Surgical rehabilitation of women with upper limb postmastectomy lymphedema
DOI: 10.32364/2587-6821-2023-7-6-6
M.V. Ermoshchenkova1,2, M.O. Myasnikova3, A.D. Zikiryakhodzhaev2,4, V.N. Galkin1,2, O.I. Startseva1,2, I.V. Reshetov2, T.S. Berestok1
1City Clinical Oncological Hospital No. 1, Moscow, Russian Federation
2I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
3I.P. Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russian Federation
4P.A. Hertsen Moscow Oncology Research Institute — Branch of the National Medical Research Radiological Centre, Moscow, Russian Federation
This study highlights the key aspects of the diagnosis of postmastectomy edema of the upper limb. Clinical examination that allows the diagnosis of lymphedema with a high degree of accuracy should be enhanced with lymphoscintigraphy and fluorescent lymphography to establish the diagnosis and predict the outcome of potential surgical intervention. We share our experience with lymphography in women with breast cancer and upper limb postmastectomy edema and various surgical interventions for lymphedema. In stage 2 lymphedema and ineffective therapy, microsurgical intervention (lymphovenous anastomosis) should be performed if indicated on the basis of lymphoscintigraphy and/or fluorescent lymphography. Upper limb liposuction is recommended in stage 3–4 lymphedema and ineffective conservative treatment or lack of stable results. Water-jet assisted liposuction has established its efficacy based on the data of various authors and our findings, i.e., lymphedema reduced by 70–100% over 1–5 years of follow-up.
Keywords: breast cancer, lymphedema, water-jet assisted liposuction, long-term outcomes, lymphatic outflow patterns.
For citation: Ermoshchenkova M.V., Myasnikova M.O., Zikiryakhodzhaev A.D., Galkin V.N., Startseva O.I., Reshetov I.V., Berestok T.S. Surgical rehabilitation of women with upper limb postmastectomy lymphedema. Russian Medical Inquiry. 2023;7(6):372–382 (in Russ.). DOI: 10.32364/2587-6821-2023-7-6-6
About the authors:
Mariya V. Ermoshchenkova — Dr. Sc. (Med.), Head of the Department of Oncomammalogy and Reconstructive Plastic Surgery, City Clinical Oncological Hospital No. 1; 18А, Build. 7, Zagorodnoe road, Moscow, 117152, Russian Federation; associate professor of the Department of Oncology, Radiotherapy, and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, Build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0002-4178-9592.
Marina O. Myasnikova — Dr. Sc. (Med.), professor of the Department of Faculty Surgery, I.P. Pavlov First Saint-Petersburg State Medical University; 6-8, Lev Tolstoy str., St. Petersburg, 197022, Russian Federation.
Azizzhon D. Zikiryakhodzhaev — Dr. Sc. (Med.), professor of the Department of Oncology, Radiotherapy, and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, Build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; Head of the Department of Oncology and Breast Reconstructive Plastic Surgery, P.A. Hertsen Moscow Oncology Research Institute — Branch of the National Medical Research Radiological Centre; 3, 2nd Botkinskiy pass., Moscow, 125284, Russian Federation; ORCID iD 0000-0001-7141-2502.
Vsevolod N. Galkin — Dr. Sc. (Med.), Head Doctor, City Clinical Oncological Hospital No. 1; 18А, Build. 7, Zagorodnoe road, Moscow, 117152, Russian Federation; professor of the Department of Oncology, Radiotherapy, and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, Build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0002-6619-6179.
Olesya I. Startseva — Dr. Sc. (Med.), professor of the Department of Oncology, Radiotherapy, and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, Build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; oncologist, Department of Oncomammalogy and Reconstructive Plastic Surgery, City Clinical Oncological Hospital No. 1; 18А, Build. 7, Zagorodnoe road, Moscow, 117152, Russian Federation; ORCID iD 0000-0003-4839-9973.
Igor V. Reshetov— Dr. Sc. (Med.), Professor, Academician of the RAS, Head of the Department of Oncology, Radiotherapy, and Reconstructive Surgery, Director of the Institute of Cluster Oncology, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, Build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0002- 0909-6278.
Tat'yana S. Berestok — oncologist, Department of Oncomammalogy and Reconstructive Plastic Surgery, City Clinical Oncological Hospital No. 1; 18А, Build. 7, Zagorodnoe road, Moscow, 117152, Russian Federation; ORCID iD 0000-0003-4839-9973.
Contact information: Mariya V. Ermoshchenkova, e-mail: maryerm@mail.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 11.05.2023.
Revised 05.06.2023.
Accepted 29.06.2023.
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