Beyond volume reduction: Systematic review and meta-analysis of microsurgical treatment of lymphedema.

Abstract

Conservative treatment remains a well-established concept for managing chronic lymphedema; however, it substantially impacts the patients' quality of life owing to the considerable time investment and strict adherence required. Therefore, lately lymphatic reconstructive procedures have gained popularity. We aimed to provide a detailed overview of the outcomes of lymphatic reconstruction and evaluate the efficacy of surgical interventions. A systematic literature review and meta-analysis were conducted. The review process was performed with Covidence by 2 independent reviewers and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies reporting postoperative outcomes following lymphatic reconstructive surgery were included. This systematic literature review identified a total of 74 studies representing surgical outcomes in 4692 patients. The overall effect of surgical intervention for primary and secondary lymphedema was significant (standardized mean difference [SMD]: 0.88; 95% CI: [0.4, 1.35]; p = 0.0003). Patients' quality of life was the most commonly assessed parameter using the Lymphedema Life Impact Scale, with significant postoperative improvement (SMD: 0.86; 95% CI: [0.70, 1.02]; p < 0.00001). Nineteen studies reported pre- and postoperative data on cellulitis in a total of 1072 patients, demonstrating a significant reduction in cellulitis incidence (SMD: 1.68; 95% CI: [1.30, 2.07]; p < 0.00001). This study highlighted the complexity of lymphedema and importance of patient-reported outcomes. To conclude, lymphatic reconstructive surgery improves patients' quality of life and poses an efficient treatment option, especially in patients who have exhausted conservative treatment options.