Artikel
Efficacy and safety assessment of lymphovenous anastomosis in patients with primary and secondary lymphoedema: a systematic review
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Autoren
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Katharina Rosian
- Ludwig Boltzmann Gesellschaft, Ludwig Boltzmann Institute for Health Technology Assessment, Österreich
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Michal Stanak
- Ludwig Boltzmann Gesellschaft, Ludwig Boltzmann Institute for Health Technology Assessment, Österreich; University of Vienna, Faculty of Philosophy and Education, Österreich
| Veröffentlicht: | 20. März 2019 |
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Gliederung
Text
Background/research question: Lymphoedema is a chronic, progressive, and debilitating condition caused by an affected lymphatic system that needs appropriate management. Supermicrosurgical techniques such as lymphovenous anastomosis (LVA) have gained popularity because of its minimal invasiveness, better aesthetic outcome, and lower costs in comparison to physical medicine.
This systematic review aims to evaluate the clinical effectiveness and safety of LVA in comparison to conservative or other surgical treatments (e.g., vascularized supraclavicular lymph node transfer [VSLNT]) for patients with primary or secondary lymphoedema concerning pain, functionality, quality of life (QoL), recurrence, and complications.
Methods: A systematic literature search was performed in 4 databases in December 2017. We applied a methodological framework based on the EUnetHTA Core Model®. According to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) scheme, we synthesised the data on each selected outcome category. The studies were systematically assessed for risk of bias (RoB) using the Risk of Bias Assessment tool for Non-randomized controlled Studies (RoBANS) and the Institute of Health Economics (IHE) Risk of Bias checklist for case series.
Results: A total of 629 citations were identified. After applying the inclusion criteria, 5 studies were assessed eligible for inclusion (1 non-randomized controlled trial [NRCT] and 4 prospective studies). Across the studies, 217 patients were enrolled, of which 204 patients were treated with LVA and 13 with VSLNT. Due to the methodological shortcomings of the available evidence (moderate to high RoB and a very low strength of evidence), no conclusions can be made about the effectiveness of the procedure. LVA might be a safe technique for patients with primary and secondary lymphoedema – particularly because no serious complications were reported.
Conclusions: New study results based on high-quality RCTs will potentially influence the effect estimate considerably, especially on QoL. Furthermore, LVA may have a role in the prevention of lymphoedema.
Competing interests: None.
References
- 1.
- Rosian K, Stanak M. Lymphovenous anastomoses in patients with primary and secondary lymphoedema - Decision Support Document No. 110. Vienna: Ludwig Boltzmann Institute for Health Technology Assessment; 2018.
