New donor site proposed for lymph node transfer to treat lymphedema

Last Updated: 2017-09-08

By Will Boggs MD

NEW YORK (Reuters Health) - Vascularized lymph node transfer (VLNT) using jejunal mesentery offers a new way to treat extremity lymphedema, according to a preliminary study.

"VLNT should be considered for patients who have been diagnosed with stage 1, 2, or 3 lymphedema and are compliant with their compression therapy," Dr. Roman Skoracki from The Ohio State University, in Columbus, told Reuters Health by email. "In the future, we may find that VLNT may also be an option to prophylactically treat patients at high risk for developing lymphedema at the time of their initial oncologic treatment."

Lymph node removal to treat malignancies is a common cause of extremity lymphedema. VLNT, the transfer of lymph nodes on a vascular pedicle, has been described using donor sites from the omentum, groin, thoracic/axillary, submental, and supraclavicular regions. Each donor site has its own disadvantages.

Dr. Skoracki's team proposed and tested the jejunal mesentery as a novel donor site for VLNT, because there is no risk of subsequent lymphedema, the scar is small and well hidden, multiple clusters of nodes can be harvested simultaneously, and the vascular anatomy is reliable.

After confirming the presence of adequate numbers of lymph nodes in the jejunal mesentery in cadaver dissections, the researchers performed jejunal mesentery VLNT in 15 patients, all but one of whose extremity lymphedema was associated with cancer treatments.

By a mean follow-up of 9.1 months, 12 of 14 patients with viable flaps had subjective improvement and seven had objective improvement (as determined by circumference measurements) in lymphedema, the researchers report in the Journal of the American College of Surgeons, online August 14.

None of the 15 patients experienced donor-site lymphedema, and there were no postoperative episodes of cellulitis. No bowel resections were performed, due to vascular insufficiency to the jejunum.

"Treatment options exist well beyond the traditional conservative management that includes manual lymphatic drainage and external compression garments, wraps, or pumps," Dr. Skoracki said. "These newer surgical interventions, including lymphovenous bypass surgery and vascularized lymph node transfer, offer significant improvement for many patients with existing lymphedema and are showing very promising results for preventing the disease in cancer patients who are at high risk for developing lymphedema as a result of their oncologic care."

"We need to better understand the pathophysiology of lymphedema and the mechanism of action of VLNT," he said. "It is frustrating that, particularly in more-advanced stages of lymphedema, the volume reduction seen with VLNT is less. I would like to see VLNT be 100% effective for all patients with lymphedema."

SOURCE: http://bit.ly/2vKFJmX

J Am Coll Surg 2017.