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

Abstract

Purpose Lymphedema is a debilitating condition that significantly affects patient’s quality of life (QoL). The aim of this study was to assess the long-term outcomes after lymphaticovenous anastomosis (LVA) for extremity lymphedema. Methods A single-center prospective study on upper and lower extremity lymphedema patients was performed. All LVA procedures were preceded by outpatient Indocyanine Green (ICG) lymphography. Quality of life measured by the Lymph-ICF was the primary outcome. Limb circumference, use of compression garments, and frequency of cellulitis episodes and manual lymphatic drainage (MLD) sessions were secondary outcomes. Results One hundred consecutive patients, predominantly experiencing upper extremity lymphedema following breast cancer (n = 85), underwent a total of 132 LVAs. During a mean follow-up of 25 months, mean Lymph-ICF score significantly decreased from 43.9 preoperative to 30.6 postoperative, representing significant QoL improvement. Decrease in upper and lower limb circumference was observed in 52% of patients with a mean decrease of 6%. Overall mean circumference was not significantly different. Percentage of patients that could reduce compression garments in the upper and lower extremity group was 65% and 40%, respectively. Number of cellulitis episodes per year and MLD sessions per week showed a mean decrease of respectively 0.6 and 0.8 in the upper extremity and 0.4 and 1.0 in the lower extremity group. Conclusions LVA resulted in significant QoL improvement in upper and lower extremity lymphedema patients. Limb circumference did not significantly improve but good results concerning compression garments, cellulitis episodes, and MLD sessions were obtained. Additionally, a simple and patient-friendly method for outpatient ICG lymphography is presented.

Indocyanine green lymphangiography is superior to clinical staging in breast cancer-related lymphedema

“…However, our results show that clinical stage 0, 1, and 2b patients have very little excess fluid-like mass compared to stage 2a. This may explain the inconsistent treatment results observed after microsurgical and physiotherapeutic lymphedema treatments 25 – 29 . Regardless, future studies are needed to elucidate whether the excess amounts of volume, fat and lean mass can predict which patients are more likely to benefit from selective BCRL treatments 30 , 31 .…”

The impact of lymphedema on health-related quality of life up to 10 years after breast cancer treatment

“…As the risk of developing BCRL following ALND is~33%, the final sample size allocation ratio between patients with and without BCRL was estimated to be 1:3. A total sample size of 856 study participants (213 with BCRL and 643 without BCRL) was designed to have an overall 80% power and a 5% significance level to detect a moderate clinical significance of 10% difference in LYMPH-ICF MDs between the BCRL and non-BCRL cohort given a common 45%SD based on published data 17,25,44 .…”

Lymphovenular anastomosis under local anesthesia for the patients at higher ASA PS score: benefits and results

“…Complex decongestive therapy, which is one of the physical treatments for lymphedema, can be effective for advanced cancer patients who cannot tolerate general anesthesia. In 2018, Cobbe et al [9] , mentioned that 14 patients had a significant reduction of volume in 21 patients as 5.3% in the 3rd treatment and 9% in the 6th treatment. In addition to the reduction of volume, CDT is also effective in decreasing skin thickness, improving of volume changes, and increasing quality of life such as better function, improved limb aesthetics, and less pain and tightness.…”