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Lymphaticovenular anastomosis in the treatment of secondary lymphoedema of the legs after cancer treatment

  • Georgina S.A. Phillips
    Affiliations
    Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford OX3 9DU, UK
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  • Sinclair Gore
    Affiliations
    Plastic and Reconstructive Surgery Department, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK

    Oxford Lymphoedema Practice, Nuffield Health, The Manor Hospital, Beech Road, Oxford OX3 7RP, UK
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  • Alex Ramsden
    Affiliations
    Plastic and Reconstructive Surgery Department, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK

    Oxford Lymphoedema Practice, Nuffield Health, The Manor Hospital, Beech Road, Oxford OX3 7RP, UK
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  • Dominic Furniss
    Correspondence
    Corresponding author at: Oxford Lymphoedema Practice, Nuffield Health, The Manor Hospital, Beech Road, Oxford OX3 7RP, UK.
    Affiliations
    Plastic and Reconstructive Surgery Department, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK

    Oxford Lymphoedema Practice, Nuffield Health, The Manor Hospital, Beech Road, Oxford OX3 7RP, UK
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Published:March 22, 2019DOI:https://doi.org/10.1016/j.bjps.2019.03.013

      Summary

      Objective

      As survival from cancer continues to improve, greater importance is placed on quality of life after surgery. Lymphoedema is a common and disabling complication of cancer treatment. Lymphaticovenular anastomosis (LVA) is a supermicrosurgical treatment option for lower limb lymphoedema. The aim of this study was to assess the effectiveness of LVA in reducing limb volume and its effect on quality of life of patients with secondary leg lymphoedema following treatment for cancer, including gynaecological cancers.

      Methods

      Limb volume and patient rated quality of life were collected prospectively pre-operatively and at every post-operative appointment in this case series. All patients presenting to the clinic with stable or progressive leg lymphoedema despite conservative therapy who were suitable candidates for LVA over a three-year period were included.

      Results

      Twenty-nine patients were treated with LVA, 19 for unilateral lymphoedema and 10 for bilateral. In unilateral cases median limb excess volume reduced from 27% to 16% post-operatively (p < 0.005) and in bilateral cases a median 8% reduction in absolute limb volume was achieved. Significant improvement in patient-reported quality of life was demonstrated, as measured by the LYMQOL: 23% improvement in unilateral and 14% improvement in bilateral patients (both p < 0.05).

      Conclusions

      In selected patients with early stage lymphoedema secondary to cancer treatment, LVA offers a minimally invasive surgical option that can achieve significant volumetric and quality of life improvements.

      Keywords

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      Linked Article

      • Stump staining for clear visualization of lymphatic vessel's lumen
        Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 72Issue 9
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          We read with great interest the article entitled “Lymphaticovenular anastomosis in the treatment of secondary lymphoedema of the legs after cancer treatment.” by Phillips et al.1 Their paper is of clinical significance in that they referred to the importance of supermicrosurgical lymphaticovenular anastomosis (LVA) to secondary lymphedema.1 In LVA surgery, secure anastomosis of lymphatic vessel is a key to successful operation, but it is sometimes difficult especially when lymphatic vessel is sclerotic.
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