The clinical significance of lympho-venous anastomoses in malignant disease.

Pedal lymphangiography has revealed lympho-venous anastomoses (LVA) in 62 patients with malignant disease. The LVAs were caused by obstruction of lymph flow and the obstruction was secondary to surgery in 23 patients, abnormal lymph nodes in 16 and a combination of surgery and abnormal nodes in 14. In 16 patients the LVA led to portal radicals giving opacification of the liver. Chest X-ray examination was normal in 41 patients. In 5 patients the initial chest examination was normal, but lung metastases or widening of the mediastinum developed 1-5 years later. Twelve patients had lung metastases or widening of the mediastinum at the time of the diagnosis of LVA. Clinical follow-up was available in 47 patients, of whom 30 died 1-60 months after diagnosis of LVA. It is concluded that the prognosis of a patient with LVA is poor, provided the cause is not a negative lymph dissection or an unrelated surgical procedure. In patients with pathological lymph nodes the presence of LVA indicate an advanced involvement. Relatively few patients with LVA had or developed lung metastases indicating that the biology of the tumor and the patient is more important than LVA to develop lung metastases.