Outcomes of Lymphovenous Anastomoses and Vascularized Lymph Node Transplant in the Combined Surgical Treatment of Lymphedema: A Prospective Cohort Study.

Abstract

Breast cancer-related lymphedema (BCRL) remains a significant burden despite conservative treatments like complex decongestive therapy (CDT). Surgical interventions, such as lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), have emerged as effective alternatives. This study evaluated the effectiveness of LVA or VLNT, or both, combined with CDT compared with CDT alone in reducing upper-limb volume in patients with BCRL. This prospective controlled study included 92 patients with BCRL divided into 4 groups: LVA ( n = 30), VLNT ( n = 15), LVA + VLNT ( n = 13), and CDT control ( n = 34). Limb volumes were measured preoperatively and 1 year postoperatively. Volume differential change, expressed as the percentage relative interlimb difference, was calculated for each group. The mean volume differential changes were -6.21% ± 5.76 for LVA, -9.61% ± 12.03 for VLNT, -7.00% ± 6.56 for LVA + VLNT, and +3.23% ± 6.83 for CDT control. Statistical analysis revealed significant reductions in limb volume for all surgical groups compared with the CDT control group ( P  < 0.0001 for LVA, P  < 0.0001 for VLNT, and P  < 0.0001 for LVA + VLNT). In patients with chronic BCRL, surgical interventions (LVA, VLNT, and LVA + VLNT) combined with CDT significantly reduced limb volume compared with CDT alone. These findings highlight the potential of these surgical options, combined with CDT, in the effective management of lymphedema.