Among the first in Northern Italy to implement the latest microsurgical techniques, a pool of specialists working at Ospedale dell’Angelo, Mestre is working to solve the problem of arm lymphedema, one of the most common problems arising in women after breast surgery.
"Lymphedema is an accumulation of lymphatic fluid” explains Guido Papaccio, head of the Breast Unit at the12 Veneziana local health authority. “It is caused by blockage of the lymph vessels resulting in a build up of fluid in a limb. Unfortunately it is common side-effect of breast cancer surgery, with arm swelling arising after the operation: up to 20% of women who have undergone axillary lymph node removal experience severe lymphedema in the ten years following surgery. So women who have solved the problem of cancer thanks to surgery are then faced with debilitating arm swelling that may appear years after the operation."
Lymphedema may also occur in the legs in other illnesses. The condition is traditionally treated by massage, lymph drainage and bandaging: the aim is to the curb and reduce the limb swelling, reducing the lymphedema by mechanically stimulating the lymph circulation.
Instead, Dr Papaccio’s Breast Unit in Mestre opted to work in partnership with lymphedema microsurgery specialists at the Vascular Surgery Unit. Together they have devised a therapeutic plan to treat and even prevent the formation of lymphedema. “We tackle blocked lymph vessels or lymph node dissection”, explains surgeon Alessandro Busetto, “by inserting fully-fledged by-passes, surgically constructing alternative lymphatic pathways. We can do this to treat a blocked vessel when lymphedema has already occurred. But the challenge we have now overcome is prevention, constructing by-passes around any vessels that may become blocked in the future."
At Ospedale dell’Angelo, specialists make an in-depth analysis of the lymphatic pathways in selected patients predisposed to the risk of lymphedema, identifying critical points before they undergo breast surgery. During the operation, the lymphatic vascular surgeon assists the cancer team. While the cancer surgeons remove the tumor, the vascular specialist prepares and constructs alternative lymphatic pathways with the by-passes to prevent lymph buildup in case the original lymphatic pathway should become blocked in years to come.
The partnership between the Breast Unit and Lymphatic Surgery at Ospedale dell’Angelo has now been made permanent and consolidated within the Department of Cardiothoracic and Vascular Surgery at the12 Veneziana local health authority: "We shall present the ‘LI.VE Venice Lymphology scheme to the public in October during the clinical lymphology symposium” explains Dr Vittorio Dorrucci. “In July we successfully performed the sixth structured operation as part of this clinical partnership and are among the first to gain this experience. At the same time, the pre and postoperative protocols agreed with the patients associations and voluntary organizations are already up and running. These are essential for preliminary work to achieve results. This scheme sees the launch of a new clinical practice which is a step ahead in the care of lymphedema, in particular care and support for women with breast cancer."
Translated from VeneziaToday