Outcome of secondary LVA for lymphedema and lymphorrhea following sarcoma resection.

Abstract

Extensive resection of lower extremity soft tissue sarcoma (STS), particularly in lymphatically high-risk regions such as the medial thigh and groin, is frequently associated with postoperative lymphorrhea and secondary lymphedema. Although lymphaticovenous anastomosis (LVA) has emerged as a physiologic treatment for lymphatic dysfunction, evidence supporting its efficacy after STS resection remains limited. This study aimed to evaluate the outcomes of secondary LVA for lymphedema and refractory lymphorrhea following lower extremity STS resection. A retrospective review was conducted by including patients who underwent secondary LVA for postoperative lymphorrhea or lymphedema after lower extremity STS resection between 2019 and 2024. Lymphedema outcomes were assessed from the changes in the lower extremity lymphedema (LEL) Index at 6 months after operation. For lymphorrhea, a per-patient mean daily drainage volume was calculated from 5 consecutive days before and after LVA; these patient-level values are summarized as median (interquartile range [IQR]). Wilcoxon signed-rank tests were used for paired comparisons. Twenty-four patients were included in this study. LVA was performed for lymphorrhea in 16 and for lymphedema in 8 patients. In the lymphorrhea cohort, the median per-patient 5-day mean daily drainage volume decreased from 250.0 mL/day before LVA to 82.0 mL/day after LVA (p < 0.01). In the lymphedema cohort, 6 patients had complete paired LEL Index data, and all 6 patients showed a decrease (median, 258.0 to 241.1 mL/day; exact two-sided p = 0.031). A total of 54 LVAs were performed, with a mean lymphatic vessel diameter of 0.65 mm; 83% of these vessels demonstrated ectasis. Secondary LVA was technically feasible and associated with reductions in lymphatic drainage volume and the circumference-based LEL Index after extensive lower extremity STS resection. Favorable lymphatic vessel morphology supports the technical feasibility of LVA in this high-risk population; however, the clinical outcome findings should be interpreted by considering the retrospective design and small subgroup sizes.