{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:19:23Z","timestamp":1792095563793,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,5,29]],"date-time":"2019-05-29T00:00:00Z","timestamp":1559088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>A lymphedema (LE) prevention surgery (LPS) paradigm for patients undergoing axillary lymphadenectomy (ALND) was developed to protect against LE through enhanced lymphatic visualization during axillary reverse mapping (ARM) and refinement in decision making during lymphaticovenous bypass (LVB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis of a prospective database was performed evaluating patients with breast cancer\u00a0who underwent ALND, ARM, and LVB from September 2016 to December 2018. Patient and tumor characteristics, oncologic and reconstructive operative details, complications and LE development were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>LPS was completed in 58 patients with a mean age of 51.7 years. An average of 14 lymph nodes (LN) were removed during ALND. An average of 2.1 blue lymphatic channels were visualized with an average of 1.4 LVBs performed per patient. End to end anastomosis was performed in 37 patients and a multiple lymphatic intussusception technique in 21. Patency was confirmed 96.5% of patients. Adjuvant radiation was administered to 89% of patients. Two patients developed LE with a median follow\u2010up of 11.8 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We report on our experience using a unique LPS technique. Refinements in ARM and a systematic approach to LVB allows for maximal preservation of lymphatic continuity, identification of transected lymphatics, and reestablishment of upper extremity lymphatic drainage pathways.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.25513","type":"journal-article","created":{"date-parts":[[2019,5,30]],"date-time":"2019-05-30T04:20:27Z","timestamp":1559190027000},"page":"160-167","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":60,"title":["Axillary reverse mapping and lymphaticovenous bypass: Lymphedema prevention through enhanced lymphatic visualization and restoration of flow"],"prefix":"10.1002","volume":"120","author":[{"given":"Graham S.","family":"Schwarz","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen R.","family":"Grobmyer","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Division of Breast Surgery Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risal S.","family":"Djohan","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6254-8811","authenticated-orcid":false,"given":"Cagri","family":"Cakmakoglu","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven L.","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Radford","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Division of Breast Surgery Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahraa","family":"Al\u2010Hilli","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Division of Breast Surgery Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Knackstedt","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Djohan","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie A.","family":"Valente","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Division of Breast Surgery Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,5,29]]},"reference":[{"key":"e_1_2_10_1_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1997.15.6.2345"},{"key":"e_1_2_10_1_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.16.3725"},{"issue":"2","key":"e_1_2_10_1_4_1","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/COC.0000000000000355","article-title":"A review of treatment for breast cancer\u2010related lymphedema: paradigms for clinical practice","volume":"41","author":"Smile TD","year":"2018","journal-title":"Am J Clin Oncol"},{"key":"e_1_2_10_1_5_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-017-5964-6"},{"key":"e_1_2_10_1_6_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21253"},{"key":"e_1_2_10_1_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001778"},{"key":"e_1_2_10_1_8_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-007-9412-x"},{"key":"e_1_2_10_1_9_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-008-0118-5"},{"key":"e_1_2_10_1_10_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-015-4721-y"},{"key":"e_1_2_10_1_11_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-008-0270-y"},{"key":"e_1_2_10_1_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30246"},{"key":"e_1_2_10_1_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182a4d626"},{"key":"e_1_2_10_1_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181e5f6a9"},{"key":"e_1_2_10_1_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30180"},{"key":"e_1_2_10_1_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002827"},{"key":"e_1_2_10_1_17_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-018-6645-9"},{"issue":"4","key":"e_1_2_10_1_18_1","first-page":"170","article-title":"Consensus document of the international society of lymphology","volume":"49","author":"Executive Committee. The Diagnosis and Treatment of Peripheral Lymphedema: 2016","year":"2016","journal-title":"Lymphology"},{"issue":"1","key":"e_1_2_10_1_19_1","article-title":"Reed MW Axillary treatment for operable primary breast cancer","volume":"4","author":"Bromham N","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_1_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(98)00319-0"},{"issue":"6","key":"e_1_2_10_1_21_1","first-page":"483","article-title":"[Early stage Stewart\u2010Treves syndrome: report of 2 cases and review of the literature]","volume":"88","author":"Bisceglia M","year":"1996","journal-title":"Pathologica"},{"key":"e_1_2_10_1_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19931201)72:11<3248::AID-CNCR2820721119>3.0.CO;2-Z"},{"key":"e_1_2_10_1_23_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.17.9291"},{"issue":"1","key":"e_1_2_10_1_24_1","first-page":"33","article-title":"The incidence and risk factors for occurrence of arm lymphedema after treatment of breast cancer","volume":"110","author":"Rebegea L","year":"2015","journal-title":"Chirurgia (Bucur)"},{"key":"e_1_2_10_1_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2015.01.014"},{"key":"e_1_2_10_1_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000010"},{"key":"e_1_2_10_1_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24171"},{"key":"e_1_2_10_1_28_1","first-page":"32","article-title":"[Lymphovenous anastomoses in the prevention of post\u2010mastectomy edema of the arm]","volume":"4","author":"Pronin VI","year":"1989","journal-title":"Sov Med"},{"key":"e_1_2_10_1_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22254"},{"key":"e_1_2_10_1_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2014.05.011"},{"key":"e_1_2_10_1_31_1","doi-asserted-by":"publisher","DOI":"10.1080\/10739680600745810"},{"key":"e_1_2_10_1_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-016-4089-0"},{"key":"e_1_2_10_1_33_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-017-5960-x"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.25513","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jso.25513","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.25513","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T20:59:34Z","timestamp":1694293174000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.25513"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,29]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1002\/jso.25513"],"URL":"https:\/\/doi.org\/10.1002\/jso.25513","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,29]]},"assertion":[{"value":"2019-02-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}