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Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

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Abstract

Objective The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic, this study was undertaken to prospectively determine the effect of Lympho Venous Anastomosis (LVA) on BCRL and to review the current literature. Study design and methods Ten patients who were previously treated for breast cancer by surgery, radiotherapy, and chemotherapy, and were unresponsive to 12-weeks of non-operative treatment, underwent an LVA procedure (Degni-Cordeiro). Objective measurements were gathered for circumferential measurement and water volumetry, and quality of life. Various types of lymphoscintigraphy were carried out pre-operatively and post-operatively at 3 and 12 months. Treatment was embedded in a multidisciplinary setting. Results Post-operative volume measurements initially showed a 4.8% reduction of lymphedema at 3 months and a 2% reduction after one year. Various scintigraphic parameters showed some improvement. Quality of life questionnaires reported minimal improvement. Reviewing the literature, only retrospective studies were found; these reported varying results for LVA procedures. The selection of patients, classification of lymphedema, indications and types of LVA, and additional therapeutic options were heterogeneous, not comparable, and lacked a validated method of effect-assessment. Conclusions Our results showed a minimal reduction in volume of lymphedema following LVA; in the literature, there was no convincing evidence of the success of LVA. Non-operative treatment and elastic stockings are still preferred by most patients with lymphedema, especially in early stages with few irreversible changes.

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Acknowledgements

Contributions R.J. Damstra was the lead author in the overall conceptualization and design of the study and the manuscript. He collected the data and prepared the databases. H.G.J Voesten participated in revising and editing the text. W.D. van Schelven participated in the design and the execution of the (semi) quantitative scintigraphic studies, as well as the analysis and the interpretation of the scans. He had the primary responsibility for the scintigraphic paragraphs. B. van de Lei performed all microsurgical procedures, participated in drafting the text and provided overall supervision of the manuscript.

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Authors and Affiliations

  1. Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Compagnonsplein 1, 9202 NN, Drachten, The Netherlands

    R. J. Damstra

  2. Department of Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands

    H. G. J. Voesten

  3. Department of Nuclear Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands

    W. D. van Schelven

  4. Department of Plastic Reconstructive, Aesthetic and Hand Surgery, University Medical Centre Groningen, Groningen, The Netherlands

    B. van der Lei

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  1. R. J. Damstra
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  2. H. G. J. Voesten
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  3. W. D. van Schelven
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  4. B. van der Lei
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Correspondence to R. J. Damstra.

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Damstra, R.J., Voesten, H.G.J., van Schelven, W.D. et al. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Res Treat 113, 199–206 (2009). https://doi.org/10.1007/s10549-008-9932-5

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