Sex, age, and body mass index as predictors of lymphovenous anastomosis and vascularized lymph node transfer outcomes: A multicenter cohort study.

BACKGROUND: Lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) are established techniques that are used to treat lymphedema. However, the extent to which patient characteristics influence long-term treatment response remains insufficiently studied. Consequently, we examined associations of sex, age, and body mass index (BMI) with long-term outcomes after LVA and VLNT to inform clinical decision-making. METHODS: A prospectively maintained, multicenter lymphedema database was reviewed for patients who underwent unilateral LVA or VLNT for chronic extremity lymphedema between January 1, 2016, and December 31, 2025. Limb circumferences were recorded preoperatively and at standardized postoperative follow-up visits. Treatment response was quantified using the relative excess reduction rate. Postoperative complications were graded according to the Clavien-Dindo classification. RESULTS: In lower extremity lymphedema, male patients showed significantly greater treatment response at 12 and 24 months after LVA and 12 months after VLNT. Higher BMI was associated with less favorable response following upper extremity VLNT at 12 and 18 months, whereas no consistent BMI effects were observed in the lower extremity. Furthermore, age showed no consistent effect. Neither variable significantly influenced the postoperative complication rates. CONCLUSIONS: Male patients with lower extremity lymphedema may demonstrate superior treatment responses compared to female patients. However, high BMI was associated with poorer response following upper extremity VLNT, thereby underlining the importance of preoperative weight loss. Age showed no consistent association with postoperative outcomes. However, future research is required to validate these preliminary results.