Quality of life evaluation and lack of correlation with volumetric results after lymphovenous anastomoses in lymphedema therapy of the lower extremity

Objective: Chronic primary or secondary lymphedema has huge effects on patients' quality of life (QOL) because of the associated swelling and pain, decreased range of motion, and depression and anxiety and generally requires numerous adaptations. Many studies have shown a positive objective effect of lymphovenous anastomoses (LVAs) on chronic lymphedema. In the present study, we assessed the effect of LVAs on QOL in patients with primary or secondary lym-phedema of the lower extremity at 6 months after surgery and examined the correlation between changes in the QOL and volumetric measurements. Methods: Only patients with either primary or secondary lymphedema of the lower extremity who had undergone LVAs were included in the present study. To assess QOL, a specially designed questionnaire based on the Lymphedema Quality of Life Inventory was used to evaluate the subjective therapeutic results from the patients' perspective. Objective therapy success was assessed using three-dimensional volumetric measurements of the lower leg. The measuring points, for both the subjective and the objective measurements, were the day before and 6 months after therapy. Results: The mean change in volume at 6 months after LVA was -6.5% +/- 5.6% (P < .001). Significantly better QOL in terms of physical (37.6% +/- 25.2%) and psychosocial (27.0% +/- 43.0%) domains and practical restrictions (22.3% +/- 24.8%) was found (P < .001 for all). No correlation was found between QOL improvement and volume decrease (P > .05). Conclusions: For patients with lymphedema of the lower extremity, LVAs can lead to a significant volumetric decrease and QOL improvement at 6 months after treatment with no demonstrable relationship between QOL improvement and volume reduction.