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LYMPHOVENOUS ANASTOMOSIS FOR THE TREATMENT OF LYMPHEDEMA: A SYSTEMATIC REVIEW OF THE LITERATURE AND META-ANALYSIS

E Nacchiero, M Maruccia, R Elia, F Robusto, G Giudice, OJ Manrique, CC Campisi, G Giudice

Abstract


Lymphovenous anastomosis (LVA) has
been described as an effective treatment for
early stages of lymphedema (LE). The aim of
this study was to deepen the evaluation of the
effectiveness of LVA by performing a metaanalysis
to provide information about its utility
in specific anatomical sites, clinical stages,
duration of lymphedema, and surgical technique.
A systematic literature search using
PubMed/Medline, Google Scholar, and Cochrane
Database was performed in November
2019. Only original studies in which exclusively
LVA was performed for primary and/or secondary
lymphedema in humans were eligible for
data extraction. A meta-analysis was performed
on articles with a well-defined endpoint
and a subgroup analysis was conducted
in relation to surgical technique, duration of
lymphedema, stage of pathology. Forty-eight
studies, including 6 clinical trials and 42 lowrisk
bias observational studies were included in
our meta-analysis. 1,281 subjects were included
and the majority of articles reported a pre-post
analysis. Lymphaticovenular anastomosis
appears to result effectively in treatment of
lymphedema with an odds ratio of 0.07 (CI:
0.04, 0.13, p<0.001). All subgroup metaanalyses
were statistically significant for LVAs
specifically with regard to anatomical site,
clinical stage, duration of LE, or type of
microsurgical procedure (p<0.05).
Our meta-analysis confirmed the efficacy
of LVAs for the treatment of lymphedema,
even when subgroup analysis was performed
for clinical stage, duration of pathology, anatomical
site of lymphedema, or type of microsurgical
procedure. Further prospective trials
with a common clearly defined outcome measure
are warranted for an unbiased evaluation.


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