Lymphovenous Anastomosis and Vascularized Lymph Node Transfer Reduce Long-term Cellulitis Events in Patients With Secondary Lymphedema: A Systematic Review and Meta-analysis.

BACKGROUND

Secondary lymphedema frequently occurs following surgery, malignancy, trauma, or radiation and is characterized by limb swelling, discomfort, and recurrent infections. Two advanced supermicrosurgical techniques-lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT)-have recently gained popularity as treatment options. However, long-term outcome data for these procedures remain limited. This systematic review and meta-analysis aim to evaluate the long-term efficacy of LVA and VLNT in patients with secondary lymphedema followed for more than 2 years postoperatively, focusing on outcomes such as cellulitis rates and limb circumference.

METHODS

This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria encompassed studies involving adult patients with secondary lymphedema treated with LVA or VLNT and with at least 24 months of follow-up. The primary outcomes were annual cellulitis incidence and limb circumference change, analyzed separately for upper and lower extremities. Meta-analysis was conducted using R version 4.3.1. Pooled effect sizes were estimated using random-effects models. Subgroup and sensitivity analyses were also performed.

RESULTS

A total of 23 studies met the inclusion criteria, covering 648 limbs treated with either LVA (n = 216) or VLNT (n = 432). The weighted average patient age was 56.3 years, and the cohort was predominantly female (99.9%). For LVA, the pooled mean reduction in annual cellulitis events was -1.13 (95% confidence interval [CI], -1.70 to -0.57) for upper extremities and -1.32 (95% CI, -2.08 to -0.55) for lower extremities. VLNT yielded greater reductions in cellulitis, with pooled mean differences of -2.43 (95% CI, -3.36 to -1.50) and -1.38 (95% CI, -2.11 to -0.65) for upper and lower limbs, respectively. Additionally, VLNT reduced limb circumference by 42.7% (95% CI, 36.7-49.7) in upper extremities and 21.98% (95% CI, 19.8-24.4) in lower extremities.

CONCLUSION

LVA and VLNT both result in durable, long-term improvements in cellulitis rates, and VLNT was shown to reduce limb circumference. Given the significant impact on patient quality of life, these interventions should remain integral to the treatment algorithm for secondary lymphedema.