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    Overview

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    Efficacy summary

    Limb volume

    In a meta-analysis of 2 studies, 25 people who had liposuction and controlled compression therapy had a statistically significant 63.95% (95% CI: 49.57 to 78.33%) greater reduction in limb volume compared with 23 people who had controlled compression therapy only at a follow up of 12 months. Furthermore, 46 people who had liposuction and controlled compression therapy had a statistically significantly greater reduction in their lymphoedema volume of 895.81 ml (95% CI: -1,140.63 to -650.98 ml) more than 23 people who had controlled compression therapy only at a follow up of 12 months (Chang, 2021).

    Limb excess volume

    In a meta-analysis of 2 studies, 163 people who had liposuction and compression therapy had a statistically significant reduction in excess limb volume of 26.59% (95% CI: 18.64 to 34.54%) at a follow up of 9 to 12 months (depending on study) compared with before surgery assessment. Furthermore, in a meta-analysis of 6 studies, 256 people who had liposuction and compression therapy had a statistically significant reduction in excess limb volume of 1,524.93 ml (95% CI: 748.84 to 2,301.01 ml) at a follow up of 12 to 24 months (depending on study) compared with before surgery assessment (Chang, 2021).

    A before-and-after study of 105 people reported a statistically significant decrease in excess arm volume from before surgery assessment to 2 weeks after surgery (p<0.0001) which was maintained to 5 years. The before surgery mean excess volume was 1,573 ml (SD 645 ml; range 570 to 3,520 ml). At 6 months follow up, the excess volume was ‑51 ml (SD 273 ml; range ‑760 to 730 ml) (Hoffner, 2018).

    A before-and-after study of 130 people reported a statistically significant decrease in excess arm volume of 1,607 ml (range 570 to 3,950 ml, SD 707 ml) at before surgery assessment to ‑43 ml (range ‑945 to 1,390 ml, SD 379 ml) at 6 months follow up (p<0.001). This reduction persisted throughout the follow up period, to a maximum of 18 years (Lee, 2016).

    A before-and-after study of 69 people reported a decrease in mean leg excess volume from 4,372 ml (range 229 to 15,166 ml) before surgery to 1,005 ml (range 1,987 to 5,613 ml) at 3 months follow up. No test of statistical significance was reported. This reduction in leg excess volume was maintained to 9 years follow up (Stewart, 2018).

    A before-and-after study of 23 people with arm lymphoedema reported, using circumferential measurements, a statistically significant decrease in the excess arm volume from a median of 799 ml (IQR 638 to 1,125 ml) before surgery to 60 ml (IQR -76 to 202 ml) at 1 month follow up (p<0.002). This excess reduction was maintained throughout the 12-month follow-up period. Similar results were obtained using perometry. Additionally, 18 people with leg lymphoedema reported, using circumferential measurements, a statistically significant decrease in the excess leg volume from a median of 3,355 ml (IQR 2,843 to 5,428 ml) before surgery to 710 ml (IQR 116 to 1,450 ml) at 1 month follow up (p<0.001). This excess reduction was maintained throughout the 12-month follow-up period. Similar results were obtained using perometry (Granoff, 2020).

    A before-and-after study of 15 people reported a mean reduction in excess extremity volume of 73% (range 48 to 94%) from before surgery assessment to a follow-up of 3.1 years. No test of statistical significance was reported (Greene, 2016).

    QoL

    Disease-specific QoL

    In a systematic review, 5 studies (115 people) were identified that assessed the QoL of people with lymphoedema having liposuction compared with before surgery data or with control using disease-specific QoL instruments. Four of these studies found that people had statistically significantly improved QoL after liposuction as measured by at least 1 instrument. One study reported improved QoL, but statistical significance was not reported (Tang, 2021).

    The before-and-after study of 23 people with arm lymphoedema reported an increase in score on the Lymphoedema Quality of Life (LYMQOL) instrument from 6.5 before surgery to 8.3 at an average follow up of 8.0 months (28% increase). Additionally, 18 people with leg lymphoedema reported an increase in score on the LYMQOL from 5.9 before surgery to 8.5 at an average follow-up of 9.1 months (44% increase). The LYMQOL is scored on a scale from 0 (poor QoL) to 10 (excellent QoL) (Granoff, 2020).

    General QoL

    In the systematic review, 4 studies (127 people) were identified that assessed the QoL of people with lymphoedema having liposuction either compared with before surgery data or with control using generic QoL instruments. One of these studies found that people had statistically significantly improved QoL after liposuction. Four studies reported improved aspects of QoL, but statistical significance was not reported (Tang, 2021).

    Cellulitis/erysipelas reduction

    The systematic review and meta-analysis identified 1 case series of 10 people that reported on the before and after surgery prevalence of cellulitis. The prevalence of severe cellulitis was statistically significantly reduced from 70% (7/10 people) before surgery compared with 10% (1/10 people) after surgery (OR: 21.00; 95% CI: 1.78 to 248.10) (Chang, 2021).

    The before-and-after study of 130 people reported a statistically significant reduction in the incidence of erysipelas from 0.47 bouts per year (range 0 to 5, SD 0.8) before surgery, to 0.06 bouts per year after surgery (87% reduction, p<0.001) (Lee, 2016).

    The before-and-after study of 69 people reported 3 cases of cellulitis over a follow-up period of up to 9 years. Before surgery, 21 people had cases of cellulitis. No test of statistical significance was reported (Stewart, 2018).

    The before-and-after study of 39 people reported 2 episodes of cellulitis in the follow-up period (0.07 episodes per year). A total of 92 episodes of cellulitis were reported before surgery (0.26 episodes per year). No test of statistical significance was reported (Granoff, 2020).