Background Lymphedema is an accumulation of protein-rich fluid in the interstitial spaces resulting from impairment in the lymphatic circulation that can impair quality of life and cause considerable morbidity. Lower extremity lymphedema (LEL) has an overall incidence rate of 20%. Conservative therapies are the first step in treatment of LEL; however, they do not provide a cure because they fail to address the underlying physiologic dysfunction of the lymphatic system. Among several surgical alternatives, lymphaticovenous anastomosis (LVA) has gained popularity due to its improved outcomes and less invasive approach. This study aims to review the published literature on LVA for LEL treatment and to analyze the surgical outcomes. Methods PubMed database was used to perform a comprehensive literature review of all articles describing LVA for treatment of LEL from Novemeber 1985 to June 2019. Search terms included “lymphovenous” OR “lymphaticovenous” AND “bypass” OR “anastomosis” OR “shunt” AND “lower extremity lymphedema.” Results A total of 95 articles were identified in the initial query, out of which 58 individual articles were deemed eligible. The studies included in this review describe notable variations in surgical techniques, number of anastomoses, and supplementary interventions. All, except one study, reported positive outcomes based on limb circumference and volume changes or subjective clinical improvement. The largest reduction rate in limb circumference and volume was 63.8%. Conclusion LVA demonstrated a considerable reduction in limb volume and improvement in subjective findings of lymphedema in the majority of patients. The maintained effectiveness of this treatment modality in long-term follow-up suggests great efficacy of LVA in LEL treatment.

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Background/Aim: To characterize the demographics, tumor staging and treatment of African American (AA) patients diagnosed with melanoma in the United States. Patients and Methods: The National Cancer Database was used to extrapolate data from patients with melanoma between January 1, 2004, and December 31, 2015. The patients were then further divided based on ethnicity (AAs vs. Caucasians) to compare patient efficacy of treatment. Results: The mean time for AA patients to receive treatment was 20.37 days compared with 11.25 days for Caucasians (p<0.001), while time to surgery was 38.86 days compared to 31.12 days for Caucasians (p<0.001). Moreover, AA race was a predictor of American Joint Committee on Cancer stage greater than II, tumor diagnosed at autopsy, presence of ulceration, and distribution in the extremities. Conclusion: AA patients with melanoma are more likely to have worse tumor staging, treatment delay, treatment at an Integrated Cancer Program, and diagnosis at autopsy. African American's (AA) have a decreased likelihood of developing melanoma when compared to other ethnicities due to the protective action of melanin (1). The incidence of melanoma amongst AAs is 1 to 1.2 per 100,000 (2). However, melanoma in AA patients is frequently diagnosed at an advanced stage due to the difficulty in differentiating between skin tone and cancer combined with lower socioeconomic levels (3, 4). In addition, melanoma survival is lower in AA patients undergoing surgical treatment compared to all other ethnicities (5). Etiologies of these disparities are difficult to assess and poorly understood (1-5). Treatment disparity in minority populations is a debated topic that deserves attention from the scientific community (6). In this study, we aimed to assess the difference in melanoma characteristics, patient population, tumor staging and treatment in AA compared to the Caucasian population. Furthermore, we speculated that significant differences exist between the two populations. Patients and MethodsThis study was considered nonregulated by the institutional review board. The National Cancer Database (NCDB), an initiative driven by the American Cancer Society and the American College of Surgeons' Commission on Cancer that registers 70% of all cancers diagnosed in the USA, was used to extrapolate data (7, 8).Eligible patients were identified according to the NCDB's variable "Race". Data were extracted for all patients diagnosed with melanoma between January 1, 2004, and December 31, 2015. The cohort was then split into two groups based on race: 1) AA or 2) Caucasian. Patients identified with others races, such as Asian or Native American, were excluded as this analysis focused on the comparison between AA patients and Caucasian patients, the largest cohort of patients with melanoma.Data was extracted on patient demographics, facility/treatment type, and tumor characteristics. Patients demographics included age, sex, insurance (Uninsured, Private, Medicaid, Medicare, Other Government, Unknown), and population density (...