Objectifying Clinical Outcomes After Lymphaticovenous Anastomosis and Vascularized Lymph Node Transfer in the Treatment of Extremity Lymphedema: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND: Upper extremity lymphedema (UEL) and lower extremity lymphedema (LEL) can develop as a result of lymph node dissection in the treatment of various malignancies. While emerging microsurgical interventions using lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) show promising outcomes for patients with lymphedema, the best approach to implementing the two procedures remains to be defined. This systematic review and meta-analysis provide a comprehensive overview of published literature on the clinical improvement of extremity lymphedema in patients who undergo either LVA, VLNT, or a combined microsurgical procedure. METHODS: From Embase, PubMed, and Web of Science databases, 52 studies were identified that met inclusion criteria. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed using the Risk Of Bias In Nonrandomized Studies-of Interventions (ROBINS-I) tool and the Cochrane tool for randomized trials (RoB 2). RESULTS: Random-effects meta-analyses of means estimated a pooled clinical improvement of 36.46% (95% CI: 29.44-43.48) for UEL and 34.16% (95% CI: 23.93-44.40) for LEL. Subgroup analyses revealed differences in clinical improvement according to the microsurgical approach. Clinical improvement of UEL was 29.44% (95% CI: 15.58-43.29) for LVA, 41.66% (95% CI: 34.13-49.20) for VLNT, and 32.80% (95% CI: 21.96-43.64) for combined VLNT + LVA, while the improvement of LEL was 31.87% (95% CI: 18.60-45.14) for LVA and 39.53% (95% CI: 19.37-59.69) for VLNT. CONCLUSION: The findings from this study elucidate the clinical improvement in extremity lymphedema from various microsurgical approaches. This knowledge could aid physicians in the shared decision-making process with UEL and LEL patients and better facilitate proper patient selection for microsurgical interventions.