Magee-Womens Hospital of UPMC is the first and only hospital in the region to offer new, sophisticated surgical techniques to cancer patients who develop lymphedema, an often debilitating and painful condition in which excess fluid collects in tissues and causes swelling.
Nearly 30 percent of cancer patients who undergo surgery or radiation will develop lymphedema, which occurs in the arm or leg when lymph nodes have been surgically removed, or from damage to the lymphatic system caused by radiation therapy. Conventional treatments include massage, physical therapy or a therapeutic compression sleeve, but for many patients these options don’t provide significant relief.
“It’s incredibly exciting when patients complete their care and their cancer is treated,” said Carolyn De La Cruz, M.D., assistant professor of surgery with the University of Pittsburgh School of Medicine and plastic surgeon at Magee. “However, those who develop lymphedema as a complication are left with a chronic, life-long debilitating disease that has no cure and has a significant impact on their quality of life.”
Magee surgeons have started performing lymphaticovenular bypass, a microscopic surgery which involves several tiny incisions in the arm or leg. Using specialized microscopic tools, surgeons redirect the lymphatic fluid to drain through small veins, alleviating a significant amount of swelling.
“Those of us who treat lymphedema like to compare it to a traffic jam in the body,” said Dr. De La Cruz. “This surgery allows us to redirect fluid by taking an alternate route, bypassing the back-up.”
Depending on the severity of the lymphedema, Magee surgeons also may offer another new approach, lymph-node transfer, which involves removing lymph nodes from elsewhere in the body and transferring them to the area of the body damaged by cancer treatment. After the procedure, the transferred lymph nodes start to drain.
“Until recently, surgical options for lymphedema haven’t been effective,” said Atilla Soran, M.D., M.P.H., clinical professor of surgery with the University of Pittsburgh School of Medicine and director of Magee’s lymphedema program. “While traditional treatment options work for a while, eventually a patient’s insurance runs out and they begin developing complications, like cellulitis, which need to be managed. The opportunity to offer surgical techniques to significantly improve the complications from lymphedema can greatly improve patients’ quality of life.”
With both procedures, the reduction is gradual, taking place over a period of about one year. Both the bypass procedure and the lymph-node transfer are most successful in patients who are cancer-free, with early-stage lymphedema. For patients with advanced lymphedema, a surgical debulking procedure in which doctors remove excess fluid from the fatty tissue of the affected limb can be a successful alternative treatment, although patients may still require compression garments and physical therapy post-surgery.