Abstract
PurposeLymphedema 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.MethodsA 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.ResultsOne 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.ConclusionsLVA 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.
Highlights
Lymphedema is a chronic, debilitating condition, characterized by abnormal accumulation of subcutaneous protein-rich fluid due to failure of the lymphatic drainage system [1,2,3,4]
Patients were eligible for lymphaticovenous anastomosis (LVA) if they experienced subjective complaints of a confirmed unilateral upper or lower limb lymphedema, stage I to III according to the International Society of Lymphology (ISL) classification, and having undergone complex decongestive therapy for at least 3 months [27]
LVAs were predominantly performed in women with unilateral upper limb lymphedema following breast cancer treatment (n = 85), classified as ISL stage IIA or Indocyanine Green (ICG) stage 3
Summary
Lymphedema is a chronic, debilitating condition, characterized by abnormal accumulation of subcutaneous protein-rich fluid due to failure of the lymphatic drainage system [1,2,3,4] It can affect any part of the body but is predominantly observed in the upper and lower extremities [5]. Treatment of lymphedema traditionally begins with complex decongestive therapy, consisting of a combination of skin care, exercise, compression therapy, and manual lymphatic drainage (MLD) [5, 9]. This treatment is time-consuming, and the effectiveness largely depends on the patient’s compliance [3]. This may result in enough symptomatic relief, none of the therapies will cure lymphedema, lifelong time-consuming therapy appointments and continuous use of compression garments are necessary, with a significant practical impact [2, 3, 8]
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