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    The content on this page is not current guidance and is only for the purposes of the consultation process.

    Lymphovenous anastomosis during axillary or inguinal node dissection for preventing secondary lymphoedema

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    1 Draft recommendations

    1.1 For people with breast cancer, lymphovenous anastomosis during axillary dissection for preventing secondary lymphoedema should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

    1.2 Clinicians wanting to do lymphovenous anastomosis during axillary node dissection for preventing secondary lymphoedema in people with breast cancer should:

    • Inform the clinical governance leads in their healthcare organisation.

    • Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.

    • Take account of NICE's advice on shared decision making, including NICE's information for the public.

    • Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).

    • Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

    1.3 Healthcare organisations should:

    • Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.

    • Regularly review data on outcomes and safety for this procedure.

    1.4 For auditing the outcomes of this procedure, the main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).

    1.5 Patient selection should be done by a multidisciplinary team experienced in managing the condition.

    1.6 The procedure should only be done by a multidisciplinary team experienced with it, including a surgeon with specific training in microvascular surgery.

    1.7 For people with other cancers, lymphovenous anastomosis during axillary or inguinal node dissection for preventing secondary lymphoedema should be used only in research. Find out what only in research means on the NICE interventional procedures guidance page.

    1.8 Further research should report details of:

    • patient selection

    • quality of life

    • longer-term outcomes for lymphoedema incidence in different conditions

    • limb volume

    • safety outcomes (including survival and metastatic cancer).

    Why the committee made these recommendations

    Evidence from clinical trials and observational studies suggests that the procedure reduces the risk of lymphoedema after axillary node dissection in people with breast cancer. It also suggests that there are no major safety concerns. While there are some limitations in the evidence, including a lack of quality-of-life data and long-term follow up, overall, it is considered adequate.

    The evidence for the procedure's efficacy in other cancers (that is, lower limb cancers and malignant melanoma) is more limited. Also, there are some safety concerns about the risk of the cancer spreading after lymphatic vessels around the dissected lymph nodes have been rediverted to nearby veins.