Liposuction for the treatment of chronic lymphoedema

Topic Status Complete

Liposuction for the treatment of chronic lymphoedema

Outcome of the appraisal

 

The use of liposuction for the treatment of chronic lymphoedema is promising, however current evidence does not support its routine adoption in Wales.

The available evidence indicates that the use of liposuction leads to a significant medium-term reduction in limb oedema volume and an improvement in quality of life for people with upper and lower limb lymphoedema, but little evidence is available for its use in craniofacial lymphoedema.

Health economic assessment estimates that liposuction in addition to standard care for the treatment of upper limb lymphoedema is unlikely to be cost-effective, with an ICER of £26,269 per QALY gained when compared to standard care alone. There is greater uncertainty, however, around the cost-effectiveness of liposuction to treat lower limb or craniofacial lymphoedema.

Health Technology Wales strongly recommends the acquisition of real-world evidence on the effectiveness, patient experience, and patient outcomes of liposuction for chronic lymphoedema, particularly in people with lower limb lymphoedema.

Why was this topic appraised?

 

Chronic lymphoedema refers to the abnormal accumulation of protein-rich fluid in tissue, leading to swelling, and affects more than 450,000 people in the UK. It is caused by an impairment in the lymphatic system which may occur either due to abnormal development or trauma. Lymphoedema primarily manifests in the upper and lower extremities, leading to pain, decreased range of movement and an increase in the risk of skin infections in the affected area. For people with lymphoedema that has not responded to non-surgical management or alternative debulking surgeries, liposuction may be considered as a treatment option.

Liposuction is a procedure which removes excess body fat using a cannula and an aspirator under negative pressure. Liposuction can be provided in conjunction with standard care, which comprises conservative self-management and behavioural interventions, including compression garments, skin care education, lifestyle management and specialised massage.

This topic was informed by NICE interventional procedures guidance (IPG) 723: ‘Liposuction for chronic lymphoedema’

Plain language summary

 

Lymphoedema is a condition where fluid builds up in limbs and causes them to swell. It most commonly affects the arms or legs, but can also occur in the chest wall, abdomen, neck and face. The fluid is usually drained by the lymphatic system, but this process can go wrong if the lymphatic system is damaged (secondary lymphoedema) or faulty from birth (primary lymphoedema).

The current standard of treatment for lymphoedema is called ‘decongestive lymphatic therapy’. There are four parts to this treatment. Patients must:

  • Wear compression bandages
  • Maintain good skin care
  • Take part in exercises – to use muscles in the affected limb and improve fluid drainage
  • Use specialised massage techniques – known as manual lymphatic drainage (MLD)

This is an intensive therapy that asks a lot from patients. If any part of the therapy isn’t done properly, then it won’t be as successful in reducing the swelling.

Liposuction is traditionally a procedure used to remove unwanted body fat. For people with Lymphoedema, it is proposed that liposuction can be used to drain the extra fluid from the swollen limb.

HTW looked for evidence on the use of liposuction for lymphoedema. The use of liposuction for the treatment of chronic lymphoedema is promising, however current evidence does not support its routine adoption in Wales.

Topic Exploration Report

TER427 11.2022

Evidence Appraisal Review

EAR056 01.2024

Guidance

GUI056 01.2024

GUI
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