Advanced surgical technologies of lymphorrhea and limbs lymphedema prevention after axillary and inguinal lymph node dissection (literature review)

   Radical axillary and inguinal lymphadenectomies are associated with lymphorrhea and limbs lymphedema, which lead to disability and life quality decrease of the absolute majority of operated patients in case of no proper prevention and treatment.

   Purpose of the study: to analyze the effectiveness of advanced technologies that use endoscopic and robotic equipment, reconstructive microsurgery in terms of preventing lymphorrhea and lymphedema after axillary and inguinal lymphadenectomy.

   The literature was searched using PubMed and Google Scholar electronic databases in accordance with keywords. Full-text publications in Russian and English over the past 15 years, containing information about the use of endoscopic, robotic and microsurgical technologies for inguinal and axillary lymphadenectomy, were analyzed. The diagrams were created using MS Office Excel 2019. The incidence of lymphorrhea after endoscopic axillary lymph node dissection (EALND) ranges from 3.1 to 94.7 %. The incidence of lymphorrhea after video-endoscopic inguinal lymphadenectomy (VEIL) ranges from 0 to 30.7 %, lymphedema – from 0 to 19.0 %. The incidence of lymphorrhea after robotic-assisted video-endoscopic inguinal lymphadenectomy (RAVEIL) varies from 0 to 29.4 %, lymphedema – 0 to 27.3 %. The incidence of lymphorrhea after robotic nipple-sparing mastectomy with immediate robotic breast reconstruction (RNSM and IRBR) have the highest heterogeneity – from 0 to 94.7 %. The effectiveness of lymphaticovenous anastomoses (LVA) was noted in 87.5–100 % of patients with lower limb lymphedema, and in 80.7–93.3 % of patients with upper limb lymphedema. The effectiveness of lymph node to vein anastomoses (LNVA) was noted in 70.6–100 % of patients with lower limb lymphedema. The effectiveness of vascularized lymph node transplantation (VLNT) was noted in 66.7–100 % of patients with lower limb lymphedema, and in 71.4–100 % of patients with upper limb lymphedema.

   Conclusion. Despite the heterogeneity of results, advanced endoscopic, robotic and microsurgical surgical techniques demonstrated a positive effect on reducing the incidence of lymphorrhea and extremities lymphedema after axillary and inguinal lymphadenectomy. However, their use simultaneously with lymphadenectomy remains impossible in the majority of cases due to the high cost and the lack of necessary equipment. Therefore, the search for more effective and at the same time accessible methods for lymphorrhea and lymphedema prevention after lymphadenectomy is vitally needed.

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