Lilja Caroline, Madsen Christoffer Bing, Damsgaard Tine Engberg, Sørensen Jens Ahm, Thomsen Jørn Bo
Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark.
Department of Plastic Surgery, Odense University Hospital, Odense, Denmark.
Gland Surg. 2024 May 30;13(5):722-748. doi: 10.21037/gs-23-503. Epub 2024 May 27.
Various surgical treatments are increasingly adopted and gaining popularity for lymphedema treatment. However, challenges persist in selecting appropriate treatment modalities targeted for individual patients and achieving consensus on choice of treatment as well as outcomes. The systematic review aimed to create a treatment algorithm incorporating the latest scientific knowledge, to provide healthcare professionals and patients with a tool for informed decision-making, when selecting between treatments or combining them in a relevant manner. This systematic review evaluated and synthesized the evidence on the effectiveness of three surgical treatments for breast cancer-related lymphedema (BCRL): lymphovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and liposuction.
We conducted a systematic search of electronic databases on 18 June 2023, including Medline, Embase, Cochrane Library, Google Scholar, and ClinicalTrials.org. Eligible studies were randomized controlled trials, non-randomized comparative studies, and observational studies that assessed the outcomes of LVA, VLNT, or liposuction in managing BCRL. The primary results of interest were changes in arm volume, lymphatic flow, and quality of life. Two independent reviewers performed the study selection and data extraction. Following this, we systematically reviewed and conducted a risk of bias assessment. Results were qualitatively presented, and a treatment algorithm was developed based on the available data.
We identified 16,593 papers, after removal of duplicates. Following assessment of studies, 73 articles met the inclusion criteria, including 2,373 patients. We were not able to conduct a meta-analysis due to considerable heterogeneity in the methodologies and outcome measures across the studies. Liposuction appears effective for patients presenting with non-pitting lymphedema. LVA indicates variable success rate, with some evidence indicating a reduction in limb volume and symptomatic relief amongst early stages of lymphedema. VLNT showed promising results for limb volume reduction and symptom improvement in patients presenting with mild and moderate lymphedema.
Liposuction, LVA, and VLNT seem to be effective treatments for BCRL, when targeted for the appropriate patient. Well-conducted high evidence clinical studies in the field are still lacking to uncover the efficacy of surgical treatment for BCRL.
各种外科治疗方法越来越多地被采用并在淋巴水肿治疗中受到欢迎。然而，在为个体患者选择合适的治疗方式以及就治疗选择和结果达成共识方面，挑战依然存在。本系统评价旨在创建一种纳入最新科学知识的治疗算法，为医疗保健专业人员和患者在选择治疗方法或以相关方式联合使用治疗方法时提供一个知情决策的工具。本系统评价评估并综合了三种治疗乳腺癌相关淋巴水肿（BCRL）的外科治疗方法的有效性证据：淋巴静脉吻合术（LVA）、带血管蒂淋巴结转移术（VLNT）和抽脂术。
我们于2023年6月18日对电子数据库进行了系统检索，包括Medline、Embase、Cochrane图书馆、谷歌学术和ClinicalTrials.org。符合条件的研究为随机对照试验、非随机对照研究以及评估LVA、VLNT或抽脂术治疗BCRL效果的观察性研究。主要关注的结果是手臂体积、淋巴流量和生活质量的变化。两名独立的评审员进行了研究筛选和数据提取。在此之后，我们进行了系统评价并进行了偏倚风险评估。结果以定性方式呈现，并根据现有数据制定了治疗算法。
去除重复文献后，我们共识别出16593篇论文。在对研究进行评估后，73篇文章符合纳入标准，包括2373名患者。由于各项研究在方法和结果测量方面存在相当大的异质性，我们无法进行荟萃分析。抽脂术对出现非凹陷性淋巴水肿的患者似乎有效。LVA的成功率各不相同，一些证据表明在淋巴水肿早期阶段肢体体积有所减小且症状得到缓解。VLNT在减轻轻度和中度淋巴水肿患者的肢体体积和改善症状方面显示出有前景的结果。
抽脂术、LVA和VLNT针对合适的患者时似乎是治疗BCRL的有效方法。该领域仍缺乏开展良好的高证据临床研究来揭示外科治疗BCRL的疗效。
