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. 2025 Jul 17;132(4):717–726. doi: 10.1002/jso.70046

Preventing Secondary Lymphedema: A Systematic Review and Meta‐Analysis on the Efficacy of Immediate Lymphovenous Anastomosis

Chandler Hinson 1, Matthew Sink 1, Dominic Henn 1, Douglas Sammer 1, Andrew Y Zhang 1, Jessica I Billig 1, Edward Chang 2, Andrei Odobescu 1,✉
PMCID: PMC12455550  PMID: 40673745

ABSTRACT

Background

Secondary lymphedema is a debilitating condition following oncologic lymphadenectomy. Despite advancements in rehabilitation and microsurgical interventions, there is no cure for lymphedema. Performing a lymphovenous anastomosis (LVA) at the time of a regional node dissection has been purported to reduce the risks of secondary lymphedema; however, there are conflicting studies and no clear consensus about the routine use of LVA for preventing lymphedema after lymphadenectomy. The present study aims to perform a comprehensive review and meta‐analysis on immediate LVA for the prevention of secondary lymphedema.

Methods

A systematic review and literature search were performed using PubMed, Embase, Web of Science, and Cochrane databases. Studies evaluating primary or immediate LVA in oncologic surgery were included. Studies with a control group were included in the meta‐analysis.

Results

Overall, 39 studies, including 3697 patients (1,722 LVA; 1975 control), met inclusion criteria. Seventeen of the studies were included in the meta‐analysis. Pooled analysis across all studies revealed a secondary lymphedema incidence of 7.1% in the LVA cohort versus 35.0% in controls. Meta‐analysis demonstrated a significant reduction in lymphedema risk with immediate LVA (RR: 0.31). Subgroup analysis confirmed strong protective effects in breast cancer patients (RR: 0.28) and a significant but lesser benefit in dermatologic malignancies (RR: 0.35).

Conclusion

Based on the current literature, immediate LVA at time of lymphadenectomy significantly reduces the risk of secondary lymphedema in patients undergoing oncologic treatment. Given these findings, patients undergoing multimodal oncologic treatment including radiation and surgical lymphadenectomy should be considered candidates for immediate LVA.

Keywords: immediate lymphovenous anastomosis, lymph node surgery, lymphatic bypass, lymphedema, microsurgery, oncologic reconstruction, supermicrosurgery

Synopsis

  • •

    This systematic review and meta‐analysis evaluates the efficacy of immediate lymphovenous anastomosis (LVA) performed at the time of oncologic lymphadenectomy in preventing secondary lymphedema.

  • •

    Across 39 studies encompassing 3697 patients, immediate LVA was associated with a significantly reduced risk of lymphedema, particularly in patients undergoing treatment for breast and dermatologic malignancies.

  • •

    These findings support the integration of LVA as a preventative strategy in high‐risk oncologic surgeries.

1. Introduction

Oncologic reconstruction is an essential component of comprehensive cancer care, restoring both form and function following surgical resection. Patients undergoing treatment for breast, dermatological, and gynecologic malignancies often require complex reconstructive procedures to optimize esthetic and functional outcomes. However, these surgeries frequently involve lymph node dissection and radiation therapy, both of which significantly disrupt the lymphatic system and place patients at risk for secondary lymphedema [1, 2, 3, 4]. Secondary lymphedema is a progressive and often debilitating condition characterized by impaired lymphatic drainage, leading to chronic limb swelling, fibrosis, inflammation, recurrent infections, and reduced quality of life [5, 6]. The incidence of secondary lymphedema varies by cancer type and surgical intervention, with rates reported as high as 40% following axillary lymph node dissection for breast cancer and around 20% following inguinal lymphadenectomy for melanoma and gynecologic malignancies [7, 8, 9]. Despite advances in microsurgery and rehabilitation strategies, there is no cure for lymphedema which underscores need for preventative strategies.

The lymphovenous anastomosis (LVA) is a supermicrosurgical procedure that aims to restore lymphatic drainage by creating bypasses between lymphatic vessels and nearby venules, allowing lymphatic fluid to drain directly into the venous circulation [10]. LVA is a well‐documented surgical treatment for lymphedema proven to have a significant benefit in volume reduction, decreased incidence of infection, reduced dependency on compression garments, and improvements in quality of life [11, 12]. More recently, interest has grown in the application of immediate LVA at the time of lymphadenectomy, where lymphatic vessels that are ligated during a nodal dissection are repaired to an adjacent vein to preserve the lymphatic drainage [13, 14]. While a number of modalities exist, all techniques utilize a dye that permits identification of the lymphatic vessels to be repaired [15]. Preliminary studies have suggested promising outcomes, with some reports indicating a significant reduction in lymphedema rates following immediate LVA [16, 17, 18].

Despite these promising early outcomes, immediate LVA or immediate lymphatic reconstruction is not yet considered the standard of care in oncological reconstruction when the lymph system is dissected. While many studies have demonstrated a significant reduction in the risk of lymphedema, others have reported contradictory results. Similarly, previous meta‐analysis have been limited by inconsistency or short follow‐up periods. Many meta‐analyses are also outdated given the recent increase in new publications examining the efficacy of immediate LVA. This study aims to provide a comprehensive review of the current literature and perform an in‐depth analysis to establish the true value of immediate LVA in mitigating the risks of secondary lymphedema following lymphadenectomy in oncological reconstruction.

2. Materials and Methods

2.1. Strategy

This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines. Our protocol for this review was registered on PROPSERO and is accessible at https://www.crd.york.ac.uk (Record: CRD42025642808).

2.2. Search and Data Sources

A literature review was performed using PubMed, Embase, Web of Science, and Cochrane. No time constraints were placed on the search. The predetermined search terms utilized included “primary” OR “prophylactic” OR “immediate” AND “lymphaticovenous anastomosis” OR “lymphovenous bypass” OR “lymphatic‐venous anastomosis” OR “lymphovenous anastomosis” OR “lymphedema prevention” OR “lymphatic reconstruction” AND “lymphedema” OR “lymphoedema” OR “secondary lymphedema” OR “postoperative lymphedema.” Appendix 1 contains the full search terms for each database.

2.3. Selection Criteria

The Covidence platform (Veritas Health Innovation, Melbourne, Australia) was used for screening. The screening was performed independently by two investigators (C.H. and M.S.); first by title and abstract and then by full‐text review. A third investigator (A.O.) resolved conflicts. Studies were eligible if they included patients undergoing immediate LVA at time of lymphadenectomy and reported on secondary lymphedema. Studies that did not focus on immediate LVA or did not report secondary lymphedema were excluded.

2.4. Data Extraction

The variables extracted from the studies included publication year, lead author, study design, patient sample size, age, body mass index (BMI), area of lymph node dissection, number of lymph nodes removed, number of LVAs performed, frequency of radiotherapy treatment, frequency of secondary lymphedema, and follow‐up period. Weighted means and frequencies along with pooling of secondary lymphedema data were performed using Microsoft Excel (Redmond, WA; College Station, TX).

2.5. Definition of Treatment and Comparison Groups

The treatment group consisted of patients who underwent immediate LVA at the time of lymphadenectomy, which could be at or before oncological resection such as mastectomy or dermatological excision. Additionally, all LVAs, both regionally at site of lymphadenectomy or distally, were included; however, all patients included in the study had LVAs regionally to the lymphadenectomy. The control group included patients who underwent the same types of oncological surgery without immediate LVA. Studies that included patients who had therapeutic LVA for established lymphedema were excluded. There was no strict age cutoff for patient inclusion; however, pediatric patients were not included in the reviewed studies given the rarity of cancer‐related lymph node dissection in this population. Studies that were case reports, case series with less than five patients, systematic reviews, and meta‐analysis were excluded. Case series with five patients or greater were included only for pooling rates of secondary lymphedema after LVA use; however, they were not included in the meta‐analysis.

2.6. Definition of Outcomes

The immediate outcome assessed was the incidence of secondary lymphedema following lymphadenectomy and oncologic surgery, comparing patients who underwent immediate LVA to those who did not. While each study utilized different techniques to assess lymphedema, it was defined for this study as an increase in extremity circumference with patient reported symptoms including extremity swelling, feeling of heaviness or tightness in an extremity, skin changes such as thickening or redness, or extremity discomfort or aching. A subgroup analyses was performed based on the type of malignancy. Specifically, secondary lymphedema incidence was stratified by breast and dermatological malignancies that required lymphadenectomy. This analysis aimed to determine whether immediate LVA had differential efficacy based on malignancy type.

2.7. Statistical Analysis

Meta‐analysis was performed using Cochrane Review Manager RevMan 5.4 (London, United Kingdom). Weighted means and frequency were calculated for patient characteristics of both cohorts (LVA cohort and control). Total incidence for lymphedema was calculated along with risk ratios (RR) with 95% confidence intervals (CI). Statistical differences were noted as a p < 0.05.

2.8. Risk of Bias

Two investigators (C.H. and M.S.) independently conducted a quality and bias assessment using a data extraction form, following the Downs and Black (D&B) checklist. The quality of each study was evaluated based on the established criteria for the D&B score, categorized as excellent ( ≥ 26), good (20–25), fair (15–19), or poor ( ≤ 14). Additionally, a level of evidence score was assigned to each study according to the American Society of Plastic Surgeons (ASPS) Level of Evidence (LOE) Rating Scale for Therapeutic Studies.

3. Results

3.1. Search Results

Our initial search identified 1024 citations (Figure 1). Following the removal of duplicates, 726 citations were screened based on their titles and abstracts. Subsequently, 78 articles were selected for full‐text review, resulting in the inclusion of 39 studies (Table S1) [18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55]. Studies were excluded for several reasons: incorrect indications (patients did not receive immediate LVA), inappropriate study design, or incorrect outcome assessment (did not report secondary lymphedema). The inclusion criteria for the meta‐analysis component included studies that compared rates of secondary lymphedema between patients who had and had not received LVA, with 17 studies meeting this requirement to be included for meta‐analysis.

Figure 1.

Figure 1

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Figure 1 illustrates the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flow diagram for the study selection process. The initial search identified 1024 records from three databases: PubMed (n = 748), Web of Science (n = 148), and Embase (n = 128). No additional references were obtained through other sources such as citation searching or gray literature. After removing 298 duplicates, 726 studies remained for screening. Of these, 648 studies were excluded based on title and abstract screening, leaving 78 studies for full‐text assessment. No studies were unavailable for retrieval. Following eligibility assessment, 39 studies were excluded due to reasons such as lack of full text (n = 7), reporting of irrelevant outcomes (n = 11), use of the wrong intervention (n = 10), incorrect study design (n = 9), or an inapplicable patient population (n = 2). Ultimately, 39 studies were included in the final systematic review.

3.2. Pooled Baseline Characteristics: Lymphovenous Anastomosis and Control Cohorts

A total of 3697 patients were included in this study with 1722 patients receiving immediate LVAs while the remaining 1975 served as controls. The weighted mean age (standard deviation [SD]) of the LVA cohort was 55.4 (5.76) while for the control cohort it was 56.62 (6.12). Notably, two studies did not provide patient ages. The weighted mean BMI (SD) was 27.10 (1.95) for the LVA cohort and 27.55 (1.66) for the control cohort, with 12 studies not reporting BMI.

Females were the predominant gender in both cohorts, comprising 93.87% of the LVA group (with four studies not reporting gender). The most common oncological pathology treated was breast cancer in both groups, occurring in 79.66% of LVA patients and 81.35% of controls. Melanoma was the second most common pathology, seen in 13.93% of LVA patients and 16.21% of controls, followed by squamous cell carcinoma (2.91%) in the LVA cohort and sarcoma (1.33%) in the control group.

The mean (SD) number of lymph nodes removed during oncological resection was similar between groups: 15.78 (3.52) for the LVA cohort and 15.75 (3.62) for the control cohort. However, 13 studies did not report lymph node counts for the LVA group. The majority of dissections and anastomoses were performed in the axilla (88.92%) for the LVA group, whereas the control cohort predominantly had dissections in the axilla as well (85.94%).

Regarding surgical characteristics, the mean (SD) number of anastomoses created in the LVA group was 2.11 (0.82), though 19 studies did not report the number of anastomoses created. Among anastomotic techniques, end‐to‐end was the most common (63.48%), followed by intussusception (18.17%) and sleeve (14.13%). Nine studies did not specify the type of anastomosis utilized.

For adjuvant oncologic treatment, 78.92% of LVA patients and 65.94% of control patients received radiotherapy, though 11 studies did not report radiotherapy status. The mean follow‐up time (SD) across all studies was 21.34 months (19.72).

Pooling across all studies, the rate of secondary lymphedema was significantly lower in the LVA cohort at 7.14% compared to 35.04% in the control cohort. Table 1 presents the demographics, surgical characteristics, and rates of lymphedema for both groups.

Table 1.

This table presents patient demographics, surgical characteristics, and lymphedema incidence between the prophylactic lymphovenous anastomosis (LVA) cohort and the control cohort. Variables include sample size, mean age, body mass index (BMI), frequency of female patients, number of lymph nodes removed, percentage of upper extremity lymphadenectomy, mean number of anastomoses performed, frequency of radiotherapy, and incidence of secondary lymphedema. Values are reported as mean (standard deviation [SD]) or frequency (%) with corresponding sample sizes provided in brackets.

LVA cohort Control cohort
Sample 1722 1975
Age: Mean (SD) [Sample Size] 55.41 (5.76) [1630] 56.62 (6.12) [1975]
BMI: Mean (SD) [Sample Size] 27.20 (1.95) [1271] 27.56 (1.66) [1239]
Female Frequency [Sample Size] 93.87% [1565] 92.90% [1832]
Lymph Nodes Removed: Mean (SD) [Sample Size] 15.78 (3.52) [1195] 15.75 (3.63) [631]
LVA Site: Upper Extremity Frequency [Sample Size] 88.92% [1742] 85.94% [1921]
Anastomosis: Mean (SD) [Sample Size] 2.11 (0.82) [634] N/A
Radiotherapy: Frequency [Sample Size] 78.92% [1309] 65.94% [869]
Lymphedema: Frequency [Sample Size] 7.14% [1722] 35.04% [1975]
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3.3. Meta‐Analysis

The meta‐analysis utilized 17 studies and included studies that had both an LVA and control cohort, which directly assesses the impact of LVA on secondary lymphedema across different oncological indications. Immediate LVA was associated with a 69% lower risk of secondary lymphedema compared to the control group (RR: 0.31, 95% CI: 0.23–0.42, p < 0.00001) (Figure 2). A total of 78 patients developed secondary lymphedema in the LVA group out of 917 patients (8.51%), compared to 692 patients in the control group out of a total of 1975 patients (35.04%). Heterogeneity was low (I 2 = 22%, p = 0.20), suggesting consistent results across studies.

Figure 2.

Figure 2

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This forest plot illustrates the pooled risk ratio (RR) with 95% confidence intervals (CI) for the incidence of secondary lymphedema in patients undergoing immediate LVA compared to controls. Each included study is represented as a data point, with the horizontal lines indicating the confidence interval and the size of the square reflecting the study weight. The diamond at the bottom represents the overall effect estimate. The meta‐analysis demonstrates a significant reduction in secondary lymphedema risk in the LVA cohort (RR: 0.31, 95% CI: 0.23–0.42, p < 0.00001), indicating that immediate LVA is associated with a 69% lower risk of developing lymphedema compared to standard oncologic surgery alone. Heterogeneity analysis (I 2 = 22%, p = 0.20) suggests low variability among included studies.

3.4. Subgroup Analysis: Malignancy Type

In subgroup analysis of breast surgery, LVA was associated with a 72% reduction in risk of secondary lymphedema compared to the control group (RR: 0.28, 95% CI: 0.20–0.39, p < 0.00001) (Figure 3), A total of 62 patients developed secondary lymphedema out of 778 patients who were in the LVA group (7.97%), compared to 571 patients out of 1596 patients in the control group (35.78%). Heterogeneity was similarly low (I 2 = 22%, p = 0.23), indicating a consistent effect across the studies within this subgroup.

Figure 3.

Figure 3

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This forest plot presents the pooled risk ratio (RR) with 95% confidence intervals (CI) for the development of secondary lymphedema after mastectomies with immediate lymphovenous anastomosis (LVA) compared to those who did not receive LVA. Each study is represented as a square, with the horizontal lines denoting the confidence interval, while the size of the square reflects the study's weight in the analysis. The diamond at the bottom represents the overall effect estimate. The meta‐analysis indicates a significant reduction in lymphedema risk for the LVA cohort (RR: 0.28, 95% CI: 0.20–0.39, p < 0.00001), demonstrating a 72% lower risk of developing secondary lymphedema compared to controls. Heterogeneity analysis (I 2 = 22%, p = 0.23) suggests a low degree of variability across included studies.

For the subgroup analysis of dermatologic malignancies, which includes both melanoma and squamous cell carcinomas, the effect of LVA was slightly less pronounced with a 65% reduction in risk of secondary lymphedema compared to the control group (RR: 0.35, 95% CI: 0.13–0.98, p = 0.05) (Figure 3). There were 7 patients who developed secondary lymphedema out of 90 LVA patients (7.78%), compared to 72 patients in 269 control group patients (26.77%). Heterogeneity was moderate (I 2 = 46%, p = 0.14), suggesting some variability among included studies (Figure 4).

Figure 4.

Figure 4

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This forest plot displays the pooled risk ratio (RR) with 95% confidence intervals (CI) for the incidence of secondary lymphedema in patients undergoing immediate lymphovenous anastomosis (LVA) following lymphadenectomy for dermatologic malignancies, including melanoma and squamous cell carcinoma. Each included study is represented by a square, with horizontal lines indicating the confidence interval, while the size of the square reflects the study's weight in the analysis. The diamond at the bottom represents the overall effect estimate. The meta‐analysis demonstrates a significant reduction in lymphedema risk for the LVA cohort (RR: 0.35, 95% CI: 0.13–0.98, p = 0.05), indicating a 65% lower risk of developing secondary lymphedema compared to controls. Heterogeneity analysis (I 2 = 46%, p = 0.14) suggests moderate variability among included studies.

3.5. Risk of Bias and Quality Score

The risk of bias and quality assessment for the included studies were conducted using the D&B checklist. Of the 39 studies evaluated, the mean (SD) D&B score was 19.72 (2.87) (Table S1). This means the average score was “Good” as there was a mix of case series, retrospective, and prospective cohort. The mean ASPS LOE (SD) was 3.31 (0.89). All studies received between 2 and 4 for LOE.

4. Discussion

Although immediate LVA has garnered recent popularity, the overall effectiveness of this procedure being routinely used in preventing secondary lymphedema remains uncertain. In our meta‐analysis, we find that immediate LVA at time of lymphadenectomy was associated with a reduction in the risk of secondary lymphedema across every oncological patient population studied. These findings suggest that immediate LVA is beneficial in reducing the risk of secondary lymphedema after surgical treatment of a malignancy.

4.1. Biologic Rationale for Immediate Lymphovenous Anastomosis

The pathophysiology of secondary lymphedema is driven by the disruption of lymphatic drainage pathways following oncologic lymphadenectomy, leading to chronic fluid stasis, inflammation, and fibrosis [56]. Once fibrosis sets in, lymphatic function is irreversibly compromised, limiting the effectiveness of delayed interventions [57]. Our findings indicate that immediate LVA mitigates this process by establishing direct lymphatic‐to‐venous bypasses, ensuring uninterrupted lymphatic flow postoperatively. Biologically, LVA prevents lymphatic endothelial apoptosis and vessel regression, mechanisms that contribute to progressive lymphatic failure [58]. Studies have demonstrated that early restoration of lymph flow sustains vessel integrity and reduces inflammatory signaling, ultimately promoting long‐term lymphatic remodeling and function preservation [59, 60, 61]. Our subgroup analysis confirms that immediate LVA is effective in minimizing risk of secondary lymphedema in both breast and dermatologic malignancies, supporting the hypothesis that earlier intervention leads to superior outcomes.

Additionally, LVA may counteract radiotherapy‐induced lymphatic damage, as 78.92% of patients in the LVA cohort had received adjuvant radiotherapy; yet, this cohort still exhibited significantly lower lymphedema rates compared to controls whom also had a high frequency of adjuvant radiotherapy use. This suggests that LVA provides a protective effect even in patients with additional risk factors, reinforcing its role as a key adjunct to oncologic surgery.

4.2. Impact of Lymphovenous Anastomosis on Quality of Life and Patient‐Reported Outcomes

Secondary lymphedema significantly reduces health‐related quality of life, leading to chronic limb swelling, physical discomfort, restricted mobility, and psychological distress [62, 63, 64]. While none of the studies included in the meta‐analysis directly reported on quality of life measures, it has been shown in the literature how microsurgical treatments improve quality of life for those with breast cancer‐related lymphedema [65, 66, 67]. Our study adds to the growing body of evidence demonstrating that patients who undergo immediate LVA report 26.53% risk reduction in symptoms associated with lymphedema due to its prevention.

Additionally, our analysis contributes to the research around the economic burden of secondary lymphedema, as lifelong management strategies—such as manual lymphatic drainage, compression therapy, and physical therapy—incur significant costs and impose long‐term limitations on patients [68, 69, 70]. By substantially lowering the incidence of lymphedema, immediate LVA reduces dependency on conservative management, translating to lower long‐term healthcare costs and improved patient autonomy.

4.3. Lymphovenous Anastomosis in Sentinel Lymph Node Biopsy and Axillary Dissection

Within breast cancer treatment, sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) cause direct trauma to the lymphatic system, with ALND carrying a particularly high risk of lymphedema due to extensive nodal clearance [71, 72]. Despite its less invasive nature, some studies have highlighted that SLNB can still result in subclinical lymphatic dysfunction, which may progress to symptomatic lymphedema over time [73]. Amongst the included studies in this review, all LVAs were conducted after ALND or other forms of lymphadenectomy, not after SLNB alone or with mastectomy. Additionally, all ALNDs and lymphadenectomies in this study were done during the same procedure. While we are unable to highlight its benefits amongst those patients that received SLNB, our study highlights the importance of integrating LVA in procedures that dissect lymph nodes. LVA can be helpful particularly in treating patients with additional risk factors which are known to increase risk of lymphedema such as high nodal burden cancer, obesity, or adjuvant radiation therapy [74, 75, 76, 77]. Immediate LVA at the time of ALND offers a practical solution by rerouting lymphatic fluid into the venous circulation, preventing stagnation and inflammatory changes that lead to chronic lymphedema. Given our findings of a 27.81% risk reduction in breast cancer patients, LVA should be strongly considered as a standard adjunct for all patients undergoing ALND within their breast cancer treatment.

4.4. Immediate Lymphovenous Anastomosis in Different Malignancies

The risk reduction associated with immediate LVA in preventing secondary lymphedema appears to vary by oncological malignancy, highlighting potential differences in pathophysiology, surgical burden, and lymphatic compromise across malignancies. The differences in risk reduction may be attributable to distinct tumor biology, variations in lymphatic disruption, and surgical techniques used for different malignancies. For example, breast cancer surgeries often involve axillary lymphadenectomy, where LVA may provide more consistent lymphatic drainage restoration, whereas dermatologic malignancies can require inguinal or cervical lymphadenectomy, which may introduce greater variability in lymphatic reconstruction efficacy. These findings reinforce the importance of considering malignancy‐specific factors when evaluating LVA's role in lymphedema prevention.

4.5. Study Quality, Limitations, and Future Directions

Despite the strength of our meta‐analysis, several limitations must be acknowledged. Most included studies were retrospective cohort studies, thereby introducing selection bias and limiting the ability to establish causal relationships. Additionally, only a small number of randomized controlled trials have assessed prophylactic LVA, emphasizing the need for prospective, multi‐institutional trials to further validate these findings. Heterogeneity in surgical technique, patient selection, and follow‐up duration also presents a challenge. Future studies should focus on standardizing anastomotic techniques, vein caliber selection, and postoperative monitoring to optimize LVA outcomes. Furthermore, multiple year long‐term follow‐up data is limited, highlighting the need for extended studies assessing late‐onset lymphedema development. Additionally, quality of life assessments should be utilized to assess decrease in morbidity associated with immediate LVA. Despite these limitations, this study differs from previous systematic reviews and meta‐analyses in several keyways. First, it includes the largest sample size to date, incorporating a broader and more comprehensive data set that enhances statistical power and generalizability. Additionally, this study integrates more recent studies, reflecting advancements in surgical techniques, patient selection, and postoperative management. Secondly, we stratify the results based on malignancy type, specifically analyzing outcomes by both breast and dermatologic malignancies. Prior reviews have primarily focused on breast, limiting their ability to assess potential differences in efficacy across various other oncologic populations.

5. Conclusion

This systematic review and meta‐analysis provide compelling evidence that immediate LVA significantly reduces secondary lymphedema risk across oncological indications, with the most pronounced benefit observed in breast cancer patients. While some view LVA as only an experimental technique, this study highlights the potential of LVA to be the standard of care when lymphadenectomy occurs in oncological reconstruction. This study shows LVA as an effective intervention that significantly reduces lymphedema risk. Despite inherent study limitations, the findings strongly support the clinical utility of LVA as a preventative strategy. Future research should prioritize randomized trials and standardized surgical techniques to refine patient selection and optimize long‐term outcomes.

Ethics Statement

Study is nonhuman subjects research and didn't require IRB approval.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Appendix 1.

JSO-132-717-s002.docx (14.5KB, docx)

Supplementary Table 1.

JSO-132-717-s001.xlsx (21.1KB, xlsx)

supmat.

JSO-132-717-s003.docx (12KB, docx)

Data Availability Statement

The study was registered on PROPSERO and data is accessible at https://www.crd.york.ac.uk/PROSPERO/ (Record: CRD42025642808). Any additional details regarding the data analysis is available upon request from the authors.

References

  • 1. Friedman J. F., Sunkara B., Jehnsen J. S., Durham A., Johnson T., and Cohen M. S., “Risk Factors Associated With Lymphedema After Lymph Node Dissection in Melanoma Patients,” American Journal of Surgery 210 (2015): 1178–1184. [DOI] [PubMed] [Google Scholar]
  • 2. Tada H., Teramukai S., Fukushima M., and Sasaki H., “Risk Factors for Lower Limb Lymphedema After Lymph Node Dissection in Patients With Ovarian and Uterine Carcinoma,” BMC Cancer 9 (2009): 47. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. Allam O., Park K. E., Chandler L., et al., “The Impact of Radiation on Lymphedema: A Review of the Literature,” Gland Surgery 9 (2020): 596–602. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Shah C., Wilkinson J. B., Baschnagel A., et al., “Factors Associated With the Development of Breast Cancer–Related Lymphedema After Whole‐Breast Irradiation,” International Journal of Radiation Oncology, Biology, Physics 83 (2012): 1095–1100. [DOI] [PubMed] [Google Scholar]
  • 5. Cormier J. N., Askew R. L., Mungovan K. S., Xing Y., Ross M. I., and Armer J. M., “Lymphedema Beyond Breast Cancer,” Cancer 116 (2010): 5138–5149. [DOI] [PubMed] [Google Scholar]
  • 6. Hayes S. C., Janda M., Cornish B., Battistutta D., and Newman B., “Lymphedema After Breast Cancer: Incidence, Risk Factors, and Effect on Upper Body Function,” Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 26 (2008): 3536–3542. [DOI] [PubMed] [Google Scholar]
  • 7. DiSipio T., Rye S., Newman B., and Hayes S., “Incidence of Unilateral Arm Lymphoedema After Breast Cancer: A Systematic Review and Meta‐Analysis,” Lancet Oncology 14 (2013): 500–515. [DOI] [PubMed] [Google Scholar]
  • 8. Beesley V., Janda M., Eakin E., Obermair A., and Battistutta D., “Lymphedema After Gynecological Cancer Treatment,” Cancer 109 (2007): 2607–2614. [DOI] [PubMed] [Google Scholar]
  • 9. Arié A. and Yamamoto T., “Lymphedema Secondary to Melanoma Treatments: Diagnosis, Evaluation, and Treatments,” Global Health & Medicine 2 (2020): 227–234. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10. Chang E. I., Skoracki R. J., and Chang D. W., “Lymphovenous Anastomosis Bypass Surgery,” Seminars in Plastic Surgery 32 (2018): 22–27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Thomas M., Pike C., Humphreys I., Bragg T., and Ghattaura A., “Impact and Outcomes After Lymphaticovenous Anastomosis for 150 Cases of Lymphoedema Followed Up Over 24 Months,” Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS 85 (2023): 104–113. [DOI] [PubMed] [Google Scholar]
  • 12. Huang A. and Chang D. W., “Lymphovenous Bypass,” Annals of Breast Surgery 8 (2024, https://abs.amegroups.org/article/view/7988. [Google Scholar]
  • 13. Jørgensen M. G., Toyserkani N. M., and Sørensen J. A., “The Effect of Prophylactic Lymphovenous Anastomosis and Shunts for Preventing Cancer‐Related Lymphedema: A Systematic Review and Meta‐Analysis,” Microsurgery 38 (2018): 576–585. [DOI] [PubMed] [Google Scholar]
  • 14. Ciudad P., Escandón J. M., Bustos V. P., Manrique O. J., and Kaciulyte J., “Primary Prevention of Cancer‐Related Lymphedema Using Preventive Lymphatic Surgery: Systematic Review and Meta‐Analysis,” Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India 55 (2022): 18–25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Chen W. F., Zhao H., Yamamoto T., Hara H., and Ding J., “Indocyanine Green Lymphographic Evidence of Surgical Efficacy Following Microsurgical and Supermicrosurgical Lymphedema Reconstructions,” Journal of Reconstructive Microsurgery 32 (2016): 688–698. [DOI] [PubMed] [Google Scholar]
  • 16. Depypere B., Vyncke T., Dhooghe N., Claes K., Blondeel P., and Van Landuyt K., “A Novel Technique for Preventive Lymphovenous Anastomosis: Anastomosing a Ligated Lymphatic Vessel,” Plastic and Reconstructive Surgery Global Open 9 (2021): e3509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17. Wan R., Hussain A., Kuruoglu D., Houdek M. T., and Moran S. L., “Prophylactic Lymphaticovenous Anastomosis (LVA) for Preventing Lymphedema After Sarcoma Resection in the Lower Limb: A Report of Three Cases and Literature Review,” Microsurgery 43 (2023): 273–280. [DOI] [PubMed] [Google Scholar]
  • 18. Chungsiriwattana W., Kongkunnavat N., Kamnerdnakta S., Hayashi A., and Tonaree W., “Immediate Inguinal Lymphaticovenous Anastomosis Following Lymphadenectomy in Skin Cancer of Lower Extremities,” Asian Journal of Surgery 46 (2023): 299–305. [DOI] [PubMed] [Google Scholar]
  • 19. Hahamoff M., Gupta N., Munoz D., et al., “A Lymphedema Surveillance Program for Breast Cancer Patients Reveals the Promise of Surgical Prevention,” The Journal of Surgical Research 244 (2019): 604–611. [DOI] [PubMed] [Google Scholar]
  • 20. Pierazzi D. M., Arleo S., and Faini G., “Distally Prophylactic Lymphaticovenular Anastomoses After Axillary or Inguinal Complete Lymph Node Dissection Followed by Radiotherapy: A Case Series,” Medicina (Kaunas, Lithuania) 58 (2022): 207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Schwarz G. S., Grobmyer S. R., Djohan R. S., et al., “Axillary Reverse Mapping and Lymphaticovenous Bypass: Lymphedema Prevention Through Enhanced Lymphatic Visualization and Restoration of Flow,” Journal of Surgical Oncology 120 (2019): 160–167. [DOI] [PubMed] [Google Scholar]
  • 22. Médor M. C., Churchill I. F., Pereira D., et al., “Lymphovenous Bypass for Immediate Lymphatic Reconstruction in Breast Cancer Patients Undergoing Axillary Lymph Node Dissection: Minimizing the Risk of Upper Extremity Lymphedema,” Journal of Reconstructive Microsurgery 40 (2024): 713–721. [DOI] [PubMed] [Google Scholar]
  • 23. Chung J.‐H., Kwon S.‐H., Jung S.‐P., Park S.‐H., and Yoon E.‐S., “Assessing the Preventive Effect of Immediate Lymphatic Reconstruction on the Upper Extremity Lymphedema,” Gland Surgery 12 (2023): 334–343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24. Le N. K., Liu L., Jesus Cruz R., et al., “Efficacy of Immediate Lymphatic Reconstruction in Prevention of Breast Cancer–Related Lymphedema,” Annals of Plastic Surgery 90 (2023): 363. [DOI] [PubMed] [Google Scholar]
  • 25. Granoff M. D., Fleishman A., Shillue K., et al., “A 4‐Year Institutional Experience of Immediate Lymphatic Reconstruction,” Plastic and Reconstructive Surgery 152 (2023): 773. [DOI] [PubMed] [Google Scholar]
  • 26. Casabona F., Bogliolo S., Valenzano Menada M., Sala P., Villa G., and Ferrero S., “Feasibility of Axillary Reverse Mapping During Sentinel Lymph Node Biopsy in Breast Cancer Patients,” Annals of Surgical Oncology 16 (2009): 2459–2463. [DOI] [PubMed] [Google Scholar]
  • 27. Cakmakoglu C., Kwiecien G. J., Schwarz G. S., and Gastman B., “Lymphaticovenous Bypass for Immediate Lymphatic Reconstruction in Locoregional Advanced Melanoma Patients,” Journal of Reconstructive Microsurgery 36 (2020): 247–252. [DOI] [PubMed] [Google Scholar]
  • 28. Ezawa M., Sasaki H., Yamada K., et al., “Long Term Outcomes From Lymphatic Venous Anastomosis After Total Hysterectomy to Prevent Postoperative Lymphedema in Lower Limb,” BMC Surgery 19 (2019): 177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29. Cook J. A., Sasor S. E., Loewenstein S. N., et al., “Immediate Lymphatic Reconstruction After Axillary Lymphadenectomy: A Single‐Institution Early Experience,” Annals of Surgical Oncology 28 (2021): 1381–1387. [DOI] [PubMed] [Google Scholar]
  • 30. Feldman S., Bansil H., Ascherman J., et al., “Single Institution Experience With Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema,” Annals of Surgical Oncology 22 (2015): 3296–3301. [DOI] [PubMed] [Google Scholar]
  • 31. Goel P., Arora J. S., and Lanier B., “Immediate Lymphatic Reconstruction Using a Handheld Fluorescence Imaging Device,” Plastic and Reconstructive Surgery Global Open 11 (2023): e5480. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Orefice S., Conti A. R., Grassi M., and Salvadori B., “The Use of Lympho‐Venous Anastomoses to Prevent Complications From Ilio‐Inguinal Dissection,” Tumori. TUMOAB 74 (1988): 347–351. [DOI] [PubMed] [Google Scholar]
  • 33. Weinstein B., Le N. K., Robertson E., et al., “Reverse Lymphatic Mapping and Immediate Microsurgical Lymphatic Reconstruction Reduces Early Risk of Breast Cancer–Related Lymphedema,” Plastic and Reconstructive Surgery 149 (2022): 1061–1069. [DOI] [PubMed] [Google Scholar]
  • 34. Johnson A. R., Fleishman A., Granoff M. D., et al., “Evaluating the Impact of Immediate Lymphatic Reconstruction for the Surgical Prevention of Lymphedema,” Plastic and Reconstructive Surgery 147 (2021): 373. [DOI] [PubMed] [Google Scholar]
  • 35. Ozmen T., Lazaro M., Zhou Y., Vinyard A., and Avisar E., “Evaluation of Simplified Lymphatic Microsurgical Preventing Healing Approach (S‐LYMPHA) for the Prevention of Breast Cancer–Related Clinical Lymphedema After Axillary Lymph Node Dissection,” Annals of Surgery 270 (2019): 1156–1160. [DOI] [PubMed] [Google Scholar]
  • 36. Lipman K., Luan A., Stone K., Wapnir I., Karin M., and Nguyen D., “Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for Lymphedema Prevention After Axillary Lymph Node Dissection—A Single Institution Experience and Feasibility of Technique,” Journal of Clinical Medicine 11 (2022): 92. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37. Agrawal J., Mehta S., Goel A., Pande P. K., and Kumar K., “Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) for Prevention of Breast Cancer‐Related Lymphedema—A Preliminary Report,” Indian Journal of Surgical Oncology 9 (2018): 369–373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38. Shaffer K., Cakmakoglu C., Schwarz G. S., et al., “Lymphedema Prevention Surgery: Improved Operating Efficiency Over Time,” Annals of Surgical Oncology 27 (2020): 4695–4701. [DOI] [PubMed] [Google Scholar]
  • 39. Nacchiero E., Maruccia M., Robusto F., Elia R., De Di Cosmo A., and Giudice G., “Prevention of Secondary Lymphedema After Complete Lymph Node Dissection in Melanoma Patients: The Role of Preventive Multiple Lymphatic–Venous Anastomosis in Observational Era,” Medicina (Kaunas, Lithuania) 58 (2022): 117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40. Boccardo F. M., Casabona F., Friedman D., et al., “Surgical Prevention of Arm Lymphedema After Breast Cancer Treatment,” Annals of Surgical Oncology 18 (2011): 2500–2505. [DOI] [PubMed] [Google Scholar]
  • 41. Takeishi M., Kojima M., Mori K., Kurihara K., and Sasaki H., “Primary Intrapelvic Lymphaticovenular Anastomosis Following Lymph Node Dissection,” Annals of Plastic Surgery 57 (2006): 300–304. [DOI] [PubMed] [Google Scholar]
  • 42. Herremans K. M., Cribbin M. P., Riner A. N., et al., “Five‐Year Breast Surgeon Experience in LYMPHA at Time of ALND for Treatment of Clinical T1–4N1–3M0 Breast Cancer,” Annals of Surgical Oncology 28 (2021): 5775–5787. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43. Scaglioni M. F., Meroni M., Fritsche E., and Fuchs B., “Combined Pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) Flap With Lymphatic Tissue Preservation and Lymphovenous Anastomosis (LVA) for Defect Reconstruction and Lymphedema–Lymphocele Prevention in Thigh Sarcoma Surgery: Preliminary Results,” Journal of Surgical Oncology 123 (2021): 96–103. [DOI] [PubMed] [Google Scholar]
  • 44. Ozmen T., Layton C., Friedman‐Eldar O., et al., “Evaluation of Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) for the Prevention of Breast Cancer‐Related Lymphedema After Axillary Lymph Node Dissection Using Bioimpedance Spectroscopy,” European Journal of Surgical Oncology: The Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 48 (2022): 1713–1717. [DOI] [PubMed] [Google Scholar]
  • 45. Morotti M., Menada M. V., Boccardo F., et al., “Lymphedema Microsurgical Preventive Healing Approach for Primary Prevention of Lower Limb Lymphedema After Inguinofemoral Lymphadenectomy for Vulvar Cancer,” International journal of gynecological cancer: official journal of the International Gynecological Cancer Society 23 (2013): 769–774. [DOI] [PubMed] [Google Scholar]
  • 46. Boccardo F., Casabona F., DeCian F., et al., “Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) for Primary Surgical Prevention of Breast Cancer‐Related Lymphedema: Over 4 Years Follow‐Up,” Microsurgery 34 (2014): 421–424. [DOI] [PubMed] [Google Scholar]
  • 47. Haravu P. N., Shakir A., Jackson K., et al., “Establishment and Feasibility of n Immediate Lymphatic Reconstruction Program in a Community Health System,” Annals of Surgical Oncology 31 (2024): 672–680. [DOI] [PubMed] [Google Scholar]
  • 48. Boccardo F., Casabona F., De Cian F., et al., “Lymphedema Microsurgical Preventive Healing Approach: A New Technique for Primary Prevention of Arm Lymphedema After Mastectomy,” Annals of Surgical Oncology 16 (2009): 703–708. [DOI] [PubMed] [Google Scholar]
  • 49. Alarcón P. Z., Torrano L., Ibarra A., Garrido M. F., Playa G. P., and Masia J., “Prophylactic Lymphedema Surgery in Lower Limb Soft Tissue Sarcomas: A Clinical Paradigm in a Promising Field,” Journal of Plastic, Reconstructive & Aesthetic Surgery 88 (2024): 524–534. [DOI] [PubMed] [Google Scholar]
  • 50. Uyulmaz S., Grünherz L., Giovanoli P., Fuchs B., and Lindenblatt N., “Primary Lymphovenous Anastomosis After Extended Soft Tissue Resection in the Medial Thigh for Reduction of Lymphocele and Lymphedema,” Annals of Plastic Surgery 93 (2024): 221–228. [DOI] [PubMed] [Google Scholar]
  • 51. Nacchiero E., Maruccia M., Vestita M., Elia R., Marannino P., and Giudice G., “Multiple Lymphatic‐Venous Anastomoses in Reducing the Risk of Lymphedema in Melanoma Patients Undergoing Complete Lymph Node Dissection. A Retrospective Case‐Control Study,” Journal of plastic, reconstructive & aesthetic surgery: JPRAS 72 (2019): 642–648. [DOI] [PubMed] [Google Scholar]
  • 52. Boccardo F., Valenzano M., Costantini S., et al., “LYMPHA Technique to Prevent Secondary Lower Limb Lymphedema,” Annals of Surgical Oncology 23 (2016): 3558–3563. [DOI] [PubMed] [Google Scholar]
  • 53. Spoer D. L., Berger L. E., Towfighi P. N., et al., “Lymphovenous Coupler‐Assisted Bypass for Immediate Lymphatic Reconstruction,” Journal of Reconstructive Microsurgery 40 (2024): 334–347. [DOI] [PubMed] [Google Scholar]
  • 54. Desai A., Dahl V., De Castro Silva I., et al., “Larger Recipient Vein Caliber During Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) Is Associated With Lower Lymphedema Rates,” Surgery 176 (2024): 1485–1491. [DOI] [PubMed] [Google Scholar]
  • 55. Boccardo F., De Cian F., Campisi C. C., et al., “Surgical Prevention and Treatment of Lymphedema After Lymph Node Dissection in Patients With Cutaneous Melanoma,” Lymphology 46 (2013): 20–26. [PubMed] [Google Scholar]
  • 56. Lee S.‐O. and Kim I.‐K., “Molecular Pathophysiology of Secondary Lymphedema,” Frontiers in Cell and Developmental Biology 12 (2024): 1363811. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57. Azhar S. H., Lim H. Y., Tan B.‐K., and Angeli V., “The Unresolved Pathophysiology of Lymphedema,” Frontiers in Physiology 11 (2020): 137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58. Tammela T. and Alitalo K., “Lymphangiogenesis: Molecular Mechanisms and Future Promise,” Cell 140 (2010): 460–476. [DOI] [PubMed] [Google Scholar]
  • 59. Mendez U., Brown E. M., Ongstad E. L., Slis J. R., and Goldman J., “Functional Recovery of Fluid Drainage Precedes Lymphangiogenesis in Acute Murine Foreleg Lymphedema,” American Journal of Physiology Heart and Circulatory Physiology 302 (2012): 2250–2256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60. Aschen S. Z., Farias‐Eisner G., Cuzzone D. A., et al., “Lymph Node Transplantation Results in Spontaneous Lymphatic Reconnection and Restoration of Lymphatic Flow,” Plastic and Reconstructive Surgery 133 (2014): 301–310. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61. Yoshida S., Koshima I., Hamada Y., et al., “Lymphovenous Anastomosis Aids Wound Healing in Lymphedema: Relationship Between Lymphedema and Delayed Wound Healing From a View of Immune Mechanisms,” Advances in Wound Care 8 (2019): 263–269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62. Morgan P. A., Franks P. J., and Moffatt C. J., “Health‐Related Quality of Life With Lymphoedema: A Review of the Literature,” International wound journal 2 (2005): 47–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 63. Jørgensen M. G., Toyserkani N. M., Hansen F. G., Bygum A., and Sørensen J. A., “The Impact of Lymphedema on Health‐Related Quality of Life Up to 10 Years After Breast Cancer Treatment,” NPJ Breast Cancer 7 (2021): 70. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 64. Gandhi A., Xu T., DeSnyder S. M., et al., “Prospective, Early Longitudinal Assessment of Lymphedema‐Related Quality of Life Among Patients With Locally Advanced Breast Cancer: The Foundation for Building a Patient‐Centered Screening Program,” Breast (Edinburgh, Scotland) 68 (2023): 205–215. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 65. Seidenstuecker K., Fertsch S., Ghazaleh A. A., et al., “Improving Quality of Life After Breast Cancer: A Comparison of Two Microsurgical Treatment Options for Breast Cancer‐Related Lymphedema (BCRL),” Clinical and Experimental Medicine 24 (2024): 82. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 66. Johnson A. R. and Singhal D., “Immediate Lymphatic Reconstruction,” Journal of Surgical Oncology 118 (2018): 750–757. [DOI] [PubMed] [Google Scholar]
  • 67. Basta M. N., Gao L. L., and Wu L. C., “Operative Treatment of Peripheral Lymphedema: A Systematic Meta‐Analysis of the Efficacy and Safety of Lymphovenous Microsurgery and Tissue Transplantation,” Plastic and Reconstructive Surgery 133 (2014): 905–913. [DOI] [PubMed] [Google Scholar]
  • 68. Dean L. T., Moss S. L., Ransome Y., et al., “It Still Affects Our Economic Situation”: Long‐Term Economic Burden of Breast Cancer and Lymphedema, Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer 27 (2019): 1697–1708. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 69. De Vrieze T., Nevelsteen I., Thomis S., De Groef A., et al., “What Are the Economic Burden and Costs Associated With the Treatment of Breast Cancer‐Related Lymphoedema? A Systematic Review,” Supportive Care in Cancer 28 (2020): 439–449. [DOI] [PubMed] [Google Scholar]
  • 70. Brayton K. M., Hirsch A. T., Brien O., Cheville P. J., Karaca‐Mandic A., and Rockson P., “Sg. Lymphedema Prevalence and Treatment Benefits in Cancer: Impact of a Therapeutic Intervention on Health Outcomes and Costs,” PLoS One 9 (2014): e114597. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 71. Johnson A. R., Kimball S., Epstein S., et al., “Lymphedema Incidence After Axillary Lymph Node Dissection: Quantifying the Impact of Radiation and the Lymphatic Microsurgical Preventive Healing Approach,” Annals of Plastic Surgery 82 (2019): S234. [DOI] [PubMed] [Google Scholar]
  • 72. Sakorafas G. H., Peros G., Cataliotti L., and Vlastos G., “Lymphedema Following Axillary Lymph Node Dissection for Breast Cancer,” Surgical Oncology 15 (2006): 153–165. [DOI] [PubMed] [Google Scholar]
  • 73. Golshan M., Martin W. J., and Dowlatshahi K., “Sentinel Lymph Node Biopsy Lowers the Rate of Lymphedema When Compared With Standard Axillary Lymph Node Dissection,” The American SurgeonTM 69 (2003): 209–212. [PubMed] [Google Scholar]
  • 74. Boughey J. C., Hoskin T. L., Cheville A. L., et al., “Risk Factors Associated With Breast Lymphedema,” Annals of Surgical Oncology 21 (2014): 1202–1208. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 75. Gillespie T. C., Sayegh H. E., Brunelle C. L., Daniell K. M., and Taghian A. G., “Breast Cancer‐Related Lymphedema: Risk Factors, Precautionary Measures, and Treatments,” Gland Surgery 7 (2018): 379–403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 76. Paskett E. D., Dean J. A., Oliveri J. M., and Harrop J. P., “Cancer‐Related Lymphedema Risk Factors, Diagnosis, Treatment, and Impact: A Review,” JCO 30 (2012): 3726–3733. [DOI] [PubMed] [Google Scholar]
  • 77. Kilbreath S. L., Refshauge K. M., Beith J. M., et al., “Risk Factors for Lymphoedema in Women With Breast Cancer: A Large Prospective Cohort,” Breast 28 (2016): 29–36. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Appendix 1.

JSO-132-717-s002.docx (14.5KB, docx)

Supplementary Table 1.

JSO-132-717-s001.xlsx (21.1KB, xlsx)

supmat.

JSO-132-717-s003.docx (12KB, docx)

Data Availability Statement

The study was registered on PROPSERO and data is accessible at https://www.crd.york.ac.uk/PROSPERO/ (Record: CRD42025642808). Any additional details regarding the data analysis is available upon request from the authors.

Articles from Journal of Surgical Oncology are provided here courtesy of Wiley

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