Lymphovenous Bypass Procedure for Breast Cancer

Overseen by Mark Schaverien

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: M.D. Anderson Cancer Center

Must not be taking: Anticoagulants

Disqualifiers: Pregnancy, BMI over 50, others

No Placebo Group

Approved in 4 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial studies whether a surgical procedure called lymphovenous bypass can prevent arm swelling in patients with certain types of breast cancer or melanoma. The surgery creates a new path for fluid to move away from the arms, which may help stop swelling before it starts. Lymphovenous bypass is a surgical procedure that has been used to treat lymphedema by creating a new pathway for lymphatic fluid to drain, potentially reducing swelling.

Will I have to stop taking my current medications?

The trial requires that you stop taking anticoagulants (blood thinners) at least 7 days before the surgery.

How is the Lymphovenous Bypass treatment different from other treatments for breast cancer-related lymphedema?

Lymphovenous Bypass (LVA) is a unique microsurgical procedure that connects tiny lymphatic vessels to small veins, helping to reduce lymphedema (swelling due to lymph fluid buildup) by improving lymphatic drainage. Unlike other treatments, it uses advanced techniques like dynamic ultrasonography to enhance the effectiveness of the procedure by identifying the best vessels for connection. ^{1 2 3 4 5}

Research Team

Mark Schaverien

Principal Investigator

M.D. Anderson Cancer Center

Eligibility Criteria

This trial is for adults over 18 with inflammatory or locally advanced non-inflammatory breast cancer, planning to have underarm lymph node surgery and radiation therapy. It's not for pregnant individuals, those unable to follow up for at least 18 months, patients on anticoagulants within a week of surgery, or with a BMI over 50.

Inclusion Criteria

Patients willing to participate

Patients able to complete informed consent

You have inflammatory breast cancer, or non-inflammatory breast cancer that is being treated with ALND and radiation therapy.

Exclusion Criteria

Patients that are known to be pregnant at the time of surgery

Patients are available for follow-up less than 18 months or do not undergo measurements within the scheduled period

You have taken blood thinners within 7 days before surgery.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Patients receive indocyanine green IV and undergo lymphangiography, then undergo LVB at the time of ALND

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

18 months

Follow-up visits at 2 weeks, 6 months, 12 months, and 18 months

Treatment Details

Interventions

• Lymphovenous Bypass (Procedure)

Trial Overview The study tests if the lymphovenous bypass procedure can prevent arm swelling (lymphedema) when done before underarm lymph node surgery in breast cancer patients. Lymphangiography and Indocyanine Green are used to help perform this preventive measure.

Participant Groups

Group I: Group I (LVB) Experimental Treatment 3 Interventions

Patients receive indocyanine green IV and undergo lymphangiography, then undergo LVB at the time of ALND.

Group II: Group II (no intervention) Active Control 1 Intervention

Patients do not receive indocyanine green, undergo lymphangiography, nor undergo LVB at the time of ALND.

Lymphovenous Bypass is already approved in Canada, Japan for the following indications:

Approved in Canada as Lymphovenous Bypass for:

• Prevention and treatment of lymphedema in patients with breast cancer or melanoma

Approved in Japan as Lymphovenous Bypass for:

• Treatment of lymphedema in patients with breast cancer or melanoma

Who Is Running the Clinical Trial?

M.D. Anderson Cancer Center

Lead Sponsor

Trials

3,107

Recruited

1,813,000+

Dr. Peter WT Pisters

M.D. Anderson Cancer Center

Chief Executive Officer since 2017

MD from University of Western Ontario

Dr. Jeffrey E. Lee

M.D. Anderson Cancer Center

Chief Medical Officer

MD from Stanford University School of Medicine

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Dr. Douglas R. Lowy

National Cancer Institute (NCI)

Chief Executive Officer since 2023

MD from New York University School of Medicine

Dr. Monica Bertagnolli

National Cancer Institute (NCI)

Chief Medical Officer since 2022

MD from Harvard Medical School

Findings from Research

Dynamic lymphaticovenular anastomosis (LVA) significantly improves clinical outcomes for patients with breast cancer-related upper extremity lymphedema compared to conventional LVA, with greater postoperative volume reduction observed at both 1 month and 1 year.

The use of dynamic ultrasonography in the dynamic LVA method allows for better incision placement by visualizing lymphatic vessels, leading to fewer sclerotic vessels encountered and enhancing the effectiveness of lymph propulsion during natural hand movements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The dynamic-lymphaticovenular anastomosis method for breast cancer treatment-related lymphedema: Creation of functional lymphaticovenular anastomoses with use of preoperative dynamic ultrasonography. Seki, Y., Kajikawa, A., Yamamoto, T., et al.[2019]

Using patent blue dye to enhance lymphaticovenular anastomosis (LVA) allows for better identification of lymphatic vessels, making the microsurgical procedure easier and safer for patients with chronic lymphoedema.

The technique not only aids in the dissection of lymphatic vessels but also confirms the success of the anastomosis by visualizing the dynamic pumping action of the lymphatics, demonstrating its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patent blue dye in lymphaticovenular anastomosis. Yap, YL., Lim, J., Shim, TW., et al.[2020]

A systematic review of 22 studies on lymphaticovenular anastomosis (LVA) found that while peri-operative care is crucial, the quality of evidence is low and descriptions of management practices are often sparse.

The preferred peri-operative care includes the use of prophylactic antibiotics, limb elevation during recovery, and starting compression therapy 4 weeks post-surgery, but more detailed protocols are needed for better comparison and optimization of care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peri-operative care for patients undergoing lymphaticovenular anastomosis: A systematic review. Winters, H., Tielemans, HJ., Sprangers, PN., et al.[2018]

Lymphovenous anastomosis (LVA) is a safe and effective microsurgical treatment for lymphedema of the lower extremity, showing objective improvement rates ranging from 23.3% to 100% across various patients, particularly benefiting those with early-stage lymphedema.

The study reviewed 74 articles involving 6260 patients, indicating that LVA can significantly enhance quality of life and reduce lymphedema symptoms, with emerging techniques potentially leading to even better outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of Lymphovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review. Verhey, EM., Kandi, LA., Lee, YS., et al.[2022]

In a study of 18 patients with secondary upper extremity lymphedema, both lymphaticovenous side-to-end anastomosis (LVSEA) and end-to-end anastomosis (LVEEA) showed similar low patency rates, with 32% and 35% respectively being patent after 6 months.

The study suggests that LVSEA may be the preferred technique for lymphaticovenous anastomosis due to a lower likelihood of lymphatic obstruction compared to LVEEA, especially in cases where the risk of obstruction is a concern.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of patency rates of different lymphaticovenous anastomosis techniques and risk factors for obstruction in secondary upper extremity lymphedema. Suzuki, Y., Sakuma, H., Yamazaki, S.[2020]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

The dynamic-lymphaticovenular anastomosis method for breast cancer treatment-related lymphedema: Creation of functional lymphaticovenular anastomoses with use of preoperative dynamic ultrasonography. [2019]

2. Singapore pubmed.ncbi.nlm.nih.gov

Patent blue dye in lymphaticovenular anastomosis. [2020]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Peri-operative care for patients undergoing lymphaticovenular anastomosis: A systematic review. [2018]

4. United States pubmed.ncbi.nlm.nih.gov

Outcomes of Lymphovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Evaluation of patency rates of different lymphaticovenous anastomosis techniques and risk factors for obstruction in secondary upper extremity lymphedema. [2020]