Archives of Plastic Surgery

  • 제50권5호
  • /
  • Pages.514-522
  • /
  • 2023
  • /
  • 2234-6163(pISSN)
  • /
  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
권호 표지
DOI QR코드

DOI QR Code

The Quality of Life after Lymphaticovenous Anastomosis in 118 Lower Limb Lymphedema Patients

  • Jin Geun Kwon (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yeongsong Kim (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Min Young Jang (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hyunsuk Peter Suh (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Changsik John Pak (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Vaughan Keeley (Lymphoedema Service, Royal Derby Hospital) ;
  • Jae Yong Jeon (Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Joon Pio Hong (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2022.10.30
  • 심사 : 2023.06.15
  • 발행 : 2023.09.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background This is a prospective study on 118 patients who underwent lymphaticovenous anastomosis (LVA) due to secondary lower limb lymphedema between January 2018 and October 2020 to evaluate patients' quality of life (QOL) using the Quality of Life Measure for Limb Lymphedema (LYMQoL) questionnaire. Methods The outcome measurement included the LYMQoL leg scoring system tool evaluating the function, appearance, symptom, mood, and overall outcome. In addition, correlation analysis was performed for three factors: based on International Society of Lymphology (ISL) stages, disease duration, and amount of volume reduction. Results The LYMQoL tool overall satisfaction score significantly increased at all intervals from 4.4 ± 0.2 preoperative to 6.5 ± 0.3 postoperative at 12 months (p < 0.001). Significant findings were seen for each domain scores compared preoperatively and at 12 months: function score (18.6 ± 0.5 to 15.4 ± 0.6), appearance score (17.8 ± 0.5 to 16.0 ± 0.6), symptom score (11.8 ± 0.3 to 8.9 ± 0.4), and mood score (14.5 ± 0.4 to 11.4 ± 0.5; p < 0.05). The correlation analysis between improvement of the overall score and the ISL stage (p = 0.610, correlation coefficient [r] = -0.047), disease duration (p = 0.659, r = -0.041), and amount of limb volume reduction (p = 0.454, r = -0.070) showed no statistical significance. Conclusion The QOL of secondary lower limb lymphedema patients was significantly improved after LVA regardless of the severity of disease, duration of disease, and amount of volume reduction after LVA. Understanding the patient-reported outcome measurement will help the surgeons to manage and guide the expectations of the patients.

키워드

과제정보

Special thanks to the Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea for advanced statistical analysis and advices.

참고문헌

  1. Schulze H, Nacke M, Gutenbrunner C, Hadamitzky C. Worldwide assessment of healthcare personnel dealing with lymphoedema. Health Econ Rev 2018;8(01):10 
  2. Grunherz L, Hulla H, Uyulmaz S, Giovanoli P, Lindenblatt N. Patient-reported outcomes following lymph reconstructive surgery in lower limb lymphedema: A systematic review of literature. J Vasc Surg Venous Lymphat Disord 2021;9(03):811-819.e2  https://doi.org/10.1016/j.jvsv.2020.11.022
  3. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer 2010;116(22):5138-5149  https://doi.org/10.1002/cncr.25458
  4. Beederman M, Chang DW. Advances in surgical treatment of lymphedema. Arch Plast Surg 2021;48(06):670-677  https://doi.org/10.5999/aps.2021.01445
  5. Ganz PA. The quality of life after breast cancer-solving the problem of lymphedema. N Engl J Med 1999;340(05):383-385  https://doi.org/10.1056/NEJM199902043400511
  6. Grada AA, Phillips TJ. Lymphedema: pathophysiology and clinical manifestations. J Am Acad Dermatol 2017;77(06):1009-1020  https://doi.org/10.1016/j.jaad.2017.03.022
  7. Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg 2013;132(05):1305-1314  https://doi.org/10.1097/PRS.0b013e3182a4d626
  8. McWayne J, Heiney SP. Psychologic and social sequelae of secondary lymphedema: a review. Cancer 2005;104(03):457-466  https://doi.org/10.1002/cncr.21195
  9. Carter J, Huang HQ, Armer J, et al. GOG 244-The Lymphedema and Gynecologic cancer (LeG) study: the impact of lower-extremity lymphedema on quality of life, psychological adjustment, physical disability, and function. Gynecol Oncol 2021;160(01):244-251  https://doi.org/10.1016/j.ygyno.2020.10.023
  10. Passik SD, McDonald MV. Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer 1998;83(12, suppl American):2817-2820  https://doi.org/10.1002/(SICI)1097-0142(19981215)83:12B+<2817::AID-CNCR32>3.0.CO;2-2
  11. Addington-Hall J, Kalra L. Who should measure quality of life? BMJ 2001;322(7299):1417-1420  https://doi.org/10.1136/bmj.322.7299.1417
  12. Voineskos SH, Nelson JA, Klassen AF, Pusic AL. Measuring patient-reported outcomes: key metrics in reconstructive surgery. Annu Rev Med 2018;69:467-479  https://doi.org/10.1146/annurev-med-060116-022831
  13. Krogsgaard MR, Brodersen J, Christensen KB, et al. What is a PROM and why do we need it? Scand J Med Sci Sports 2021;31(05):967-971  https://doi.org/10.1111/sms.13892
  14. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009;124(02):345-353  https://doi.org/10.1097/PRS.0b013e3181aee807
  15. Santosa KB, Qi J, Kim HM, Hamill JB, Wilkins EG, Pusic AL. Longterm patient-reported outcomes in postmastectomy breast reconstruction. JAMA Surg 2018;153(10):891-899  https://doi.org/10.1001/jamasurg.2018.1677
  16. Keeley VCSLJ, Veigas D, Riches K, Hilliam R. A quality of life measure for limb lymphoedema (LYMQOL). J Lymphoedema 2010;5:26-37 
  17. Salgarello M, Mangialardi ML, Pino V, Gentileschi S, Visconti G. A prospective evaluation of health-related quality of life following lymphaticovenular anastomosis for upper and lower extremities lymphedema. J Reconstr Microsurg 2018;34(09):701-707  https://doi.org/10.1055/s-0038-1642623
  18. Cheng MH, Loh CYY, Lin CY. Outcomes of vascularized lymph node transfer and lymphovenous anastomosis for treatment of primary lymphedema. Plast Reconstr Surg Glob Open 2018;6(12):e2056 
  19. Cornelissen AJM, Kool M, Lopez Penha TR, et al. Lymphaticovenous anastomosis as treatment for breast cancer-related lymphedema: a prospective study on quality of life. Breast Cancer Res Treat 2017;163(02):281-286  https://doi.org/10.1007/s10549-017-4180-1
  20. Bullinger M, Alonso J, Apolone G, et al. Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment. J Clin Epidemiol 1998;51(11):913-923  https://doi.org/10.1016/S0895-4356(98)00082-1
  21. Wedin M, Fredrikson M, Ahlner E, et al. Validation of the Lymphoedema Quality of Life Questionnaire (LYMQOL) in Swedish cancer patients. Acta Oncol 2020;59(03):365-371  https://doi.org/10.1080/0284186X.2019.1701199
  22. Cha HG, Oh TM, Cho MJ, et al. Changing the paradigm: lymphovenous anastomosis in advanced stage lower extremity lymphedema. Plast Reconstr Surg 2021;147(01):199-207  https://doi.org/10.1097/PRS.0000000000007507
  23. Pereira N, Lee YH, Suh Y, et al. Cumulative experience in lymphovenous anastomosis for lymphedema treatment: the learning curve effect on the overall outcome. J Reconstr Microsurg 2018;34(09):735-741  https://doi.org/10.1055/s-0038-1648220
  24. Kwon JG, Hong DW, Suh HP, Pak CJ, Hong JP. Patient-specific surgical options for breast cancer-related lymphedema: technical tips. Arch Plast Surg 2021;48(03):246-253  https://doi.org/10.5999/aps.2020.02432
  25. Cho MJ, Kwon JG, Pak CJ, Suh HP, Hong JP. The role of duplex ultrasound in microsurgical reconstruction: review and technical considerations. J Reconstr Microsurg 2020;36(07):514-521  https://doi.org/10.1055/s-0040-1709479
  26. Kwon JG, Jeong S, Pak CJ, Suh HP, Hong JP. Comparative analysis between side-to-end and end-to-end lymphaticovenous anastomosis for secondary lower limb lymphedema. Plast Reconstr Surg 2022;150(05):1138-1148  https://doi.org/10.1097/PRS.0000000000009647
  27. Coriddi M, Dayan J, Sobti N, et al. Systematic review of patient-reported outcomes following surgical treatment of lymphedema. Cancers (Basel) 2020;12(03):565 
  28. Janse AJ, Gemke RJ, Uiterwaal CS, van der Tweel I, Kimpen JL, Sinnema G. Quality of life: patients and doctors don't always agree: a meta-analysis. J Clin Epidemiol 2004;57(07):653-661  https://doi.org/10.1016/j.jclinepi.2003.11.013
  29. Sitzia J, Sobrido L. Measurement of health-related quality of life of patients receiving conservative treatment for limb lymphoedema using the Nottingham Health Profile. Qual Life Res 1997;6(05):373-384  https://doi.org/10.1023/A:1018487411186
  30. Weiss JM, Spray BJ. The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema. Lymphology 2002;35(02):46-58 
  31. Kim SJ, Park YD. Effects of complex decongestive physiotherapy on the oedema and the quality of life of lower unilateral lymphoedema following treatment for gynecological cancer. Eur J Cancer Care (Engl) 2008;17(05):463-468  https://doi.org/10.1111/j.1365-2354.2007.00877.x
  32. Lee HS, Bae YC, Nam SB, Yi CR, Yoon JA, Kim JH. The relationship between lymphedema severity and awareness of lymphedema surgery. Arch Plast Surg 2021;48(05):534-542 https://doi.org/10.5999/aps.2020.02215