Journal of plastic, reconstructive & aesthetic surgery : JPRAS · 2025
Lymphovenous anastomosis for prevention of upper limb lymphoedema following axillary clearance: A prospective cohort study on clinical and quality of life outcomes.
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Hobday Dorian, Kanapathy Muholan, Reed Benedict, Kwok Jason, Hamilton Stephen, Mosahebi Afshin, Varghese Jajini, Davenport Andrew, Naderi Naghmeh
Аннотация
BACKGROUND: Upper limb lymphoedema is a debilitating post-operative complication of axillary lymph node clearance. Preventative lymphovenous anastomosis has been reported to significantly reduce the risk of lymphoedema. We present results on the incidence of lymphoedema and quality of life outcomes for a single center, prospective cohort study.
METHOD: Preventative lymphovenous anastomosis following axillary lymph node clearance, for breast cancer or skin cancer of the trunk, was performed at Royal Free Hospital London from March 2021 to October 2024 for 41 patients. The follow-up duration was 36 months. Incidence of lymphoedema was evaluated based on relative arm volume and bioimpedance measurements. Quality-of-life was assessed via Short Form-36 and Lymphoedema Life Impact Scale questionnaires.
RESULTS: Of 38 patients, 2 (5.3%) developed lymphoedema, with an average follow-up of 22.5 months (1-36 months). Three patients were excluded due to disease recurrence. There was an increase in relative arm volume at 3-months post-operatively across the cohort (7.2% difference), but this was not statistically significant. Analysis of bioimpedance suggested that it is a useful proxy for relative arm volume measurement. Quality of life in this cohort did not appear to be markedly affected by post-operative time or incidence of lymphoedema. Subjective physical symptoms of lymphoedema occur in patients both with and without clinically diagnosed lymphoedema.
CONCLUSION: This is the first study to report the long-term outcomes with a follow-up of 36 months and correlate clinical and objective bioimpedance measurements alongside quality-of-life data. These data could guide the design of future clinical trials.
METHOD: Preventative lymphovenous anastomosis following axillary lymph node clearance, for breast cancer or skin cancer of the trunk, was performed at Royal Free Hospital London from March 2021 to October 2024 for 41 patients. The follow-up duration was 36 months. Incidence of lymphoedema was evaluated based on relative arm volume and bioimpedance measurements. Quality-of-life was assessed via Short Form-36 and Lymphoedema Life Impact Scale questionnaires.
RESULTS: Of 38 patients, 2 (5.3%) developed lymphoedema, with an average follow-up of 22.5 months (1-36 months). Three patients were excluded due to disease recurrence. There was an increase in relative arm volume at 3-months post-operatively across the cohort (7.2% difference), but this was not statistically significant. Analysis of bioimpedance suggested that it is a useful proxy for relative arm volume measurement. Quality of life in this cohort did not appear to be markedly affected by post-operative time or incidence of lymphoedema. Subjective physical symptoms of lymphoedema occur in patients both with and without clinically diagnosed lymphoedema.
CONCLUSION: This is the first study to report the long-term outcomes with a follow-up of 36 months and correlate clinical and objective bioimpedance measurements alongside quality-of-life data. These data could guide the design of future clinical trials.