Key finding

Surgical treatment of both primary and secondary lymphedema using vascularized lymph node transplantation (VLNT) resulted in significant progressive reduction in limb volume (upper and lower), decreased episodes of cellulitis, and improvements in life impact scores.

Study summary

This was a single-center study of 134 patients who had undergone VLNT for advanced stage lymphedema. The vast majority of cases had occurred secondary to cancer and treatment with surgery, chemotherapy, radiation, or a combination. All the patients had been prehabilitated for 3 months with compression, referred to a nutritionist for a body mass index >40 kg/m2, and treated for recurrent cellulitis. A variety of flaps were used and individualized to the patients. At 2 years after VLNT, 90.2% of patients had experienced significant limb volume reduction and >90% had improvement in one or more quality of life measures.

Commentary

Patients with lymphedema represent some of the saddest and most depressed persons we see. The condition might not be well managed or managed consistently, and referral centers can be scarce or cost prohibitive. Cellulitis is a frequent occurrence and can worsen the condition, representing most of the hospitalizations and associated healthcare costs. I would like to see data on VLNT for persons with non–cancer-related lymphedema. Is this procedure even covered by third-party payers or is it considered experimental or investigational? Even a proportion of limb reduction could significantly improve quality of life. VLNT could offer hope.

Article InfoPublication HistoryJ Surg Oncol 2022;125:603-614.Identification

DOI: https://doi.org/10.1016/j.jvsv.2022.04.003

Copyright

© 2022 Published by Elsevier Inc.

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