Surgical Lymphedema Treatment

A Meta-Analysis and Recommendations

Magnus J Chun, BS; Fouad Saeg, MD; Derek Miller, BS; Christina Jardak, MD; Abby Duplechain, BS; Angela Sultan, MS; Christopher Homsy, MD


ePlasty. 2022;22(e51) 

In This Article

Abstract and Introduction


Background: Lymphedema is a common complication of lymph node surgery; however, evidence on diagnosing, monitoring, and treating the condition is sparse. This meta-analysis evaluates the outcomes of common surgical treatments of lymphedema and provides suggestions for future research directions.

Methods: A review of PubMed and Embase was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. All English-language studies published through June 1, 2020, were included. We excluded nonsurgical interventions, literature reviews, letters, commentaries, nonhuman or cadaver studies, and studies with inadequate sample size (N < 20).

Results: A total of 583 cases from 15 studies in patients with lymphedema met our inclusion criteria for our 1-arm meta-analysis: 387 upper extremity treatments and 196 lower extremity treatments. The volume reduction rates of lymphedema for upper extremity and lower extremity treatments were 38.0% [95% confidence interval (CI), 25.9%-50.2%] and 49.5% (95% CI, 32.6%-66.3%), respectively. The most common postoperative complications were cellulitis, reported in 4.5% of patients (95% CI, 0.9%-10.6%), and seromas, reported in 4.6% (95% CI, 0%-17.8%) of patients. Average quality of life measures across all studies improved by 52.2% (95% CI, 25.1%-79.2%) for patients who underwent upper extremity treatment.

Conclusions: Surgical management of lymphedema shows great promise. Our data suggest that adopting a standardized system of limb measurement and disease staging can increase effectiveness of treatment outcomes.


Lymphedema is a chronic disease marked by lymphatic fluid accumulation that causes swelling and tissue changes, skin discoloration, limb heaviness, altered sensation, and pain.[1] Lymphedema can be classified into either primary (genetic) or secondary (acquired) lymphedema. Secondary lymphedema is caused by an injury, insult, or obstruction to the lymphatic system, usually due to surgical excision of lymph nodes or some form of medical therapy.[1] Upper extremity lymphedema is commonly seen in patients with breast cancer as a postoperative complication of mastectomy, axillary lymph node dissections, and, to a lesser degree, sentinel lymph node dissections.[2] Up to 65% of women undergoing treatment for breast carcinoma experience lymphedema.[3–5]

Recent advances in treating lymphedema have sought to reduce the volume of lymphedematous limbs and improve patient satisfaction.[6] These newer treatments include but are not limited to lymphovenous bypass, vascularized lymph node transplant (VLNT), lymphaticovenous anastomosis (LVA), vascularized groin lymph node transfer, lymph node flap transfer (LNFT), microsurgical lymphaticovenous implantation, and lymphovenous shunt.

In 1990, Baumeister and Siuda found that autologous lymph vessel transplantation was a fundamental step toward microsurgical treatment of lymphedema.[7] Since then, many lymphatic reconstruction procedures have been considered for managing the condition. However, there are still limitations to treatment options. Garza et al concluded that there is a lack of consistency in the literature for the design of personalized surgical management strategies in patients with lymphedema.[8] Raju and Chang concluded that further exploration into standardized protocols is needed for the diagnosis and treatment of lymphedema to improve patient outcomes.[9]

There are no official guidelines from any health care organization regarding a recommended protocol for diagnosing, monitoring, and treating lymphedema. The 3 specific objectives of this review are to (1) analyze the current treatment options and the data being reported, (2) report short- and long-term treatment outcome data as well as patient satisfaction outcomes, and (3) propose evidence-based guidelines to improve and enhance the consistency with which the treatment for lymphedema is delivered.