Quality-of-life impact of lymphovenous anastomosis in breast cancer-related lymphedema: A systematic review and meta-analysis

BACKGROUND: Breast cancer-related lymphedema (BCRL) substantially impairs quality of life (QOL) following axillary lymph node dissection (ALND). Lymphovenous anastomosis (LVA) is used for prevention (immediate lymphatic reconstruction, ILR) and treatment of BCRL. This meta-analysis evaluated LVA effectiveness in QOL across both settings. METHODS: Literature search identified 795 studies and 13 met inclusion criteria: 4 (258 ILR + ALND and 400 ALND-only) examined LVA for prevention and 9 (316 patients) evaluated LVA for BCRL treatment. QOL was assessed using different validated questionnaires. Meta-analysis was conducted using random-effects modeling and Hartung-Knapp-Sidik-Jonkman adjustment for conservative confidence intervals. Results are reported as standardized mean differences (SMD) with 95% confidence intervals (CI). RESULTS: ILR + ALND did not show statistically significant QOL benefits compared to ALND-only (SMD 0.77, 95% CI -1.17 to 2.70, p = 0.23) with substantial heterogeneity (I² = 95%), indicating variability in measurement approaches. However, therapeutic LVA for established BCRL demonstrated statistically significant improvement in QOL (SMD 0.86, 95% CI 0.62-1.10, p < 0.0001) with low heterogeneity (I² = 26%, p = 0.16), suggesting consistent benefit. Subgroup analysis by QOL domains demonstrated significantly improved physical function (SMD 1.54, 95% CI 0.38-2.71, p = 0.02) and mental health (SMD 1.03, 95% CI 0.37-1.68, p = 0.01). However, household (p = 0.08), social (p = 0.07), and mobility activities (p = 0.27), did not reach statistical significance. CONCLUSION: Therapeutic LVA significantly improved QOL in patients with BCRL across physical function and mental health domains. In contrast, insufficient evidence exists for prophylactic ILR during ALND on QoL outcomes, limited by few studies, substantial heterogeneity, and inclusion of all ALND patients rather than those who developed lymphedema, potentially obscuring its protective effects.