Outcomes of Lymphovenous Anastomoses and Vascularized Lymph Node Transplant in the Combined Surgical Treatment of Lymphedema: A Prospective Cohort Study

Introduction: Breast Cancer-Related Lymphedema (BCRL) remains a significant burden despite conservative treatments like Complex Decongestive Therapy (CDT). Surgical interventions such as Lymphovenous Anastomosis (LVA) and Vascularized Lymph Node Transfer (VLNT) have emerged as effective alternatives. This study aims to evaluate the effectiveness of LVA and/or VLNT combined with CDT, compared to CDT alone, in reducing upper limb volume in BCRL patients. Patients and Methods: This prospective controlled study included 92 BCRL patients, divided into four groups: LVA (n=30), VLNT (n=15), LVA + VLNT (n=13), and CDT Control (n=34). Limb volumes were measured preoperatively and one year postoperatively. Volume differential change (RID%) was calculated for each group. Results: The mean volume differential changes were: LVA (-6.21% ± 5.76), VLNT (-9.61% ± 12.03), LVA+VLNT (-7.00% ± 6.56), and CDT control (+3.23% ± 6.83). Statistical analysis revealed significant reductions in limb volume for all surgical groups compared to the CDT control group (p < 0.0001 for LVA, p < 0.0001 for VLNT, and p < 0.0001 for LVA + VLNT). Conclusions: In chronic BCRL patients, surgical interventions (LVA, VLNT, and their grouping) combined with CDT, significantly reduce limb volume compared to CDT alone. These findings highlight the potential of these surgical options, combined with CDT, in the effective management of lymphedema. Level of evidence: Level II (Controlled Trial)