The Concept of Palliative Lymphaticovenular Anastomosis

Introduction: Lymphaticovenular anastomosis (LVA) is the first-line surgical treatment for lymphedema. The therapeutic effects of LVA, including edema reduction and cellulitis prevention, vary among patients. We examined cases of palliative LVA in patients with lymphedema who were in the terminal stage due to recurrence or distant metastasis of the primary disease, with a focus on the course and usefulness of palliative LVA. Methods and Results: A total of 13 palliative LVAs were performed in 12 patients undergoing palliative treatment. LVA was performed without interfering with chemotherapy or radiation. Data on site and stage of edema, compression treatment status, number of anastomoses, percentage change in circumferential diameter (the total circumference at six locations was compared), treatment efficacy, and patient prognosis were collected. Edema was present in the upper and lower extremities of 10 and 2 patients, respectively. The average postoperative decrease in circumferential diameter was 8.6%. Psychological evaluation was based on the self-reports of patients, and 11 out of 12 patients showed improvement in their mental state. Two patients died during the observation period due to deterioration in the underlying disease. Conclusion: We reported our experience with palliative LVA in patients with advanced malignancies. Many patients had favorable physical and psychological outcomes. Surgery can be performed safely with appropriate planning based on the condition of the patients. Palliative LVA may be a treatment option for patients with recurrent or distant metastases of the primary disease who are refractory to edema treatment.