Abstract
Secondary lymphedema is a frequent long-term complication following cancer treatment. Although several surgical options exist, lymph node-to-vein anastomosis (LNVA) has recently gained renewed attention as a potential treatment for secondary lymphedema. This systematic review aimed to evaluate the current evidence regarding the efficacy of LNVA in the treatment of secondary lymphedema. A literature search was conducted on November 10, 2025, in Embase, MEDLINE, the Cochrane Library, and Google Scholar. ClinicalTrials.gov and the International Clinical Trials Registry Platform were also screened for ongoing studies. Studies reporting outcomes after LNVA in patients with secondary lymphedema were included. Two independent reviewers performed study screening and data extraction. Risk of bias was assessed using ROBINS-I and the JBI Critical Appraisal Checklist for Case Series, and the certainty of evidence was evaluated using GRADE. Three studies met the inclusion criteria: two retrospective cohort studies and one case series. Across studies, LNVA was associated with modest reductions in limb circumference and partial symptom relief in some patients. However, all studies demonstrated serious or high risk of bias, and the overall certainty of evidence was rated as very low. Current evidence supporting LNVA for secondary lymphedema is limited and of low methodological quality. Well-designed prospective studies are required to determine the true clinical value of LNVA.