The efficacy of lymphaticovenular anastomosis in breast cancer-related lymphedema

H Winters, H J P Tielemans, M Hameeteman, V A A Paulus, C H Beurskens, N J Slater, D J O Ulrich, H Winters, H J P Tielemans, M Hameeteman, V A A Paulus, C H Beurskens, N J Slater, D J O Ulrich

Abstract

Introduction: Lymphedema 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 methods: Patients 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.

Results: Twenty-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.

Conclusion: Treatment 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.

Keywords: Lymphaticovenular anastomosis; Lymphedema surgery; Lymphedema treatment.

Figures

Fig. 1
Fig. 1
Linear pattern demonstrated by ICG lymphography in a patient with BCRL. This pattern indicates that the lymphatics possess contractility
Fig. 2
Fig. 2
Average volume differences between the healthy and affected extremity at different time points during follow-up. Error bars indicate standard deviation (SD). Significance was reached between baseline and 6 months of follow-up (p < 0.001), between baseline and 12 months of follow-up (p < 0.001), and between 6 months of follow-up and 12 months of follow-up (p < 0.02)
Fig. 3
Fig. 3
Mean reduction and standard error (SE) of the LYMQOL-arm index score regarding the subdomains. A lower score in the subdomains indicates that patients were less affected by the lymphedema in that subdomain

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