The Effect of Lymphaticovenous Anastomosis in Breast Cancer-Related Lymphedema: A Review of the Literature

Anouk J.M. Cornelissen, Jop Beugels, Lotte Ewalds, Esther M. Heuts, MD, Xavier H.A. Keuter, Andrzej Piatkowski, Rene´ R.W.J. vanderHulst,and Shan Shan Qiu Shao. Lymphatic Research and Biology. 2018

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The Effect of Lymphaticovenous Anastomosis in Breast Cancer-Related Lymphedema: A Review of the Literature

Anouk J.M. Cornelissen, Jop Beugels,  Lotte Ewalds, Esther M. Heuts, MD, Xavier H.A. Keuter, Andrzej Piatkowski, Rene´ R.W.J. vanderHulst,and Shan Shan Qiu Shao. Lymphatic Research and Biology. 2018

Background: Lymphedema affects *15% of all patients after breast cancer treatment. The aim of this review was to assess the clinical effects (improvement in arm circumference and quality of life) of lymphaticovenous anastomosis (LVA) in treating breast cancer-related lymphedema (BCRL).

 Methods and Results: A systematic literature search was conducted in Medline, Embase and the Cochrane Library in July 2017, to identify all studies on LVA for the treatment of BCRL. The primary outcome was limb volume or circumference reduction and the secondary outcome was the improvement of quality of life. The search yielded 686 results, of which 15 articles were included in this review. All studies reported on BCRL in terms of volume or circumference reduction. Thirteen out of the included studies reported a positive surgical effect on reduction in volume or circumference. Twelve articles mentioned qualitative measures, being symptom improvement and improvement in quality of life. The number of patients who experienced symptoms relief ranged from 50% to 100% in the studies.

Conclusions: The current review showed that the effects of LVA for the treatment of BCRL are variable among studies, although overall LVA seems effective in early stage BCRL. Higher quality studies are needed to confirm the effectiveness of LVA.

Main findings

  • Of 686 articles 15 of these articles explored the results of LVA in BCRL and were included in the review.
  • The follow-up in some studies is not long enough to evaluate the long-term effect of the anastomoses in the limb reduction and decrease in subjective symptoms.
  • One of the largest included studies is by Chang et al., clearly proposed that LVA is substantially more effective in early stages of lymphedema in the upper extremity than late stage or lower limb. Due to the fact that in early stages the lymphatic wall is not completely damaged, the contractility is still present. Contributing to the idea that LVA is more effective during early stages of lymphedema.
  • The volume and level of evidence of the studies on the effects of LVA in this specific patient population were low.
  • The success of LVA depends upon surgical skills. Unfortunately, a lot of details on the surgery itself were unknown or poorly described. It is unknown how experienced/ qualified the surgeons were. This means that the quality of the LVAs cannot be guaranteed.