The Effectiveness of Lymphatic Bypass Supermicrosurgery

NCT ID: NCT05682885

Last Updated: 2025-01-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

140 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-10-06

Study Completion Date

2027-11-18

Brief Summary

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This study evaluate the effectiveness of lymphatic bypass supermicrosurgery (LBS) and axillary lymph node dissection (ALND) compare to ALND alone to prevent breast cancer treatment-related lymphedema (BCRL).

Detailed Description

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In the intervention group, LBS was performed after ALND with the intima-to-intima coaptation using the supermicrosurgery technique. The anastomosis is done between the afferent lymphatic vessel to the recipient's vein, or if possible, from the afferent to the efferent lymphatic vessel. The upper extremity lymphedema (UEL) index and indocyanine green (ICG) lymphography are utilized to evaluate the development of lymphedema.

Conditions

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Breast Cancer Related Lymphedema Lymphedema Arm

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This study is a single-blind pragmatic parallel arm randomized clinical trial to analyze the effectiveness of lymphatic bypass supermicrosurgery (LBS).
Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants
Blinding is implemented in two conditions: the main researcher (Bayu Brahma) will not know the identity and medical history of the patient when assessing the indocyanine green (ICG) lymphography results and the patients will not know the received type of surgical procedure.

Study Groups

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Axillary lymph node dissection with LBS

70 subjects will be needed for each group. A standard mastectomy or lumpectomy incision is made and ALND will be done in the same incision. The lymphatic vessels and lymph nodes will be resected using a near-infrared (NIR) camera. To locate lymphatic vessels, a microscope with ICG lymphography navigation is employed. LBS was performed by making intima-to-intima anastomosis between the afferent lymphatic vessels and the recipient's veins, or to the efferent lymphatic vessels. The anastomosis patency will be assessed by observing the ICG fluorescent flow. After surgery, follow-up will be done every 2 months and every 3 months in the second year. UEL index, ICG lymphography, and quality of life evaluation will be done. The cumulative incidence of BCRL, the free survival time of BCRL, and subclinical lymphedema (SCL) progression will be reported descriptively. BCRL risk factors and collateral lymphatic pathway will be observed as well.

Group Type EXPERIMENTAL

Lymphatic Bypass Supermicrosurgery

Intervention Type PROCEDURE

Axillary Lymph Node Dissection with Lymphatic Bypass Supermicrosurgery

Axillary lymph node dissection without LBS

70 subjects will be needed for each group. A standard mastectomy or lumpectomy incision is made and ALND will be done in the same incision. After primary breast cancer removal, a standard ALND level I, II, and if necessary, level III is performed. After surgery, follow-up will be done every 2 months and every 3 months in the second year. History taking, physical examination, radiology and histopathology examination, UEL index, and ICG lymphography evaluation will be done during follow-up. Each subject will complete the lymphedema quality of life questionnaire. The cumulative incidence of BCRL, the free survival time of BCRL, and SCL progression will be reported descriptively. BCRL risk factors and collateral lymphatic pathway will be observed as well.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Lymphatic Bypass Supermicrosurgery

Axillary Lymph Node Dissection with Lymphatic Bypass Supermicrosurgery

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Breast cancer patient aged \>18 years old
* Breast cancer patient with clinically ALNs metastases (cN1 or cN2).
* Breast cancer patient with no clinical metastasis and tumor size ≥5cm or no sentinel lymph node biopsy facility in the hospital.
* Any breast cancer patients that receive neoadjuvant systemic therapy.

Exclusion Criteria

* Stage IV breast cancer patients who do not show clinical and radiological improvement after primary systemic therapy.
* Breast cancer patients with previous surgeries such as mastectomy, axillary lymph node biopsy, sentinel lymph node biopsy (SLNB), and ALND.
* Breast cancer patients with prior breast, chest wall, axillary, or neck radiotherapy.
* Breast cancer patients with preoperative lymphatic system abnormality detected by ICG lymphography.
* Breast cancer patients with iodine allergy, asthma, decreased kidney function, pregnancy, and lactation.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Dharmais National Cancer Center Hospital

OTHER_GOV

Sponsor Role lead

Responsible Party

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Bayu Brahma

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Bayu Brahma, MD

Role: PRINCIPAL_INVESTIGATOR

Dharmais Hospital National Cancer Center, Indonesia

Locations

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Dharmais National Cancer Center Hospital

Jakarta, Jakarta Special Capital Region, Indonesia

Site Status

Countries

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Indonesia

References

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Brahma B, Yamamoto T. Breast cancer treatment-related lymphedema (BCRL): An overview of the literature and updates in microsurgery reconstructions. Eur J Surg Oncol. 2019 Jul;45(7):1138-1145. doi: 10.1016/j.ejso.2019.01.004. Epub 2019 Jan 4.

Reference Type BACKGROUND
PMID: 30638810 (View on PubMed)

Brahma B, Putri RI, Reuwpassa JO, Tuti Y, Alifian MF, Sofyan RF, Iskandar I, Yamamoto T. Lymphaticovenular Anastomosis in Breast Cancer Treatment-Related Lymphedema: A Short-Term Clinicopathological Analysis from Indonesia. J Reconstr Microsurg. 2021 Oct;37(8):643-654. doi: 10.1055/s-0041-1723940. Epub 2021 Mar 1.

Reference Type BACKGROUND
PMID: 33648010 (View on PubMed)

Yamamoto T, Yamamoto N, Doi K, Oshima A, Yoshimatsu H, Todokoro T, Ogata F, Mihara M, Narushima M, Iida T, Koshima I. Indocyanine green-enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow patterns. Plast Reconstr Surg. 2011 Oct;128(4):941-947. doi: 10.1097/PRS.0b013e3182268cd9.

Reference Type BACKGROUND
PMID: 21681123 (View on PubMed)

Yamamoto T, Narushima M, Yoshimatsu H, Yamamoto N, Kikuchi K, Todokoro T, Iida T, Koshima I. Dynamic Indocyanine Green (ICG) lymphography for breast cancer-related arm lymphedema. Ann Plast Surg. 2014 Dec;73(6):706-9. doi: 10.1097/SAP.0b013e318285875f.

Reference Type BACKGROUND
PMID: 24322632 (View on PubMed)

Brahma B, Putri RI, Karsono R, Andinata B, Gautama W, Sari L, Haryono SJ. The predictive value of methylene blue dye as a single technique in breast cancer sentinel node biopsy: a study from Dharmais Cancer Hospital. World J Surg Oncol. 2017 Feb 7;15(1):41. doi: 10.1186/s12957-017-1113-8.

Reference Type BACKGROUND
PMID: 28173818 (View on PubMed)

Akita S, Nakamura R, Yamamoto N, Tokumoto H, Ishigaki T, Yamaji Y, Sasahara Y, Kubota Y, Mitsukawa N, Satoh K. Early Detection of Lymphatic Disorder and Treatment for Lymphedema following Breast Cancer. Plast Reconstr Surg. 2016 Aug;138(2):192e-202e. doi: 10.1097/PRS.0000000000002337.

Reference Type BACKGROUND
PMID: 27465179 (View on PubMed)

Ishiura R, Yamamoto T, Saito T, Mito D, Iida T. Comparison of Lymphovenous Shunt Methods in a Rat Model: Supermicrosurgical Lymphaticovenular Anastomosis versus Microsurgical Lymphaticovenous Implantation. Plast Reconstr Surg. 2017 Jun;139(6):1407-1413. doi: 10.1097/PRS.0000000000003354.

Reference Type BACKGROUND
PMID: 28538568 (View on PubMed)

Yamamoto T, Yamamoto N, Hara H, Mihara M, Narushima M, Koshima I. Upper extremity lymphedema index: a simple method for severity evaluation of upper extremity lymphedema. Ann Plast Surg. 2013 Jan;70(1):47-9. doi: 10.1097/SAP.0b013e3182275d23.

Reference Type BACKGROUND
PMID: 21734534 (View on PubMed)

Suami H. Anatomical Theories of the Pathophysiology of Cancer-Related Lymphoedema. Cancers (Basel). 2020 May 23;12(5):1338. doi: 10.3390/cancers12051338.

Reference Type BACKGROUND
PMID: 32456209 (View on PubMed)

Other Identifiers

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227/KEPK/IX/2022

Identifier Type: -

Identifier Source: org_study_id

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