The efficacy of lymphaticovenular anastomosis in breast cancer-related lymphedema

Abstract

IntroductionLymphedema can be a debilitating condition, causing a great decrease in a person’s quality of life (QoL). Treatment with lymphaticovenular anastomosis (LVA), in which an anastomosis is created between the lymphatic and venous system, may attenuate lymphedema symptoms and reduce swelling. In this study, we share the results using LVA to treat breast cancer-related lymphedema (BCRL) at our institution.Materials and methodsPatients were eligible for inclusion if they suffered from unilateral BCRL, if functional lymphatics were available, if compression therapy was used for at least 6 months, and if the follow-up was 12 months at minimum. Lymph vessel functionality was assessed preoperatively using indocyanine green (ICG). During surgery, 1–3 anastomoses were created and shunt patency was confirmed using ICG. Arm volumes were measured before surgery and at 6- and 12-month follow-up. QoL was measured before surgery and at 6-month follow-up. Arm volume differences between the healthy arm and affected arm were compared between the time points.ResultsTwenty-nine consecutive female patients with unilateral BCRL were included. The preoperative mean difference in arm volumes was 701 ± 435 ml (36.9%). This was reduced to 496 ± 302 ml (24.7%) at 6-month follow-up (p = 0.00). At 12-month follow-up, the mean difference in arm volume was 467 ± 303 ml (23.5%) (p = 0.02). The overall perceived QoL was increased from 5.8 ± 1.1 to 7.4 ± 0.7 (p = 0.00). The functionality score decreased from 2.2 to 1.8 (p = 0.00), the appearance score decreased from 2.6 to 1.9 (p = 0.00), the symptoms score decreased from 2.8 to 1.8 (p = 0.00), and the mood score decreased from 2.7 to 1.5 (p = 0.00). Fifteen patients (53.6%) were able to discontinue the use of compression garment.ConclusionTreatment with LVAs is effective in reducing arm volume difference in patients suffering from BCRL. Although no complete reduction of the edema was achieved at 12-month follow-up, the procedure significantly increased the patients’ QoL.

Efficacy and safety assessment of lymphovenous anastomosis in patients with primary and secondary lymphoedema: A systematic review of prospective evidence

“…Consequently, the improvement of patients' QoL is the main goal of lymphoedema treatments (Cornelissen et al, 2017). With the advancement of microsurgical techniques, LVA is gaining popularity and is used as a surgical treatment for extremity lymphoedema regardless of the fact that its clinical profile is not supported by highquality data (Akita et al, 2015;Lee, Laredo, & Neville, 2011;Winters et al, 2017).…”

“…Consecutive patient recruitment and the prospective study design were unclear in one study (Poumellec et al, 2017), but the study was still included. Another study was included at first, but excluded after data extraction because of retrospective analysis of patient data (Winters et al, 2017).…”

“…It may also lead to irreversible changes like fibrosis or the excess of adipose tissue. These patient-reported symptoms can occur individually or in combination (Gesellschaft Deutschsprachiger Lymphologen [GDL], 2017; Leung, Tirlapur, & Meads, 2015;Poumellec, Foissac, Cegarra-Escolano, Barranger, & Ihrai, 2017;Scaglioni, Fontein, Arvanitakis, & Giovanoli, 2017;Winters et al, 2017;Witty & Larouche, 2011).…”

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

“…Four papers reported on LVB outcomes using the LYMQOL (Table 3). Winters et al, in two separate studies-one with 29 patients and 12 month follow up and another with 12 patients and 6 month follow up-compared pre-operative to post-operative LYMQOL surveys in patients with upper extremity lymphedema [36,37]. In both studies, all subscales and the overall quality of life improved significantly (p < 0.01).…”

Lymphovenous Anastomosis Bypass Surgery

“…However, studies with a minimum of 1-year followup or longer have still demonstrated promising results confirming the efficacy of this approach for treating lymphedema. [46][47][48] This highlights the need for experience and an indepth understanding of supermicrosurgical techniques, as well as the anatomy and physiology of the lymphatic system. Once the anastomosis is completed, the final outcome and improvement in patient symptoms are obviously dependent on a patent anastomosis.…”