Long-term quality of life outcomes following lymphaticovenous anastomosis (LVA) for 92 cases of lymphedema: results from over 5 years of follow-up

Background: Lymphedema in the upper or lower extremities can significantly impact quality of life (QoL) in patients living with limitations in normal range of motion, as well as psychological distress. The aim of this study was to assess long-term patient-reported outcomes (PROMs) after lymphaticovenous anastomosis (LVA) in the treatment of extremity lymphedema following treatment for malignancy or in the case of primary lymphedema. Methods: This single center study included consecutive patients from a prospectively maintained database who underwent LVA microsurgery between 2015 and 2019 in Maastricht University Medical Center in the Netherlands. Clinical data, including demographic and surgical variables were collected for analysis. Pre- and postoperative PROMs were assessed using the Lymph-ICF questionnaire. Statistical analysis included multivariate linear regression to identify clinical predictors of improvement in lymphedema-related symptoms. Results: PROMs were analyzed from 92 consecutive patients who underwent LVA during a mean follow-up time of 77 months. Mean Lymph-ICF scores significantly decreased from 39.84 ± 16.99 preoperative to 30.54 ± 19.64 postoperative (p < 0.001), correlating with a significant improvement in QoL. Patient-reported impairments in function, activity limitations, and participation restrictions decreased postoperatively across all patients regardless of sex, age at LVA, BMI, number of LVA's performed, and preoperative lymphedema severity. Conclusion: LVA resulted in significant QoL improvement in upper and lower extremity lymphedema patients, which appears to be independent of baseline demographic and perioperative surgical characteristics. This study emphasizes the significant burden of lymphedema-related symptoms, while also highlighting the impactful role of reconstructive microsurgery in reducing morbidity over the long-term. Synopsis: Lymphedema severely impacts quality of life. This single-center study of 92 patients showed significant long-term improvements in patient-reported outcomes after lymphaticovenous anastomosis. Benefits were consistent across all baseline characteristics, underscoring the broad value of reconstructive microsurgery.