Relapse to Pre-Surgical Condition Following Lymphovenous Anastomosis (LVA): Analysis of Risk Factors in a Cohort of 90 Patients

Summary Background: Secondary lymphedema in breast cancer patients is a debilitating condition that adversely impacts quality of life. Lymphovenous anastomosis (LVA) has shown promising results, but its long-term effectiveness is a subject of ongoing investigation. This study aims to evaluate relapse to a pre-surgical condition and associated risk factors in breast cancer-related lymphedema patients treated with LVA. To our knowledge, this is the first study to analyze lymphedema relapse following LVA, providing valuable insights for managing patient expectations. Methods: Between 2018 and 2023, 90 patients who underwent LVA for breast cancer-related lymphedema at the Department of Plastic and Reconstructive Surgery were included in this retrospective study. We evaluated relapse and potential risk factors, along with changes in limb circumference, subjective improvement, and frequency of infection episodes. Results: Relapse to the pre-surgical condition occurred in 11 patients (12.2%), with a mean time to relapse of 27.4 months post-surgery. Patients with ISL stage III lymphedema (HR 9.88, p < 0.05) and a history of prior infections (HR 3.99, p < 0.05) had a higher incidence of relapse. Two out of three patients without regular use of preoperative compressive therapy experienced relapse (p < 0.05). No significant associations were found between relapse and post-surgery compression therapy, prior radiotherapy, duration of lymphedema, age or body mass index. Conclusions: The low relapse rate suggests that LVA is an effective long-term treatment for breast cancer-related lymphedema. However, an advanced stage lymphedema and history of prior infections in the affected limb may influence LVA’s long-term effectiveness. Further studies are needed to identify additional risk factors for relapse.