The LYMPH Trial - Microsurgical Versus Conservative Treatment of Chronic Breast Cancer Associated Lymphedema

To date, conservative complex physical decongestion therapy (CDT) is the gold standard

for BCRL (breast cancer related lymphedema) and includes manual lymphatic drainage, local

compression with bandages and garments, physical exercises and meticulous skin care. It

is, however, too often ineffective to prevent stage progression in curing BCRL and purely

symptomatic. Lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT)

are two surgical techniques that, in contrast to CDT, are able to actually address the

underlying causes and eventually restore the lymphatic drainage. LVA achieves this by

creating numerous bypasses between lymphatic vessels and venules allowing the drainage of

excessive fluid within the subcutaneous tissues into the venous system, while VLNT

usually brings functioning lymph nodes to an area devoid of lymph nodes or with

dysfunctional lymph nodes, thus enabling the spontaneous development of new lymphatic

pathways. Both techniques have shown very promising results with low complication rates

and improved Quality of Life (QoL) for the patients. However, no multicentric randomized

controlled trial (RCT) has yet prospectively evaluated the superiority of these surgical

techniques over CDT alone, limiting patient's access to most effective treatment

available. Requests for cost reimbursement must still be submitted to insurance companies

in most countries and are often rejected, thus delaying surgical treatment and resulting

in prolonged suffering of affected patients. This is untenable seeing as affected

patients suffer from a heavy physical, psychological and financial burden. This

pragmatic, randomized, multicenter trial aims to establish a solid scientific basis

assessing the superiority of surgical treatment over CDT alone.