Advances in surgical management of chronic lymphedema: current strategies and future directions

Lymphedema is a chronic condition caused by the accumulation of protein-rich fluid in the interstitial tissue, resulting in edema and a diminished quality of life. When first-line treatments like complete decongestive therapy (CDT) fail, surgical options are considered. These include physiological procedures like lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), which aim to restore lymphatic function, as well as reductive procedures such as liposuction and excisional techniques, which reduce limb volume. Previous studies have evaluated these surgeries, but the literature remains scattered. This rapid review consolidates current research on surgical treatments for lymphedema. We reviewed the PubMed database and included systematic reviews, meta-analyses, randomized clinical trials, and literature reviews published between 2014 and 2024. Studies were selected if they reported outcomes such as objective volume reduction, patient-reported quality of life (QOL), or infection rates. Nineteen publications were selected for review. The most common procedures represented were LVA (N = 12) and VLNT (N = 10), though reductive operations such as liposuction and radical excision were also represented. Both LVA and VLNT, either alone or combined, demonstrated positive outcomes in terms of volume reduction, QOL, and infection prevention. Reductive surgeries were effective in reducing long-term volume but had less favorable cosmetic outcomes and variable infection rates. Overall, while surgical approaches have proven beneficial, the variability in outcome measures and inconsistent follow-up periods limit comparability across studies. Further research is needed to better guide patients in selecting the most appropriate surgical option based on their lymphedema characteristics and personal goals.