133. Quantifying The Relative Contribution of Conservative Therapy Versus Surgical Debulking in the Outcomes of Lymphedema Patients With Fat Hypertrophy

PURPOSE: Debulking with power-assisted liposuction (PAL) is an effective surgical treatment for fat-dominant lymphedema. Specifying outcomes achieved between conservative management and PAL will more accurately assess the benefits of nonsurgical and surgical treatments for fat-dominant lymphedema. METHODS: A retrospective review of unilateral upper or lower extremity lymphedema patients optimized with compression prior to PAL from January 2018 to January 2024 was performed. Outcome measures including relative limb volume differences (%) and bioimpedance spectroscopy (L-dex) scores were reviewed at baseline, immediate preoperative, and postoperative timepoints. RESULTS: A total of 49 patients met inclusion criteria. Pre-operative conservative management reduced baseline relative limb volume difference in 73% of patients prior to PAL. The median contributions to total relative limb volume reduction were 16% (Q1-Q3: -1% to 37%) from conservative management and 84% (Q1-Q3: 63% to 101%) from surgical PAL. Conservative management reduced the baseline L-dex score in 87% of patients prior to PAL. Conservative management achieved a median reduction of 10.2 points (Q1-Q3: 6.7 to 19.9) from baseline L-dex score, and surgical PAL achieved a median reduction of 6.9 points (Q1-Q3: -5.8 to 26.3) from the last preoperative measurement timepoint. CONCLUSION: Preoperative therapy optimization results in large reductions in relative limb volume difference and L-dex score prior to surgical PAL. Larger improvements in L-dex after therapy versus PAL emphasizes the importance of pre-operative therapy in reducing the fluid component of the disease. Failure to separate outcomes of conservative management from lymphatic procedures can overestimate the outcomes of lymphatic surgery.