The panel, a multidisciplinary (breast surgeons, plastic surgeons, radiation oncology, LE
therapists, PMR and our own Alicia Staley) international group presented their findings and recommendations.
Stated goals were recognizing the issue, the possible lack of a definitive solution, the
multidisciplinary nature of treatment and that early treatment and/or prevention is key.
The recommendations were:
1) recognize the underreporting of this problem and educate ourselves and patients
2) noted risk factors include extensive surgery and adjuvant treatments as well as obesity (a common theme throughout the conference)
3) establish a surveillance plan with patient education within NCCN guidelines and involving LE specialists
4) assess limb changes: note that no recommendations have been made by any group in
terms of how to assess those changes/which is best
5) recognize that process is probably multifactorial: obstruction with acute and chronic
inflammation, wound healing, scarring. Future therapies may target inhibition of
inflammation and regeneration of lymphatics
6) “Historical” risk factors not supported, so probably no risk with IV, blood pressure cuffs (how do you treat LE? With compression! – editorial comment 🙂 ), flying and heavy lifting
7) Encourage weight normalization and exercise: low weights, low reps with gradual increase
8) Consider preventative strategies with axillary reverse mapping and LYMPHA Press
9) For the affected patient, early treatment with lymphovascular surgery or lymph node transfer should be considered (not easy access; few who do these).