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.
Keywords Lympho-venous anastomosis (LVA) - Microsurgery - Evidence-based medicine - Lymphoscintigraphy - Inverse water volumetry - Review - Breast cancer related lymphedema