December 2019 #PRSJournalClub: “Developing a Lymphatic Surgery Program: A First-Year Review”

by Ara A. Salibian, MD (@AraSalibianMD)

The December 2019 #PRSJournalClub focused in on an exciting new study in PRS Journal entitled “Developing a Lymphatic Surgery Program: A First-Year Review.” The study objectively analyzed the clinical experience during the first year of establishing a lymphatic surgery program with both immediate and delayed lymphatic reconstruction.

On December 16th, study authors Dr. Dhruv Singhal (@DrDhruvSinghal) and Anna Rose Johnson (@annarose719) from the Division of Plastic and Reconstructive Surgery at Beth Israel Deaconess Medical Center answered questions from around the world and provided further insights into the fascinating results of their study in a discussion hosted by PRS Journal on Facebook.

Click here to read the study as well as view this month’s comprehensive collection of #PRSJournalClub articles.

Lymphedema surgery is being increasingly performed throughout the United States as a means of both preventing (immediate) and treating (delayed) lymphedema. This type of surgery, however, is typically only performed in specialized centers and requires an well-coordinated multi-disciplinary team to facilitate the diagnosis, management and surveillance of patients. The authors of this study sought to analyze their experience during the first year after establishing a lymphatic surgery program in 2016.

The program at their institution consists of a lymphatic surgery team (plastic surgeon), lymphatic medicine (cardiologist with focused vascular and lymphatic specialization) and lymphatic treatment clinic (lymphedema therapists) that all work together to care for these patients. Patients with lymphedema are screened through the medicine and treatment clinics whereas patients presenting for preventative procedures are all seen by the lymphatic surgery team. The authors clinical algorithm included lymphovenous bypasses at the time of axillary dissection for immediate reconstruction and debulking procedures followed by physiologic interventions such as flow-through omental transfer for delayed reconstruction. 

During their first year, 142 patients presented for evaluation with a strong predominance of breast cancer patients as well as outside referrals. 32 patients underwent immediate lymphatic reconstruction for prevention and 13 delayed reconstruction for chronic lymphedema. The authors reported a 5.6% lymphedema rate among patients undergoing immediate reconstruction and a 21% reduction of excess volume with significant improvement in lymphedema and quality-of-life scores in those undergoing delayed reconstruction. The authors reinforced the importance of a lymphatic medicine team to evaluate patients with chronic lymphedema as 14% of these patients presenting to their center were eventually given an alternate diagnosis. The challenges and importance of postoperative surveillance were also importantly discussed. Finally, the authors highlighted the need to collaborate with surgical oncology, urology and gynecology teams to increase awareness of lymphatic reconstruction for patients seen by these specialties.

The article and the implications of its results were discussed in another fantastic #PRSJournalClub podcast. This month’s podcast hosted special guest moderator Dr. David Song, Chair of the Department of Plastic Surgery at Georgetown University Medical Center.  As usual, he was joined by PRS Resident Ambassadors Raj Parikh (@rajparikhmd), Lily Mundy (l23mundy) and Kyle Sanniec (@DrKyleSanniec). The panel brought up excellent points on best practices for lymphedema surgical treatment, treatment algorithms, and the need for further establishment of multi-disciplinary centers.

Listen to this great podcast below!

On December 16th, PRS journal hosted a fantastic interactive discussion with Drs. Singhal and Johnson on Facebook!  Questions were fielded from all over the world in what became a phenomenal discussion on outreach for reaching lymphedema patients, healthcare costs, infrastructure establishment and evaluation of outcomes among many other excellent points. 

Check out some of the great discussions from Sunday below! 

This December #PRSJournalClub article (as well as other Journal Club selections from December), selected classic pairings and videos, and the entire Facebook Q&A are archived on here.

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