Alternative Lymphatic Drainage Pathways in the Trunk Following Oncologic Therapy

Area of Science:

• Oncology
• Vascular Surgery
• Lymphedema Research

Background:

• Breast cancer treatments can cause trunk and upper extremity lymphedema, indicating lymphatic dysfunction.
• Indocyanine green-lymphangiography is a key tool for characterizing lymphatic dysfunction.
• A validated staging system exists for truncal lymphedema.

Purpose of the Study:

• To identify risk and protective factors for truncal and upper extremity lymphedema.
• To investigate the role of alternative lymphatic drainage pathways.
• To inform medical and surgical treatment strategies for lymphedema.

Main Methods:

• Lymphangiography was performed on patients with suspected lymphedema undergoing revisional breast surgery.
• Axillary and inguinal lymphatic flow was evaluated for alternative drainage patterns.
• Statistical analysis, including Cohen's kappa and binomial regression, was used to assess risk and protective factors.

Main Results:

• Eighty-eight percent of patients exhibited alternative lymphatic flow, primarily to the ipsilateral axilla and groin.
• Ipsilateral axillary and contralateral inguinal drainage were linked to a reduced risk of truncal lymphedema.
• Radiation therapy and axillary lymph node dissection were associated with an increased risk of lymphedema.

Conclusions:

• Specific alternative lymphatic drainage pathways serve as protective factors against truncal lymphedema.
• Radiation, axillary dissection, and contralateral axillary drainage are risk factors for upper extremity lymphedema.
• Findings guide postoperative manual lymphatic drainage and surgical eligibility for lymphovenous bypass.