Surgical Intervention and Lymphatic Diseases.
Condition: Lymphedema
MeSH terms: Lymphedema; Lymphatic Diseases
Study type: Observational

Summary: 
      Supermicrosurgical LVA has been proven effective in treating moderate to severe lymphedema,
      including cases with diffuse dermal backflow (DB) and even severe lymphatic fluid leakage.
      Therefore, the use of LVA should not be limited to mild lymphedema, and its indications
      should be expanded to become a primary surgical approach for more severe lymphedema cases.
      Among all surgical procedures for lymphedema, LVA is the least invasive, allowing for rapid
      recovery, minimizing the complications, and reducing medical costs.
    

Detailed description: 
      Lymphatic-related diseases such as lymphedema often result from damage to the lymphatic
      system due to tumor removal and lymph node dissection surgeries, as well as tissue fibrosis
      caused by post-operative radiation therapy. This can lead to obstruction in the proximal
      channels of lymphatic flow, resulting in swelling, deformity of the distal limbs, poor wound
      healing, or cellulitis.

      In the case of lymphatic-related diseases like lymphedema, improvement can be achieved
      through surgical interventions. Surgery can be categorized into physiologic reconstruction
      and volume reduction procedures. Among them, Supermicrosurgical Lymphaticovenous Anastomosis
      (LVA) is a form of physiologic reconstruction. LVA involves the separation of lymphatic
      vessels in the affected limb and their anastomosis with nearby small veins to alleviate limb
      swelling and reduce the risk of cellulitis. When using lymphaticovenous bypass surgery to
      treat lymphedema, the ideal scenario is to use veins for anastomosis that do not have venous
      blood reflux. This is because veins generally have higher blood pressure than lymphatic
      fluid, and if venous blood flows into the lymphatic vessels over the long term, it can reduce
      the patency of the lymphaticovenous anastomosis site. The choice of anastomosis technique,
      based on the size and position of the lymphatic vessels and veins, can also impact the
      post-operative outcomes. Therefore, factors such as lymphatic vessel size, flow rate,
      function, vein size, pressure, and the presence of reflux are closely related to the success
      of lymphaticovenous bypass surgery.

      Supermicrosurgical LVA has been proven effective in treating moderate to severe lymphedema,
      including cases with diffuse dermal backflow (DB) and even severe lymphatic fluid leakage.
      Therefore, the use of LVA should not be limited to mild lymphedema, and its indications
      should be expanded to become a primary surgical approach for more severe lymphedema cases.
      Among all surgical procedures for lymphedema, LVA is the least invasive, allowing for rapid
      recovery, minimizing the complications, and reducing medical costs.
    

Intervention name(s): Cancer-related Unilateral; Normal + Ectasis LVs
Intervention type(s): Other; Other
Intervention description(s): This group included patients who have used only contraction type LVs.; This group included patients who had only non- contraction type LVs.
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        All adult patients (age >20 years) receiving LVA for gynecologic cancer-related unilateral
        lower limb lymphedema at a tertiary medical center were retrospectively reviewed from
        October 2015 to July 2022.