Prophylactic lymphaticovenous anastomoses for resection of soft tissue tumors of the thigh to prevent secondary lymphedema–a retrospective comparative cohort analysis

Abstract

Background: Patients with soft tissue tumors of extremities are at risk to develop secondary lymphedema after tumor resection caused by disruption of lymphatic vessels and sclerosis. Subsequently, this study aimed to evaluate the beneficial effects of lymphaticovenous anastomoses (LVAs) after soft tissue tumor resection of the thigh in a prophylactic approach. Methods: In a retrospective cohort study, we compared eight patients with a median age of 68.5 years (49-80) who received LVAs in combination with tumor resection for treatment of soft tissue tumors of the thigh region with a prior cohort of 20 patients with a median age of 63.0 years (23-84) who received soft tissue sarcoma resection of the thigh region. All patients of LVA cohort received 1-2 LVAs (mean 1.25 ± 0.49) at the dorsum of the foot and three patients at the SEKI-point (mean 0.375 ± 0.51). Mean maximum tumor diameter of LVA group was 19.5 ± 5.2 cm and 12.3 ± 6.6 cm of control group. All patients receiving LVA were assessed for development of lymphedema via bilateral measurements of circumference and assessment of lymphedema quality of life index (LyQLI). Results: One of the eight patients who received LVAs showed moderate impairment in the LyQLI at a follow-up of 12 months while 45% of the control cohort complained about symptoms of secondary lymphedema at a median follow-up of 22 months (p-values LyQLI: p = .018 [physical domain]; p = .018 [psychosocial domain]; p = .020 [practical domain]). Conclusion: LVAs performed in combination with tumor resection of thigh soft tissue tumors reduce negative consequences of lymph stasis and prevent development of secondary lymphedema.

Prophylactic lymphaticovenous anastomosis (LVA) for preventing lymphedema after sarcoma resection in the lower limb: A report of three cases and literature review

“…in the medial thigh and groin after STS resection (Wagner et al, 2022), and is the most relevant patient concern during followup visits (Friedmann et al, 2011;Tashiro et al, 2019). Chronic and debilitating lymphedema can result in infection, lymphangitis, sclerosis, deep venous thrombosis, functional impairment, and possible amputation that significantly decreases a patient's quality of life (Abboud et al, 2021;Gupta & Moore, 2018).…”

“…Promisingly, their case reports/series showed consistently good results in both flap survival and prevention of lymphedema. The only publication that is from a different group has a lower risk of bias because it included a control group (Wagner et al, 2022). Wu et al from Mayo Clinic recently published an article about risk factors for lymphedema after sarcoma resection and reconstruction in the thigh (Wu et al, 2020).…”

“…When the tumor is localized in the lower limb, particularly the medial thigh area which accommodates a rich lymphatic network, lymphedema is an unavoidable concern (Cheville et al, 2003; Wu et al, 2020). In fact, secondary lymphedema has the highest risk (53%) in the medial thigh and groin after STS resection (Wagner et al, 2022), and is the most relevant patient concern during follow‐up visits (Friedmann et al, 2011; Tashiro et al, 2019). Chronic and debilitating lymphedema can result in infection, lymphangitis, sclerosis, deep venous thrombosis, functional impairment, and possible amputation that significantly decreases a patient's quality of life (Abboud et al, 2021; Gupta & Moore, 2018).…”

“…Data show that the highest incidence of lymphedema in non‐breast malignancies is sarcoma (approximately 30%) (Friedmann et al, 2011). Therefore, the occurrence and progression of the secondary lymphedema, an entity that significantly affects the quality of life, is a major concern in these patients (Morgan et al, 2005; Wagner et al, 2022).…”

“…Over the last two decades, the secondary lymphedema in the upper extremity following tumor resection has been studied extensively (Boccardo et al, 2011; Jørgensen et al, 2018) and preventative interventions have been described (Boccardo et al, 2014). However, outcomes of prophylactic lymphaticovenous anastomosis (LVA) to prevent the secondary lymphedema after sarcoma resection in the lower extremity have been underreported (Scaglioni et al, 2021a; Wagner et al, 2022). In this study, we report three cases and review the literature with regard to prophylactic LVA in lower limb sarcoma.…”