Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Nov 2:22:e51.
eCollection 2022.

Surgical Lymphedema Treatment: A Meta-Analysis and Recommendations

Magnus J Chun  1 , Fouad Saeg  1 , Derek Miller  2 , Christina Jardak  3 , Abby Duplechain  1 , Angela Sultan  1 , Christopher Homsy  4
Affiliations
Review

Surgical Lymphedema Treatment: A Meta-Analysis and Recommendations

Magnus J Chun et al. Eplasty. .

Abstract

Background: Lymphedema is a common complication of lymph node surgery; however, evidence on diagnosing, monitoring, and treating the condition is sparse. This meta-analysis evaluates the outcomes of common surgical treatments of lymphedema and provides suggestions for future research directions.

Methods: A review of PubMed and Embase was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. All English-language studies published through June 1, 2020, were included. We excluded nonsurgical interventions, literature reviews, letters, commentaries, nonhuman or cadaver studies, and studies with inadequate sample size (N < 20).

Results: A total of 583 cases from 15 studies in patients with lymphedema met our inclusion criteria for our 1-arm meta-analysis: 387 upper extremity treatments and 196 lower extremity treatments. The volume reduction rates of lymphedema for upper extremity and lower extremity treatments were 38.0% [95% confidence interval (CI), 25.9%-50.2%] and 49.5% (95% CI, 32.6%-66.3%), respectively. The most common postoperative complications were cellulitis, reported in 4.5% of patients (95% CI, 0.9%-10.6%), and seromas, reported in 4.6% (95% CI, 0%-17.8%) of patients. Average quality of life measures across all studies improved by 52.2% (95% CI, 25.1%-79.2%) for patients who underwent upper extremity treatment.

Conclusions: Surgical management of lymphedema shows great promise. Our data suggest that adopting a standardized system of limb measurement and disease staging can increase effectiveness of treatment outcomes.

Keywords: Breast Cancer; Lymph Node; Lymphedema; Lymphovenous Bypass; Mastectomy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
PRISMA flow diagram for study selection.
Figure 2
Figure 2
Forest plot representing the pooled average volume reduction rate following UE and LE lymphedema treatment. The arcsine of square root proportion model was used. Pooled estimate was reported as incidence rate as a percentage and CI. Average volume reduction was larger for LE lymphedema treatment. CI, confidence interval; UE, upper extremity; LE, lower extremity.
Figure 3
Figure 3
Forest plot representing the percentage of patients with worsening lymphedema at average follow-up time for UE and LE lymphedema treatment. The arcsine of square root proportion model was used. Pooled estimate was reported as incidence rate as a percentage and CI. Worsening lymphedema was seen more in the UE lymphedema treatment cohort than in the LE lymphedema treatment cohort. CI, confidence interval; UE, upper extremity; LE, lower extremity.
Figure 4
Figure 4
Forest plot representing the percentage of patients with postoperative complications at average follow-up time for upper extremity lymphedema treatment. The arcsine of square root proportion model was used. Pooled estimate was reported as incidence rate as a percentage and CI. Patients undergoing VLNT are at a higher risk of postoperative complications. CI, confidence interval; LVA, lymphovenous anastomosis; VLNT, vascularized lymph node transfer.
Figure 5
Figure 5
Forest plot representing the percentage of patients with worsening lymphedema at average follow-up time for upper extremity lymphedema treatment. The arcsine of square root proportion model was used. Pooled estimate was reported as incidence rate as a percentage and CI. Worsening lymphedema was seen more in the LVA cohort than the VLNT cohort. CI, confidence interval; LVA, lymphovenous anastomosis; VLNT, vascularized lymph node transfer.
Figure 6
Figure 6
Publication bias assessment. Egger's regression test was used for the 15 eligible studies.
See this image and copyright information in PMC

References

    1. Sleigh BC, Manna B. Lymphedema. StatPearls. Updated May 29, 2022. Accessed September 13, 2022. https://www.ncbi.nlm.nih.gov/books/NBK537239/
    1. Hahamoff M, Gupta N, Munoz D, et al. . A lymphedema surveillance program for breast cancer patients reveals the promise of surgical prevention. J Surg Res. 2019;244:604-611. doi:10.1016/j.jss.2017.10.00810.1016/j.jss.2017.10.008 - DOI - DOI - PubMed
    1. Spillane AJ, Saw RP, Tucker M, Byth K, Thompson JR. Defining lower limb lymphedema after inguinal or ilio-inguinal dissection in patients with melanoma using classification and regression tree analysis. Ann Surg. 2008;248(2):286-293. doi:10.1097/SLA.0b013e31817ed7c310.1097/SLA.0b013e31817ed7c3 - DOI - DOI - PubMed
    1. Burnett AF, Stone PJ, Klimberg SV, Gregory JL, Roman JR. Lower extremity glandography (LEG): a new concept to identify and enhance lymphatic preservation. Int J Gynecol Cancer. 2011;21(3):582-586. doi:10.1097/IGC.0b013e31820f5d6510.1097/IGC.0b013e31820f5d65 - DOI - DOI - PubMed
    1. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer. 2010;116(22):5138-5149. doi:10.1002/cncr.2545810.1002/cncr.25458 - DOI - DOI - PubMed

LinkOut - more resources