Correlation between patency and clinical improvement after lymphaticovenous anastomosis (LVA) in breast cancer-related lymphedema: 12-month follow-up

Abstract

Purpose Breast cancer-related lymphedema (BCRL) is caused by an interruption of the lymphatic system after breast cancer treatment. Lymphaticovenous anastomosis (LVA), by which one or more patent lymphatic collecting vessels are connected to subcutaneous veins, shows promising results. Postoperatively, the patency of these anastomosis can be evaluated; however, little is known concerning the long-term patency after LVA in patients with BCRL. The aim of this study was to analyse the long-term patency, quality of life (QoL) and arm circumference after LVA, and to explore differences between patent and non-patent anastomosis and its correlation with clinical improvement. Methods Twenty-five patients underwent indocyanine green (ICG) lymphography, lymph ICF-questionnaire, and arm circumference measurement preoperatively and 12 months after the LVA procedure. Results Seventy-six percent of the patients showed at least one patent anastomosis after 12 months. Quality of life according to the Lymph-ICF increased significantly (p < 0.000); however, arm circumference showed no significant decrease. Sixtyfive percent discontinued wearing compression stockings. The patent anastomosis group, compared with the non-patent anastomosis group showed, without significance, more improvement in QoL, arm circumference, and discontinuation of compression stockings, as well as a lower rate of infections both pre-and postoperatively, a shorter duration of lymphedema preoperatively, and a higher rate of early lymphedema and ICG stage. Conclusions LVA showed an acceptable patency and positive correlation between a patent anastomosis and clinical improvement after 12 months. Further research with a larger study population is required to determine whether outcomes or patient characteristics significantly correlate with a patent anastomosis after LVA operation.

Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up

“…Improvement in QoL was related to the total number of LVAs performed per patient in this study. This could be explained by previous observation that a higher of anastomoses could be associated with a better patency rate and the suggestion of a positive correlation between a patent anastomosis and clinical improvement [17].…”

“…The postoperative protocol was followed as previously described [17]. In brief, patients were not allowed to wear compression garments or receive MLD in the first four weeks after surgery to minimize the chance of damaging the newly formed, fragile anastomosis.…”

“…Limb circumference was measured at standardized landmarks on the arm or leg, and together with the patient's BMI, the UEL-or LEL-index was calculated [32]. Patients had to remove their compression garment 24 h prior to the follow-up moment in order to achieve a more reliable measurement [17].…”

“…ICG lymphography is an innovative imaging technique that combines the administration of the fluorescent dye ICG with a near-infrared camera. This imaging modality enables direct visualization of the lymphatic system and is therefore used to determine the stage of lymphedema and evaluate the functionality of lymphatic vessels [10,15,17,18]. In addition, ICG lymphography can guide surgeons during surgery by facilitating real-time decision-making, leading to more reliable and improved outcomes following LVA [1].…”

Intraoperative Real-Time Visualization of the Lymphatic Vessels Using Microscope-Integrated Laser Tomography

“…Gentle pressure was applied to the lymphatic vessel distal to the anastomosis site to facilitate passage of the lymphatic fluid through the anastomosis site. 13 The patency status was classified in the following three groups: patent, nonpatent, and not seen. The assessment of the score was done by two independent researchers.…”