Lymphaticovenular anastomosis in the treatment of secondary lymphoedema of the legs after cancer treatment

Georgina S.A. Phillips, Sinclair Goreb , Alex Ramsdenb ,Dominic Furniss. Journal of Plastic, Reconstructive & Aesthetic Surgery (2019) 000, 1–9

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Lymphaticovenular anastomosis in the treatment of secondary lymphoedema of the legs after cancer treatment

Georgina S.A. Phillips, Sinclair Goreb , Alex Ramsdenb ,Dominic Furniss. Journal of Plastic, Reconstructive & Aesthetic Surgery (2019) 000, 1–9

Objective: As survival from cancer continues to improve, greater importance is placed on quality of life after surgery. Lymphoedema is a common and disabling complication of cancer treatment. Lymphaticovenular anastomosis (LVA) is a supermicrosurgical treatment option for lower limb lymphoedema. The aim of this study was to assess the effectiveness of LVA in reducing limb volume and its effect on quality of life of patients with secondary leg lymphoedema following treatment for cancer, including gynaecological cancers.

Methods: Limb volume and patient rated quality of life were collected prospectively pre- operatively and at every post-operative appointment in this case series. All patients presenting to the clinic with stable or progressive leg lymphoedema despite conservative therapy who were suitable candidates for LVA over a three-year period were included.

Results: Twenty-nine patients were treated with LVA, 19 for unilateral lymphoedema and 10 for bilateral. In unilateral cases median limb excess volume reduced from 27% to 16% post- operatively ( p < 0.005) and in bilateral cases a median 8% reduction in absolute limb volume was achieved. Significant improvement in patient-reported quality of life was demonstrated, as measured by the LYMQOL: 23% improvement in unilateral and 14% improvement in bilateral patients (both p < 0.05).

Conclusions: In selected patients with early-stage lymphoedema secondary to cancer treatment, LVA offers a minimally invasive surgical option that can achieve significant volumetric and quality of life improvements

Main findings

  • Small sample size N= 29
  • The cohort consisted of 29 women, with an average age of 50 years (range 28 – 76). The underlying diagnosis was cervical cancer in 15, endometrial in four, melanoma in three, leiomyosarcoma in two and the remaining three patients had diagnosis’ of ovarian cancer, synovial sarcoma and rhabdomyosarcoma.
  • Of the 29 patients in this study, four (two unilateral, two bilateral) have discontinued compression therapy after LVA and three have reduced their use of compression garments.
  • Reduction in limb volume was seen in 34 out of 39 treated limbs and improved quality of life was reported in 24. Significant improvements were seen inpatient’s rating of limb function, symptoms, mood, appearance and overall quality of life post LVA
  • In the study volumetric improvement does not correlate with improvement in LYMQOL. Some patients reported large improvement sinquality of life with small volumetric improvements.
  • Further research should look at the longer term multi-centre outcomes of LVA.