Clinical Outcomes Following Lymphaticovenular Anastomosis Combined with Excisional Debulking Surgery for Genital Lymphedema: A Retrospective Observational Study

Abstract

Objective: This study aimed to evaluate the feasibility and clinical efficacy of lymphaticovenular anastomosis (LVA) combined with excisional debulking surgery in the treatment of Genital lymphedema (GL). In addition, we developed and applied a Genital Lymphedema Quality-of-Life Questionnaire (GL-QoL) to comprehensively assess the multidimensional impact of GL on patients' quality of life. Methods: A retrospective analysis was conducted on 20 patients with GL who underwent LVA combined with excisional debulking surgery between December 2023 and December 2025. The cohort included 16 women and 4 men, with a mean age of 54.70 ± 17.92 years. All patients had a history of pelvic or inguinal lymph node dissection and adjuvant radiotherapy. Preoperative assessment included clinical examination, lymphoscintigraphy, and indocyanine green (ICG) lymphography to confirm the diagnosis and evaluate lymphatic drainage patterns. Two to three surgical incisions were performed per patient, and multiple lymphaticovenular anastomoses were created using end-to-end, octopus-style, or sleeve techniques. The GL-QoL questionnaire was administered preoperatively and postoperatively, and differences were analyzed using paired t-tests. Results: All procedures were completed successfully without major perioperative complications. Postoperatively, genital swelling was markedly reduced, lymphorrhea resolved, and the frequency of cellulitis episodes significantly decreased. ICG lymphography demonstrated functional reconstruction of type II subcutaneous lymphatic reflux pathways. Total GL-QoL scores and all subdomains—including urinary function, sexual function, psychosocial impact, and daily activities—showed significant improvement compared with preoperative values (P < 0.001). During a follow-up period of 92–365 days (mean, 276 ± 65.54 days), only one patient experienced recurrence following additional radiotherapy; no other significant recurrences were observed. Representative cases demonstrated substantial improvement in sexual function and pruritus. Conclusion: LVA combined with excisional debulking surgery represents a safe, minimally invasive, and physiologic–anatomic reconstructive strategy for GL. This combined approach reduces fibrotic tissue burden while restoring lymphatic drainage pathways, resulting in sustained symptom relief and significant quality-of-life improvement. The newly developed GL-QoL questionnaire appears to sensitively capture disease burden and therapeutic response. Larger, multicenter studies with longer follow-up are warranted to validate its psychometric properties and confirm long-term outcomes