Synchronous supraclavicular vascularized lymph node transfer and liposuction for gynecological cancer-related lower extremity lymphedema: A clinical comparative analysis of three different procedures

Abstract

Objective: Gynecological cancer-related lower extremity lymphedema (GC-LEL), a chronic, progressive condition, lacks a standardized treatment. Currently, supraclavicular vascularized lymph node transfer (SC-VLNT) is a favored approach in the treatment of lymphedema, and there is a trend toward combination technology. This study conducts a comparative analysis of three techniques for treating GC-LEL with simultaneous SC-VLNT and liposuction.

Methods: A cohort of 35 patients with GC-LEL was examined, comprising 13 patients who underwent single lymph nodes flap with a skin paddle (SLNF+P), 12 who received single lymph nodes flap without a skin paddle (SLNF), and 10 who accepted dual lymph nodes flap without a skin paddle (DLNF). Patient demographics and outcomes were meticulously documented, covering intra- and postoperative variables.

Results: The median limb volume reduction were 56.4% (SLNF+P), 60.8% (SLNF), and 50.5% (DLNF) in stage II, and 54.0% (SLNF+P), 59.8% (SLNF), and 54.4% (DLNF) in stage III. DLNF group procedures entailed longer flap harvesting and transplantation times. The SLNF+P group, on average, had an 8-day postoperative hospitalization, longer than others. All patients noted subjective improvements in Lymphedema Quality of Life scores, with lymphoscintigraphy revealing enhanced lymphatic flow in 29 of the 35 cases. A notable decrease in cellulitis incidence was observed. Additionally, the occurrence of cellulitis decreased significantly, except for DLNF (Stage Ⅱ). The median follow-up time was 16 months (range, 12-36 months), with no reported severe postoperative complications.

Conclusions: For advanced GC-LEL, SLNF combined with liposuction is a preferred treatment, offering fewer complications, shorter operative time, and hospitalization.

Keywords: Combination therapy; Liposuction; Lower extremity; Lymphedema; Vascularized lymph node.

Fig 1

A and B, Intraoperative and postoperative view of the single lymph nodes flap with a skin paddle (SLNF+P) group. C and D, Intraoperative and postoperative view of the single lymph nodes flap without a skin paddle (SLNF) group. E and F, Intraoperative and postoperative view of the dual lymph nodes flap without a skin paddle (DLNF) group.

Fig 2

A, Preoperative lymphoscintigraphy images display significant obstruction to the right lower extremity superficial lymphatic channels and significant dermal backflow. B, Lymphoscintigraphy demonstrated significant improvement in lymph flow at 12 months postoperatively.

Fig 3

Lymphedema Quality of Life (LYMQOL) scores for three different groups of patients with different stages are shown using median and interquartile spacing. DLNF, Dual lymph nodes flap without a skin paddle; SLNF, single lymph nodes flap without a skin paddle; SLNF+P, single lymph nodes flap with a skin paddle.

Fig 4

Preoperative (top) and postoperative (bottom) pictures of three patients who underwent vascularized lymph node transfer (VLNT) combined with liposuction. A and B, A 55-year-old woman suffered from chronic right lower extremity lymphedema over 4 years. After the single lymph nodes flap with a skin paddle (SLNF+P) with simultaneous liposuction was performed, the patient had significant improvement, function satisfaction, and acceptable appearance at the 28-month follow-up. C and D, A 53-year-old woman had chronic lymphedema of the right lower extremity for 6 months. After single lymph nodes flap without a skin paddle (SLNF) with concomitant liposuction, the patient had a significant reduction in volume and improved quality of life at 12-month follow-up. E and F, A 56-year-old woman suffered from lymphedema in the right lower extremity with two episodes of cellulitis over 2 years. After dual lymph nodes flap without a skin paddle (DLNF) with simultaneous liposuction was performed, the circumferential size of the right lower extremity was significantly reduced at the 14-month follow-up.

Supplementary Fig

Ultrasonography showed three lymph nodes within the flap.