Lymphaticovenular Anastomosis for Patients with Lymphedema of the Upper Extremity at Siriraj Hospital: A Quantitative Analysis Study

Abstract

Background: Lymphedema occurrence in patients that underwent breast cancer-related lymphedema (BCRL) treatment can become a major problem. Over the past decade, lymphaticovenular anastomosis (LVA) has become widely utilized. This surgery replicates the body’s system by creating a connection between the lymphatic tracts and the venous system and replaces a damaged lymphatic system caused by the consequences from BCRL. Objective: To analyze the results of LVA surgery targeting particularly the upper extremity areas from BCRL patients at Siriraj Hospital, Thailand. Materials and Methods: This retrospective study was based on the medical records of patients that underwent LVA surgery between January 2010 and August 2018. Lymphoscintigraphy examination (⁹⁹ᵐTc-dextran lymphoscintigraphy) or ICG lymphography was performed to confirm the physician’s diagnosis. The present study aimed to compare the arm circumference size and the rate of infection of patients between the pre-surgery and post-surgery of LVA. Results: One hundred eighteen patients underwent the LVA operation and were included in the study. They had an average of 3.2±1.3 anastomoses. The average duration for the follow-up after surgery was 32 weeks. The different sizes in both arms were 5.8±1.6 cm and 5.5±1.4 cm, which were measured from 10 centimeters above and below the elbows, respectively. Comparing the sizes of the arms based on pre-surgery and post-surgery measurements, the arm circumference decreased by 0.9±0.6 centimeters (15.5%) and 0.9±0.4 centimeters (16.4%) post-surgery for the position above and below the elbow, respectively. The number of infections decreased from 1.9±0.8 times per year to 0.8±0.1 times per year. However, it was found that the rate of applying skin-care treatments in patients was relatively low at 3.4%. Conclusion: The authors’ revealed that LVA surgery of the upper extremity is one of the most effective treatments for lymphedema patients. According to the authors experience in Siriraj Hospital, this treatment is not only decreasing the size of the limb, but it can also minimize the infection rate. However, most patients note that other additional treatments, such as elastic bandage, elastic stocking, or skin-care treatment, are still necessary. Keywords: Lymphedema, Lymphatic obstruction, Breast Cancer Related Lymphedema (BCRL), Lymphaticovenular anastomosis (LVA)