PDF(Pubmed)
Abstract：
UNASSIGNED: Various surgical treatments are increasingly adopted and gaining popularity for lymphedema treatment. However, challenges persist in selecting appropriate treatment modalities targeted for individual patients and achieving consensus on choice of treatment as well as outcomes. The systematic review aimed to create a treatment algorithm incorporating the latest scientific knowledge, to provide healthcare professionals and patients with a tool for informed decision-making, when selecting between treatments or combining them in a relevant manner. This systematic review evaluated and synthesized the evidence on the effectiveness of three surgical treatments for breast cancer-related lymphedema (BCRL): lymphovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and liposuction.
UNASSIGNED: We conducted a systematic search of electronic databases on 18 June 2023, including Medline, Embase, Cochrane Library, Google Scholar, and ClinicalTrials.org. Eligible studies were randomized controlled trials, non-randomized comparative studies, and observational studies that assessed the outcomes of LVA, VLNT, or liposuction in managing BCRL. The primary results of interest were changes in arm volume, lymphatic flow, and quality of life. Two independent reviewers performed the study selection and data extraction. Following this, we systematically reviewed and conducted a risk of bias assessment. Results were qualitatively presented, and a treatment algorithm was developed based on the available data.
UNASSIGNED: We identified 16,593 papers, after removal of duplicates. Following assessment of studies, 73 articles met the inclusion criteria, including 2,373 patients. We were not able to conduct a meta-analysis due to considerable heterogeneity in the methodologies and outcome measures across the studies. Liposuction appears effective for patients presenting with non-pitting lymphedema. LVA indicates variable success rate, with some evidence indicating a reduction in limb volume and symptomatic relief amongst early stages of lymphedema. VLNT showed promising results for limb volume reduction and symptom improvement in patients presenting with mild and moderate lymphedema.
UNASSIGNED: Liposuction, LVA, and VLNT seem to be effective treatments for BCRL, when targeted for the appropriate patient. Well-conducted high evidence clinical studies in the field are still lacking to uncover the efficacy of surgical treatment for BCRL.
UNASSIGNED: We conducted a systematic search of electronic databases on 18 June 2023, including Medline, Embase, Cochrane Library, Google Scholar, and ClinicalTrials.org. Eligible studies were randomized controlled trials, non-randomized comparative studies, and observational studies that assessed the outcomes of LVA, VLNT, or liposuction in managing BCRL. The primary results of interest were changes in arm volume, lymphatic flow, and quality of life. Two independent reviewers performed the study selection and data extraction. Following this, we systematically reviewed and conducted a risk of bias assessment. Results were qualitatively presented, and a treatment algorithm was developed based on the available data.
UNASSIGNED: We identified 16,593 papers, after removal of duplicates. Following assessment of studies, 73 articles met the inclusion criteria, including 2,373 patients. We were not able to conduct a meta-analysis due to considerable heterogeneity in the methodologies and outcome measures across the studies. Liposuction appears effective for patients presenting with non-pitting lymphedema. LVA indicates variable success rate, with some evidence indicating a reduction in limb volume and symptomatic relief amongst early stages of lymphedema. VLNT showed promising results for limb volume reduction and symptom improvement in patients presenting with mild and moderate lymphedema.
UNASSIGNED: Liposuction, LVA, and VLNT seem to be effective treatments for BCRL, when targeted for the appropriate patient. Well-conducted high evidence clinical studies in the field are still lacking to uncover the efficacy of surgical treatment for BCRL.
摘要：
■淋巴水肿治疗越来越多地被采用和越来越受欢迎。然而,在选择针对个体患者的适当治疗模式以及在治疗选择和结局方面达成共识方面仍然存在挑战.系统评价旨在创建一种融合最新科学知识的治疗算法，为医疗保健专业人员和患者提供明智决策的工具，在治疗之间进行选择或以相关方式组合它们时。这项系统评价并综合了三种手术治疗乳腺癌相关淋巴水肿（BCRL）的有效性的证据：淋巴静脉吻合术（LVA）。血管化淋巴结转移（VLNT），抽脂.
■我们于2023年6月18日对电子数据库进行了系统搜索，包括Medline，Embase,科克伦图书馆,谷歌学者，和ClinicalTrials.org。符合条件的研究是随机对照试验，非随机对照研究，以及评估LVA结果的观察性研究，VLNT,或吸脂术管理BCRL。感兴趣的主要结果是手臂体积的变化，淋巴流动，和生活质量。两名独立的审阅者进行了研究选择和数据提取。在此之后,我们系统回顾并进行了偏倚风险评估.结果被定性地呈现，并根据现有数据开发了治疗算法。
■我们确定了16,593篇论文，删除重复项之后。在评估研究之后，73篇文章符合纳入标准，包括2373名患者。我们无法进行荟萃分析，因为研究中的方法和结果指标存在相当大的异质性。吸脂术对表现为非麻点性淋巴水肿的患者似乎有效。LVA表示可变成功率，一些证据表明，在淋巴水肿的早期阶段，肢体体积减少和症状缓解。VLNT在轻度和中度淋巴水肿患者的肢体体积减少和症状改善方面显示出令人鼓舞的结果。
■吸脂，LVA,VLNT似乎是BCRL的有效治疗方法，当针对合适的患者时。在该领域进行良好的高证据临床研究仍然缺乏揭示BCRL手术治疗的功效。
■我们于2023年6月18日对电子数据库进行了系统搜索，包括Medline，Embase,科克伦图书馆,谷歌学者，和ClinicalTrials.org。符合条件的研究是随机对照试验，非随机对照研究，以及评估LVA结果的观察性研究，VLNT,或吸脂术管理BCRL。感兴趣的主要结果是手臂体积的变化，淋巴流动，和生活质量。两名独立的审阅者进行了研究选择和数据提取。在此之后,我们系统回顾并进行了偏倚风险评估.结果被定性地呈现，并根据现有数据开发了治疗算法。
■我们确定了16,593篇论文，删除重复项之后。在评估研究之后，73篇文章符合纳入标准，包括2373名患者。我们无法进行荟萃分析，因为研究中的方法和结果指标存在相当大的异质性。吸脂术对表现为非麻点性淋巴水肿的患者似乎有效。LVA表示可变成功率，一些证据表明，在淋巴水肿的早期阶段，肢体体积减少和症状缓解。VLNT在轻度和中度淋巴水肿患者的肢体体积减少和症状改善方面显示出令人鼓舞的结果。
■吸脂，LVA,VLNT似乎是BCRL的有效治疗方法，当针对合适的患者时。在该领域进行良好的高证据临床研究仍然缺乏揭示BCRL手术治疗的功效。
