Highlights
- •Lymphoedema is a disabling complication that burdens cancer survivorship.
- •Vascularised lymph node transfer (VLNT) reconstructs lymphatic return.
- •Meta-analysis showed VLNT can reduce limb volume and cellulitis episodes.
- •Extra-abdominal donor sites more effectively reduced limb volumes than intra-abdominal donor sites.
- •Standardised outcome reporting and randomised trials are recommended.
Abstract
Background
Lymphoedema after cancer treatment is a chronic and disabling complication that presents
a significant health care burden during survivorship with limited treatment options.
Vascularised lymph node transfer (VLNT) can reconstruct lymphatic flow to reduce limb
volumes, but limited higher-order evidence exists to support its effectiveness.
Aim
The aim of the study was to systematically review and meta-analyse the effectiveness
of VLNT in reducing upper limb (UL) or lower limb (LL) volume and cellulitis episodes
in patients with cancer treatment–related lymphoedema (CTRL).
Methods
PubMed, Medline (Ovid) and Embase databases were searched between January 1974 and
December 2019. Full-length articles where VLNT was the sole therapeutic procedure
for CTRL, reporting volumetric limb, frequency of infection episodes and/or lymphoedema-specific
quality-of-life data, were included in a random-effects meta-analysis of circumferential
reduction rate (CRR). Methodological quality was assessed using STROBE/CONSORT, and
a novel, lymphoedema-specific scoring tool was used to assess lymphoedema-specific
methodological reporting. Sensitivity analyses on the site of VLNT harvest and recipient
location were performed.
Results
Thirty-one studies (581 patients) were eligible for inclusion. VLNT led to significant
limb volume reductions in UL (above elbow pooled CRRs [CRRP] = 42.7% [95% confidence interval (CI): 36.5–48.8]; below elbow CRRP = 34.1% [95% CI: 33.0–35.1]) and LL (above knee CRRP = 46.8% [95% CI: 43.2–50.4]; below knee CRRP = 54.6% [95% CI: 39.0–70.2]) CTRL. VLNT flaps from extra-abdominal donor sites were
associated with greater volume reductions (CRRP = 49.5% [95% CI: 46.5–52.5]) than those from intra-abdominal donor sites (CRRP = 39.6% [95% CI: 37.2–42.0]) and synchronous autologous breast reconstruction/VLNT
flaps (CRRP = 32.7% [95% CI: 11.1–54.4]) (p < 0.05). VLNT was also found to reduce the mean number
of cellulitis episodes by 2.1 episodes per year (95% CI: −2.7– −1.4) and increased
lymphoedema-specific quality-of-life scores (mean difference in Lymphoedema-Specific
Quality of Life (LYMQOL) “overall domain” = +4.26).
Conclusions
VLNT is effective in reducing excess limb volume and cellulitis episodes in both UL
and LL lymphoedema after cancer treatment. However, significant heterogeneity exists
in outcome reporting, and standardisation of reporting processes is recommended.
Keywords
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Article info
Publication history
Published online: May 20, 2021
Accepted:
February 22,
2021
Received:
February 13,
2021
Identification
Copyright
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