LYMPHA technique group<br>LVA at the time of Axillary Dissection | Procedure: LYMPHA(LYmphatic Microsurgical Preventive Healing Approach) technique<br>* Patients will receive a lymphatic-venous anastomosis at time of their required Axillary Dissection<br>|
| No Intervention: Non-LYMPHA technique group<br>No preventive surgical approach | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| lymphatic flow | Difference in lymphatic flow between LYMPHA technique group and Non-LYMPHA technique group | 6 months | 
| limb volume | Difference in limb volume between LYMPHA technique group and Non-LYMPHA technique group | 6 months | 
| lymphatic flow | Difference in lymphatic flow between LYMPHA technique group and Non-LYMPHA technique group | 1 year | 
| limb volume | Difference in limb volume between LYMPHA technique group and Non-LYMPHA technique group | 1 year |