How lymph node ‘re-plumb’ eases pain after cancer

In In The News by Barbara Jacoby

By: Martyn Halle

From: dailymail.co.uk

Complex operation could solve painful limb swelling
  • Lymph nodes in armpits are often removed to stop cancer spreading 
  • These glands usually produce clear fluid that circulates through body 
  • Removing them can lead to limbs becoming very swollen and painful 
  • Doctors now reconnecting lymphatic channels to veins to stop pain

A complex operation to ‘re-plumb’ the circulation system in the arms may be a solution to painful and unsightly limb swelling that is common after surgery for breast cancer.

Alongside a mastectomy – removal of the breast tissue – it is sometimes necessary to take away some or all of the glands known as lymph nodes in the armpit to stop the spread of cancer through the rest of the body.

These glands are part of the immune system and produce a clear fluid that circulates around the body through vessels similar to veins and arteries. When the lymph glands are removed, fluid is still produced but is cut off from draining around the body, and the arm can become extremely swollen by a build-up of fluid.

Alex Ramsden, a plastic surgeon who runs the Oxford Lymphoedema Practice with Professor Dominic Furniss, says: ‘Some women find relief by wearing a compression sleeve to reduce the fluid build-up. It takes away some of the pain, but it’s not a cure and if you take it off the swelling comes back.’

Ramsden and Furniss carry out microsurgery on the tiny lymphatic channels in the arm, reconnecting them to veins in the upper arm so the excess lymph fluid drains back into the body.

The stitches used to connect the vessels are less than the width of a human hair. Prior to the operation, a green dye is injected into the area where the nodes have been removed so the surgeons have a map to work from to help them make the new connections. The procedure lasts up to five hours.

Ramsden adds: ‘We’re re-plumbing very fine structures so it is time-consuming. But we do the operation as a day case under local anaesthetic, which allows patients to read a book, play music or use their tablet or mobile phone with their other arm.’

Studies of the relatively new procedure – lymphatic venous anastomosis, or LVA – have produced mixed results, with some suggesting little benefit, while others show that up to 87 per cent of patients may be able to stop using compression garments.

It is possible to carry out LVA in the groin area of the body for men who have had lymph nodes removed after prostate cancer surgery.

Kefah Mokbel, breast surgeon at the London Breast Institute, Princess Grace Hospital, said: ‘Removing lymph nodes is a crucial part of curing cancer for some patients, but we also have to think about the quality of life of survivors. And there are many more now, thanks to advances in treatment.’

Ramsden, who works at Oxford NHS Trust, says that many women have difficulty getting funding for the operation. ‘It’s frustrating – many Clinical Commissioning Groups will not pay hospitals to do the operation.’

The Welsh Government has seized the initiative and is running a three-year pilot offering LVA to 42 women a year for three years at a cost to the NHS of £733,000.

Ramsden says: ‘Women should be able to have this operation on the NHS. We cure their cancer – and then force them to pay to treat this complication.’