Groin-only lymphaticovenous anastomosis: a paradigm shift for lower extremity lymphedema – a prospective cohort propensity-score matched analysis

Based on the recent advancement in the concepts of lymphosome and the use of antegrade lymph flow, shifting lymphaticovenous anastomosis (LVA) more proximally to the groin region for lower extremity lymphedema (LEL) offers theoretical advantages, but its efficacy compared to conventional distal LVA remains underexplored. This prospective cohort study compared 45 patients who underwent groin-only LVA (study group) with 144 patients who underwent non-groin LVA (control group), matched using propensity score analysis. Patients with a history of previous LVA, liposuction, or excisional therapy were excluded. Patient characteristics, intraoperative findings, functional parameters, and pre- and post-LVA volume changes were recorded and matched. The primary endpoint was the volume reduction at 6 and 12 months post-LVA. After matching, 29 patients were included in each group. The study group demonstrated significantly fewer incisions, fewer recipient veins, and less venous-lymphatic reflux but required deeper dissection compared to the control group (P < 0.001, < 0.001, = 0.014, < 0.001, respectively). At the 6- and 12-month follow-up, the study group showed a statistically significantly greater reduction in lower leg volume compared to the control group (P = 0.011 and 0.029, respectively). While not statistically significant, the study group also demonstrated greater volume reduction in the overall lower limb and thigh at both time points. These findings suggest that groin-only LVA may be a more effective approach for treating LEL, potentially offering benefits like simplified surgical planning, improved efficiency, and a less invasive approach.