Caroline Lilja

What is the title of your thesis?

Surgical Treatment of Breast Cancer-Related Lymphedema.

At which department and/or research unit did you complete your PhD?

Research Unit for Plastic Surgery at Odense University Hospital, affiliated with the Department of Clinical Research at the University of Southern Denmark.

Who was your principal supervisor?

Jørn Bo Thomsen.

What question did you aim to answer with your thesis?

The overall aim of this PhD project was to optimize and evaluate the efficacy of lymphovenous anastomosis (LVA) surgery for the treatment of breast cancer-related lymphedema (BCRL).

What did you find?

Based on the results of this PhD project, it can be concluded that LVA surgery does not reverse the chronic structural volume-changes caused by lymphedema. However, it may reduce the excess fluid burden associated with the condition and thereby alleviate symptoms experienced in daily life.

LVA surgery seems to provide meaningful improvements for patients with primarily fluid component of their lymphedema, however, the available evidence remains insufficient to determine its full, long-term effect.

How did you do it?

The thesis is based on three clinical studies and a systematic literature review, which together resulted in six scientific articles.

We investigated how LVA can be planned and performed in a more targeted manner, and how robot-assisted surgery and local anesthesia can be used safely and effectively without compromising the procedure or increase the operative time. We also evaluated the treatment’s impact on lymphedema, quality of life, and function, as well as the patients’ own experiences of LVA surgery and its impact on their everyday lives.

Our systematic literature review preceded the clinical studies and provided the foundation for the subsequent research by evaluating the evidence for surgical treatment of upper-extremity lymphedema and identifying important gaps in the existing knowledge.

How can your research be applied (in the clinic, society, etc.)?

My research can primarily be used to improve the treatment of patients with breast cancer-related lymphedema, both the treatment itself and the information patients receive about their options and what they can realistically expect.

Our research suggests that the effect of lymphedema treatment should not necessarily be assessed based on arm volume alone. It is also important to consider factors such as fluid content, function, symptoms, quality of life, and patients’ own experiences of their condition and treatment.

In the longer term, I hope this research can contribute to more individualised and patient-centered treatment pathways, giving patients a better basis for making informed decisions about their treatment. At the same time, more targeted treatment may potentially help reduce the long-term burden on both patients and the healthcare system.