Long‐term patency of multiple lymphatic‐venous anastomoses in cancer‐related lymphedema: A single center observational study

Abstract

Objectives Lymphedema is always initially treated by combined decongestive physiotherapy (CDP). Those cases, refractory to CDP, may be managed by surgical therapy. One of the most used microsurgical procedures is represented by the technique of lymphatic‐venous anastomosis (LVA). But very few papers report long term results of LVA. The aim of this study is to assess the long‐term patency of multiple lymphatic‐venous anastomosis (MLVA) for the treatment of secondary lymphedemas. Methods From January 2014 to December 2014, 101 patients (mean age: 56.94 ± 8.98 years; female/male: 86/15) affected by secondary cancer‐related lymphedema (38 lower and 63 upper limbs) were treated by MLVA. All lymphedemas had previously been treated by conservative therapy without sustained results. Many patients (78%) had 1–3 episodes of acute lymphangitis/year. Lymphoscintigraphy, venous duplex‐ultrasonography, and abdominal or axillary ultrasound investigation were performed preoperatively. MLVA patency was assessed by the lymphatic transport index (LyTI) and lymphoscintigraphic pattern. Results At 1 year after surgery, excess volume reduction was 75%–90% in the early stage II secondary lymphedemas, and 60%–75% in the late stage II. The decrease in volume maintained stability in the 5‐years follow‐up period. Two more advanced lower and one upper limb lymphedemas had 45%–60% reduction. LyTI showed a significant decrease between the preoperative mean value (31.7 ± 9.43) and after 18 months from surgery (11.2 ± 1.91) (p < .001). MLVA patency was shown in 98 (97%) patients. No patients had evidence of postoperative lymphangitis. Conclusions This study demonstrated the long‐term patency of MLVA in the treatment of cancer‐related lymphedemas.

Surgical treatment algorithm for breast cancer lymphedema—a systematic review

“…Geographically, the Netherlands (seven articles) ( 20 , 30 , 31 , 36 , 41 , 48 , 50 ) and Japan (six articles) ( 34 , 39 , 42 , 43 , 45 , 47 ) were the most represented regions/areas in the literature. Other contributing regions/areas included Italy (three articles) ( 27 , 29 , 51 ), France (two articles) ( 35 , 38 ), United Kingdom (two articles) ( 32 , 33 ), United States (two articles), Chile (one article) ( 28 ), Peru (one article) ( 44 ), Korea (one article) ( 46 ) and Taiwan (one article) ( 49 ), see Figure 2 .…”

“…A significant number of studies further divided stage II into sub-groups, with 42.1% classified as stage IIa and 25.3% as stage IIb. Other classifications systems employed, included the Campisi staging of lymphedema (n=5) ( 35 , 37 , 40 , 41 , 50 ), lymphoscintigraphy (n=5) ( 28 , 29 , 34 , 42 , 46 ), ICG-L (n=3) ( 30 , 32 , 34 ), Arm Dermal Backflow Scale (n=1) ( 20 ), and Cheng Lymphedema Grading System (n=1) ( 49 ).…”

Regional control after precision lymph node dissection for clinically evident melanoma metastasis

“…Due to the concern about risks of lymphedema, multiple approaches have been reported to try to reduce lymphedema after axillary or groin dissection. Microsurgical lymphatic‐venous anastomoses have been reported to reduce lymphedema dramatically, 17,18 but a systematic review and meta‐analysis summarized that “Low‐quality studies and a high risk of bias halt the formulating of strong recommendations in favor of [prophylactic lymphatic surgery].” 19 A current clinical trial randomizing to lymphaticovenous anastomosis (or not) after lymph node dissection (NCT05136079) suggests that there is still equipoise in testing whether this approach is effective. Other promising approaches include lymph node transfer, omental transfer, and preservation of the saphenous vein (for groin dissection) and preservation of axillary vein fascia (for axillary dissection), and there is evidence that some may be helpful, but randomized trials are needed to confirm such benefit 20 .…”

“…2,16 Due to the concern about risks of lymphedema, multiple approaches have been reported to try to reduce lymphedema after axillary or groin dissection. Microsurgical lymphatic-venous anastomoses have been reported to reduce lymphedema dramatically, 17,18 but a systematic review and meta-analysis summarized that "Low-quality studies and a high risk of bias halt the formulating of strong recommendations in favor of [prophylactic lymphatic surgery]." 19 A current clinical trial randomizing to lymphaticovenous anastomosis (or not) after lymph node dissection (NCT05136079)…”

Comments on “long‐term patency of multiple lymphatic‐venous anastomoses in cancer‐related lymphedema: A single‐center observational study”

“…multiple lymphatic-venous anastomoses in cancer-related lymphedema: A single center observational study" by Boccardo et al (2022) The authors are to be congratulated for their excellent work. In addition to their work, we would like to offer our opinion.…”