4 Efficacy

4 Efficacy

This section describes efficacy outcomes from the published literature that the committee considered as part of the evidence about this procedure. For more detailed information on the evidence, see the interventional procedure overview.

4.1 In a case series of 146 patients treated by liposuction for primary or secondary lymphoedema, postoperative limb excess volume was statistically significantly reduced to 3% (from 20% at baseline) in the upper limb group (p<0.001) and to 3% (from 21% at baseline) in the lower limb group (p<0.01), at 12‑month follow-up. In a systematic review and meta-analysis of 105 patients from 4 studies, excess volume reduction at 12- to 38‑month follow-up was 97% (95% confidence interval 86.24 to 107.02; I2=0%) in patients treated by liposuction on the upper limb. In a case series of 60 women treated by liposuction, excess volume was 75 ml (±35 ml) at 1 month after surgery, −26 ml (±40 ml) at 3 months, –133 ml (±40 ml) at 6 months and −213 ml (±35 ml) at 1 year, from baseline values of 1,365 ml (±73 ml). In a case series of 15 patients (12 women, 3 men) treated by liposuction, mean volume reduction of the treated limb was 73% (48% to 94%), at the end of the 3‑year follow-up. In a case series of 88 patients treated by liposuction, median volume difference between the affected and unaffected limb was 761 ml (−147 ml to 1,554 ml) from baseline measurements of 3,686 ml (2,851 ml to 5,121 ml) in patients with primary lymphoedema, and −38 ml (−1,151 ml to 1,135 ml) from baseline values of 3,320 ml (2,533 ml to 4,783 ml) in patients with secondary lymphoedema. The same study reported that men with primary lymphoedema had a statistically significantly greater volume reduction than women (median 1,629 ml versus 275 ml, p<0.001). In a case series of 15 patients (14 women, 1 man) with chronic lymphoedema treated by liposuction, average reduction in oedema volume was 1,095 ml (−4,319 ml to 1,058 ml, 8%). In the same case series, average reduction in limb circumference size was 3.0 cm (−6.3 cm to 0.6 cm, 7%) at 1‑year follow-up.

4.2 In the case series of 15 patients (14 women, 1 man), recurrent lymphoedema was reported in 32% (7/22) of patients' limbs at 1‑year follow-up.

4.3 In a case series of 80 patients, mean blood loss as a percentage of the total aspirate was smaller in the group in which a tourniquet and adrenaline were used (100 ml, 5%) than in the group treated with a tourniquet and no adrenaline (225 ml, 13%; no p value reported).

4.4 In the case series of 146 patients, limbs were immediately softer after the procedure, and redness, hyperkeratosis and papillomatosis were alleviated.

4.5 In the case series of 88 patients treated by liposuction, the rate of cellulitis was statistically significantly reduced from 8 (per limb per year) at baseline to 0.2 in the patients with primary lymphoedema and from 6 to 0.3 in the secondary lymphoedema group, at 24‑month follow-up. In a case series of 130 patients there was a statistically significant reduction (87%, p<0.001) in the rate of erysipelas from 0.47 bouts/year before liposuction (range 0 to 5, standard deviation [SD] 0.8; 76 patients, 534 episodes over 1,147 person years) to 0.06 bouts/year after liposuction (range 0 to 3, SD 0.3; 16 patients, 60 episodes over 983 person years.

4.6 In the case series of 146 patients treated by liposuction, 11% (16/146) of patients were able to completely eliminate the use of compression garment at 1‑year follow‑up.

4.7 In the systematic review and meta-analysis of 105 patients, 3 studies reported improved wellbeing, decreased depression and anxiety at 12- to 38‑month follow-up after liposuction. In the case series of 60 women treated by liposuction, quality of life measured by Short Form 36 (SF‑36, 0=worse possible level of functioning to 100=best possible level of functioning) was statistically significantly increased from baseline values for the physical (to 45±1.2 from 43±1.3, p=0.03) and mental component scores (to 52±1.2 from 49±1.3, p=0.01). The same study reported that at 3‑month follow-up, the physical functioning, bodily pain, mental health and vitality dimensions were statistically significantly improved from baseline assessment (p<0.05); this remained true at 12‑month follow-up, and social functioning was also statistically significantly improved from baseline assessment, p<0.05.

4.8 The specialist adviser listed return of the swollen (lymphoedema) limb to normal size as the key efficacy outcome.

  • National Institute for Health and Care Excellence (NICE)