WP 2.21: Lymphovenous anastomoses in the treatment of lower limb lymphedema – a pragmatic, open label, randomized controlled trial

Lymphedema, encompassing accumulation of lymphatic fluid in the extremities, often results from cancer treatments such as lymph node biopsy, dissection, or radiotherapy(1). Lymphedema substantially reduces patients’ mental and physical health and overall well-being(2). Additionally, it imposes a notable economic burden on both patients and society (3). Lower limb lymphedema (LLL) is most likely more common than upper limb lymphedema, as the risk of developing lymphedema following the same procedures such as lymph node dissections (axillary/inguinal) is more than double for the lower limbs(4). Moreover, the range of cancers that can lead to lymphedema due to treatment is broader for the lower extremities (cervix, ovarian, prostate, melanoma a.o.) compared to the upper extremities (breast, melanoma).

Inventive and potentially curative LLL treatments are being explored. Among these, lymphovenous anastomoses (LVA) have internationally been implemented. LVA aims to circumvent impaired lymphatic vessels by establishing connections with neighboring veins through anastomoses under a microscope, facilitating direct drainage of lymphatic fluid into the venous system(5). Some centers report promising outcomes from LVA for treating lymphedema while other reports are less positive (6-8); in addition, negative studies are prone to publication bias.

Results of LVA range from miraculous (removing lymphedema completely) to no improvement or even deterioration (8, 9). Our department has been the sole provider of LVA in Denmark until recently with mixed results. Heterogeneity in patient selection including varying lymphedema severity, patient demographics, and comorbidities influence the efficacy of LVA. Secondly, lack of validated and standardized evaluation of LVA’s effectiveness can lead to significantly differing results(10) and a randomized study of LVA’s effect along with exploration of the best measurement methods is much needed.

Awarded to: Lisbet Rosenkrantz Hölmich (Herlev and Gentofte Hospital) – CFA2

Awarded grant to support VIP personnel.