Correlation between patency and clinical improvement after lymphaticovenous anastomosis (LVA) in breast cancer‑related lymphedema: 12‑month follow‑up

Abstract: Purpose Breast cancer-related lymphedema (BCRL) is caused by an interruption of the lymphatic system after breast cancer treatment. Lymphaticovenous anastomosis (LVA), by which one or more patent lymphatic collecting vessels are connected to subcutaneous veins, shows promising results. Postoperatively, the patency of these anastomosis can be evaluated; however, little is known concerning the long-term patency after LVA in patients with BCRL. The aim of this study was to analyse the long-term patency, quality of life (QoL) and arm circumference after LVA, and to explore diferences between patent and non-patent anastomosis and its correlation with clinical improvement.

Methods: Twenty-fve patients underwent indocyanine green (ICG) lymphography, lymph ICF-questionnaire, and arm circumference measurement preoperatively and 12 months after the LVA procedure.

Results: Seventy-six percent of the patients showed at least one patent anastomosis after 12 months. Quality of life according to the Lymph-ICF increased signifcantly (p<0.000); however, arm circumference showed no signifcant decrease. Sixtyfve percent discontinued wearing compression stockings. The patent anastomosis group, compared with the non-patent anastomosis group showed, without signifcance, more improvement in QoL, arm circumference, and discontinuation of compression stockings, as well as a lower rate of infections both pre- and postoperatively, a shorter duration of lymphedema preoperatively, and a higher rate of early lymphedema and ICG stage.

Conclusions: LVA showed an acceptable patency and positive correlation between a patent anastomosis and clinical improvement after 12 months. Further research with a larger study population is required to determine whether outcomes or patient characteristics signifcantly correlate with a patent anastomosis after LVA operation.

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