Lymphaticovenous Anastomosis Does Not Increase Recurrence Risk In Melanoma
Thomas Y. Xia, BS1, Cagri Cakmakoglu, MD2, Grzegorz Kwiecien, MD3, Graham Schwarz, MD2, Brian Gastman, MD2.
1Case Western Reserve University, School of Medicine, Cleveland, OH, USA, 2Cleveland Clinic, Department of Plastic Surgery, Cleveland, OH, USA, 3Mayo Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
Purpose: Following complete lymph node dissection (CLND), prophylactic lymphaticovenous anastomosis (LVA) can be performed to prevent lymphedema in the extremities. One concern with LVA is facilitation of distant cancer metastasis. The purpose of this study was to look the impact of prophylactic LVA on distant-metastasis free survival (DMFS) and relapse-free survival (RFS) times in cutaneous melanoma patients.
Methods: This was a prospective study of patients who underwent CLND with or without LVA between 2012 and 2021. All cases were performed by a single surgeon at a tertiary care center. Patients were excluded if they had microscopic lymphatic disease, stage IV disease before CLND, or follow-up time less than 12 months.
Results: Twenty-three LVA patients were included, along with 22 comparison patients who underwent CLND alone. The groups were similar in age, sex, and cancer stages. Average sizes of metastatic lymph node were 45.91±23.32 mm and 44.54±35.03 mm in the LVA and comparison groups, respectively (p=0.99). There were no differences in DMFS and RFS times between the two groups. 
Conclusion: Prophylactic LVA performed for grossly metastatic melanoma does not negatively impact recurrence risk and cancer-free survival. Our finding is applicable to all cancers that may require CLND during their treatment course.
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