Correlation between patency and clinical improvement after lymphaticovenous anastomosis (LVA) in breast cancer-related lymphedema: 12-month follow-up

Joost A G N Wolfs, Luuke G E H de Joode, René R W J van der Hulst, Shan S Qiu, Joost A G N Wolfs, Luuke G E H de Joode, René R W J van der Hulst, Shan S Qiu

Abstract

Purpose: Breast cancer-related lymphedema (BCRL) is caused by an interruption of the lymphatic system after breast cancer treatment. Lymphaticovenous anastomosis (LVA), by which one or more patent lymphatic collecting vessels are connected to subcutaneous veins, shows promising results. Postoperatively, the patency of these anastomosis can be evaluated; however, little is known concerning the long-term patency after LVA in patients with BCRL. The aim of this study was to analyse the long-term patency, quality of life (QoL) and arm circumference after LVA, and to explore differences between patent and non-patent anastomosis and its correlation with clinical improvement.

Methods: Twenty-five patients underwent indocyanine green (ICG) lymphography, lymph ICF-questionnaire, and arm circumference measurement preoperatively and 12 months after the LVA procedure.

Results: Seventy-six percent of the patients showed at least one patent anastomosis after 12 months. Quality of life according to the Lymph-ICF increased significantly (p < 0.000); however, arm circumference showed no significant decrease. Sixty-five percent discontinued wearing compression stockings. The patent anastomosis group, compared with the non-patent anastomosis group showed, without significance, more improvement in QoL, arm circumference, and discontinuation of compression stockings, as well as a lower rate of infections both pre- and postoperatively, a shorter duration of lymphedema preoperatively, and a higher rate of early lymphedema and ICG stage.

Conclusions: LVA showed an acceptable patency and positive correlation between a patent anastomosis and clinical improvement after 12 months. Further research with a larger study population is required to determine whether outcomes or patient characteristics significantly correlate with a patent anastomosis after LVA operation.

Keywords: Breast cancer-related lymphedema; LVA; Lymphaticovenous anastomosis; Patency; Quality of life.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
ICG lymphography with NIRF camera in 2 patients. Lymph vessels used for anastomosis are indicated by arrows, and location of the scar on the skin is indicated by curved lines. a Viable lymph vessels preoperatively and b non-patent anastomosis postoperatively (ICG flow stops at anastomosis site). c Viable lymph vessels preoperatively and d a patent anastomosis postoperatively

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Source: PubMed

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