Comparison of patient-reported outcomes between upper and lower extremity lymphedema following lymphaticovenous anastomosis.

Abstract

Surgical outcome of lymphaticovenous anastomosis (LVA) may differ between upper and lower extremity lymphedema. We aimed to compare patient-reported outcomes between upper and lower extremity lymphedema in patients who underwent LVA. Patients who underwent LVA between June 2018 and November 2023 were included. Lymphedema quality of life questionnaire (LYMQOL) assessments were conducted preoperatively and at 3, 6, and 12 months postoperatively. LYMQOL scores were compared between patients with upper and lower extremity lymphedema using univariable and multivariable analyses. A total of 296 patients were included: 131 with upper extremity and 165 with lower extremity lymphedema. At 1 year postoperatively, improvement was observed in function (58.5%), body image (58.5%), symptom (54.9%), and mood domains (54.5%). Among patients who experienced postoperative quality-of-life (QOL) improvement, postoperative improvements in LYMQOL scores increased between 6 and 12 months across all domains (P < 0.05). Overall, QOL score improved significantly in the upper extremity (P = 0.036) but not in the lower extremity (P = 0.952). In multivariable analysis, upper extremity lymphedema was associated with higher odds of improvement in the symptom (odds ratio = 1.93, P = 0.010) and mood (odds ratio = 2.12, P = 0.011) domains, compared to lower extremity lymphedema at 1 year postoperatively. Improvements in patient-reported outcomes following LVA persisted for up to 1 year in patients with lower and upper extremity lymphedema. Upper extremity lymphedema demonstrated significantly higher improvement rates in the symptom and mood domains compared with those who had lower extremity lymphedema.