Clinical efficacy of vascularized lymph node transfer combined with lymphatico-venous anastomosis in treating unilateral upper limb lymphedema after radical mastectomy for breast cancer

Chen Zongcan; Chen Junzhe; Wu Xiangkui; Xiao Shun'e; Li Hai; Wu Bihua; Deng Chengliang

doi:10.3760/cma.j.cn501225-20250228-00105

Volume 41 Issue 6

Jun. 2025

Turn off MathJax

Article Contents

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2025 > 41(6): 534-542

Chen Zongcan, Chen Junzhe, Wu Xiangkui, et al. Clinical efficacy of vascularized lymph node transfer combined with lymphatico-venous anastomosis in treating unilateral upper limb lymphedema after radical mastectomy for breast cancer[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2025, 41(6): 534-542. Doi: 10.3760/cma.j.cn501225-20250228-00105

Citation:

PDF( 11423 KB)

Clinical efficacy of vascularized lymph node transfer combined with lymphatico-venous anastomosis in treating unilateral upper limb lymphedema after radical mastectomy for breast cancer

doi: 10.3760/cma.j.cn501225-20250228-00105

Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China

Funds:

General Program of National Natural Science Foundation of China 82372541

Regional Science Foundation Project of National Natural Science Foundation of China 82260391

Regional Science Foundation Project of National Natural Science Foundation of China 82360448

More Information

Corresponding author: Deng Chengliang, Email: cheliadeng@sina.com
Received Date: 2025-02-28

Abstract

Abstract

Objective To investigate the clinical efficacy of vascularized lymph node transfer (VLNT) combined with lymphatico-venous anastomosis (LVA) in treating unilateral upper limb lymphedema after radical mastectomy for breast cancer. Methods This study was a retrospective cohort study. Forty female patients aged 35-75 years with unilateral upper limb lymphedema after radical mastectomy for breast cancer who met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University from April 2021 to January 2024. Based on the treatment method, patients were divided into LVA group (18 cases) who underwent LVA treatment only and VLNT+LVA group (22 cases) who underwent VLNT combined with LVA treatment. The volumes of the affected limbs in both groups of patients were measured before treatment and 3, 6, and 12 months after treatment. The differences in affected limb volumes at each time point before and after treatment (i.e., the volume differences of affected limbs at each time point after treatment) were calculated. Analysis of covariance (ANCOVA) was used to control the influence of confounding factors such as baseline data on the volume differences of affected limbs at each time point after treatment. The quality of life was assessed using the Lymphedema Quality of Life Questionnaire before treatment and 12 months after treatment. During the follow-up period, the occurrence of infectious complications in patients of both groups were monitored. Ultrasonography or radionuclide imaging was performed 12 months after treatment to evaluate the survival of lymph nodes in patients in VLNT+LVA group. Results The volume differences of affected limbs in patients in VLNT+LVA group 6 and 12 months after treatment were (521±193) and (694±355) cm³, respectively, which were significantly greater than (377±92) and (452±229) cm³ in LVA group (with mean differences of 144 and 242 cm³, respectively, 95% confidence intervals of 44-244 and 46-438 cm³, respectively, t values of 2.90 and 2.49, respectively, both P values < 0.05). ANCOVA showed that after adjusting for baseline data, the volume difference of affected limb of patients in VLNT+LVA group 6 and 12 months after treatment were significantly greater than those in LVA group (with F values of 6.52 and 5.26, respectively, P < 0.05). Twelve months after treatment, the quality of life scores of patients in LVA group and VLNT+LVA group were 8 (4, 9) and 7 (4, 9), respectively, which were significantly higher than 6 (3, 7) and 5 (2, 7) before treatment (with Z values of -2.97 and -3.46, respectively, both P values < 0.05). However, there was no statistically significant difference in quality of life score of patients between the two groups 12 months after treatment (P > 0.05). During the 12-month post-treatment follow-up, patients in neither group developed infectious complications such as erysipelas, cellulitis, or lymphangitis. Transplanted lymph nodes of patients survived well in VLNT+LVA group 12 months after treatment. Conclusions Compared with LVA alone, VLNT combined with LVA also improves the volume of affected limb and the quality of life of patients with unilateral upper limb lymphedema following radical mastectomy for breast cancer with better mid- and long-term efficacy, which is worthy of clinical promotion.
- Breast neoplasms,
- Upper extremity,
- Lymphedema,
- Microsurgery,
- Quality of life,
- Vascularized lymph node transfer,
- Lymphatico-venous anastomosis

(1) The combined application of vascularized lymph node transfer (VLNT) and lymphatico-venous anastomosis (LVA) exhibited complementary effects in treating unilateral upper limb lymphedema following radical mastectomy for breast cancer. This approach demonstrated superior mid- to long-term outcomes surpassing that of LVA alone, breaking through the bottleneck limitation of diminishing efficacy of LVA alone.
(2) The indocyanine green-methylene blue dual mapping technique was utilized to locate the donor site of lower-limb lymph nodes and reduce the occurrence of iatrogenic lymphedema in the donor site.
(3) This study proposed the theory that elbow compression may enhance "lymph node pump", providing further mechanistic insights into lymphatic drainage optimization.

FullText(HTML)

References(40)

References

[1]	Jørgensen MG, Toyserkani NM, Hansen FG, et al. The impact of lymphedema on health-related quality of life up to 10 years after breast cancer treatment[J]. NPJ Breast Cancer, 2021, 7(1): 70. DOI: 10.1038/s41523-021-00276-y.
[2]	宋达疆, 李赞, 章一新, 等. 带蒂腹直肌肌皮瓣联合游离腹壁下动脉穿支皮瓣及携带髂腹股沟淋巴组织瓣行乳腺癌根治术后乳房再造及上肢淋巴水肿治疗的效果[J]. 中华烧伤杂志, 2020, 36(4): 297-303. DOI: 10.3760/cma.j.cn501120-20190117-00011.
[3]	Huang J, Li J, Li Y, et al. Bibliometric analysis of breast cancer-related lymphedema research trends over the last 2 decades[J]. Front Oncol, 2024, 14: 1360899. DOI: 10.3389/fonc.2024.1360899.
[4]	Shang R, Zhou J, Pan T, et al. Bibliometric and visual analysis of breast cancer-related lymphedema: knowledge structure, research status, and future trends[J]. Medicine (Baltimore), 2025, 104(7): e41510. DOI: 10.1097/MD.0000000000041510.
[5]	Gillespie TC, Sayegh HE, Brunelle CL, et al. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments[J]. Gland Surg, 2018, 7(4): 379-403. DOI: 10.21037/gs.2017.11.04.
[6]	Gilchrist L, Levenhagen K, Davies CC, et al. Effectiveness of complete decongestive therapy for upper extremity breast cancer-related lymphedema: a review of systematic reviews[J]. Med Oncol, 2024, 41(11): 297. DOI: 10.1007/s12032-024-02421-6.
[7]	Thompson B, Gaitatzis K, Janse de Jonge X, et al. Manual lymphatic drainage treatment for lymphedema: a systematic review of the literature[J]. J Cancer Surviv, 2021, 15(2): 244-258. DOI: 10.1007/s11764-020-00928-1.
[8]	AlJindan FK, Lin CY, Cheng MH. Comparison of outcomes between side-to-end and end-to-end lymphovenous anastomoses for early-grade extremity lymphedema[J]. Plast Reconstr Surg, 2019, 144(2): 486-496. DOI: 10.1097/PRS.0000000000005870.
[9]	Seidenstuecker K, Fertsch S, Ghazaleh AA, et al. Improving quality of life after breast cancer: a comparison of two microsurgical treatment options for breast cancer-related lymphedema (BCRL) [J]. Clin Exp Med, 2024, 24(1): 82. DOI: 10.1007/s10238-024-01344-w.
[10]	Drobot D, Zeltzer AA. Surgical treatment of breast cancer related lymphedema-the combined approach: a literature review[J]. Gland Surg, 2023, 12(12): 1746-1759. DOI: 10.21037/gs-23-247.
[11]	Sun F, Hall A, Tighe MP, et al. Perometry versus simulated circumferential tape measurement for the detection of breast cancer-related lymphedema[J]. Breast Cancer Res Treat, 2018, 172(1): 83-91. DOI: 10.1007/s10549-018-4902-z.
[12]	Lo Torto F, Kaciulyte J, Di Meglio F, et al. Orthotopic vascularized lymph node transfer in breast cancer-related lymphedema treatment: functional and life quality outcomes[J]. Microsurgery, 2024, 44(2): e31147. DOI: 10.1002/micr.31147.
[13]	Lim P, Li H, Neoh D, et al. Health-related quality of life measurement tools for lymphedema: a review of the literature[J]. Plast Reconstr Surg Glob Open, 2022, 10(4): e4276. DOI: 10.1097/GOX.0000000000004276.
[14]	Wolfs JAGN, de Joode LGEH, van der Hulst RRWJ, et al. Correlation between patency and clinical improvement after lymphaticovenous anastomosis (LVA) in breast cancer-related lymphedema: 12-month follow-up[J]. Breast Cancer Res Treat, 2020, 179(1): 131-138. DOI: 10.1007/s10549-019-05450-2.
[15]	Qiu SS, Pruimboom THJP, Cornelissen A, et al. Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up[J]. Breast Cancer Res Treat, 2020, 184(1): 173-183. DOI: 10.1007/s10549-020-05839-4.
[16]	Morishima S, Tsukuura R. Comments on "long-term patency of multiple lymphatic-venous anastomoses in cancer-related lymphedema: a single-center observational study"[J]. Microsurgery, 2023, 43(2): 199. DOI: 10.1002/micr.30998.
[17]	Boccardo F, Santori G, Villa G, et al. Long-term patency of multiple lymphatic-venous anastomoses in cancer-related lymphedema: a single center observational study[J]. Microsurgery, 2022, 42(7): 668-676. DOI: 10.1002/micr.30944.
[18]	Winters H, Tielemans HJP, Verhulst AC, et al. The long-term patency of lymphaticovenular anastomosis in breast cancer-related lymphedema[J]. Ann Plast Surg, 2019, 82(2): 196-200. DOI: 10.1097/SAP.0000000000001674.
[19]	Yoshida S, Koshima I, Imai H, et al. Modified intraoperative distal compression method for lymphaticovenous anastomosis with high success and a low venous reflux rates[J]. J Plast Reconstr Aesthet Surg, 2021, 74(9): 2050-2058. DOI: 10.1016/j.bjps.2020.12.103.
[20]	Yang JC. Lymphatic-based lymphosome: a novel hypothesis with clinical implication for supermicrosurgical lymphaticovenous anastomosis[J]. Plast Reconstr Surg Glob Open, 2023, 11(12): e5503. DOI: 10.1097/GOX.0000000000005503.
[21]	Suami H. Anatomical theories of the pathophysiology of cancer-related lymphoedema[J]. Cancers (Basel), 2020, 12(5): 1338. DOI: 10.3390/cancers12051338.
[22]	Suami H, Scaglioni MF. Anatomy of the lymphatic system and the lymphosome concept with reference to lymphedema[J]. Semin Plast Surg, 2018, 32(1): 5-11. DOI: 10.1055/s-0038-1635118.
[23]	Onoda S, Satake T, Kinoshita M. Relationship between lymphaticovenular anastomosis outcomes and the number and types of anastomoses[J]. J Surg Res, 2022, 269: 103-109. DOI: 10.1016/j.jss.2021.08.012.
[24]	Schaverien MV, Badash I, Patel KM, et al. Vascularized lymph node transfer for lymphedema[J]. Semin Plast Surg, 2018, 32(1): 28-35. DOI: 10.1055/s-0038-1632401.
[25]	Ngo QD, Munot S, Mackie H, et al. Vascularized lymph node transfer for patients with breast cancer-related lymphedema can potentially reduce the burden of ongoing conservative management[J]. Lymphat Res Biol, 2020, 18(4): 357-364. DOI: 10.1089/lrb.2019.0048.
[26]	Donahue PMC, MacKenzie A, Filipovic A, et al. Advances in the prevention and treatment of breast cancer-related lymphedema[J]. Breast Cancer Res Treat, 2023, 200(1): 1-14. DOI: 10.1007/s10549-023-06947-7.
[27]	Subramanyam P, Janarthanan R, Palaniswamy SS. Early demonstration of spontaneous perinodal lymphangiogenesis by lymphoscintigraphy after vascularized lymph node transplantation - a pilot study[J]. Indian J Nucl Med, 2022, 37(1): 1-6. DOI: 10.4103/ijnm.ijnm_123_21.
[28]	Kusajima EG, Yamamoto Y, Ishikawa K, et al. Sentinel node restoration by vascularized lymph node transfer in mice[J]. Microsurgery, 2024, 44(1): e30981. DOI: 10.1002/micr.30981.
[29]	Kwiecien GJ, Gharb BB, Tadisina KK, et al. Quantity of lymph nodes in the vascularized lymph node transfer influences its lymphaticovenous drainage[J]. J Reconstr Microsurg, 2018, 34(1): 41-46. DOI: 10.1055/s-0037-1606320.
[30]	Ward J, King I, Monroy-Inglesias M, et al. Limb volume reduction and infection outcomes following vascularized lymph node transfer for cancer treatment-related lymphoedema: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2022, 48(2): e147. DOI: 10.1016/j.ejso.2021.12.286.
[31]	Cheng MH, Chen SC, Henry SL, et al. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes [J]. Plast Reconstr Surg, 2013, 131(6): 1286-1298. DOI: 10.1097/PRS.0b013e31828bd3b3.
[32]	Wei M, Wang L, Wu X, et al. Synchronous supraclavicular vascularized lymph node transfer and liposuction for gynecological cancer-related lower extremity lymphedema: a clinical comparative analysis of three different procedures[J]. J Vasc Surg Venous Lymphat Disord, 2024, 12(5): 101905. DOI: 10.1016/j.jvsv.2024.101905.
[33]	Gould DJ, Mehrara BJ, Neligan P, et al. Lymph node transplantation for the treatment of lymphedema[J]. J Surg Oncol, 2018, 118(5): 736-742. DOI: 10.1002/jso.25180.
[34]	Scaglioni MF, Arvanitakis M, Chen YC, et al. Comprehensive review of vascularized lymph node transfers for lymphedema: outcomes and complications[J]. Microsurgery, 2018, 38(2): 222-229. DOI: 10.1002/micr.30079.
[35]	Di Taranto G, Bolletta A, Chen SH, et al. A prospective study on combined lymphedema surgery: gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy[J]. Microsurgery, 2021, 41(1): 34-43. DOI: 10.1002/micr.30641.
[36]	Yang JC, Wu SC, Hayashi A, et al. Lower limb lymphedema patients can still benefit from supermicrosurgical lymphaticovenous anastomosis (LVA) after vascularized lymph node flap transfer (VLNT) as delayed lymphatic reconstruction-a retrospective cohort study[J]. J Clin Med, 2021, 10(14): 3121. DOI: 10.3390/jcm10143121.
[37]	Garza RM, Beederman M, Chang DW. Physical and functional outcomes of simultaneous vascularized lymph node transplant and lymphovenous bypass in the treatment of lymphedema[J]. Plast Reconstr Surg, 2022, 150(1): 169-180. DOI: 10.1097/PRS.0000000000009247.
[38]	Kappos EA, Fabi A, Halbeisen FS, et al. Vascularized lymph node transfer (VLNT) versus lymphaticovenous anastomosis (LVA) for chronic breast cancer-related lymphedema (BCRL): a retrospective cohort study of effectiveness over time[J]. Breast Cancer Res Treat, 2025, 210(2): 319-327. DOI: 10.1007/s10549-024-07567-5.
[39]	Elia R, Chen HC, Cazzato G, et al. Evaluation of modulation of immunity by lymph node transfer: a preliminary histological evidence in lymphedema patients[J]. Microsurgery, 2024, 44(1): e31123. DOI: 10.1002/micr.31123.
[40]	邓呈亮, 陈君哲, 章一新. 继发性肢体淋巴水肿的外科整合治疗[J/CD]. 中华损伤与修复杂志(电子版), 2024, 19(3): 185-191. DOI: 10.3877/cma.j.issn.1673-9450.2024.03.001.