Gastroepiploic Vascularized Lymph Node Transfer For The Treatment Of Extremity Lymphedema: Comparison Between Middle And Distal Inset
Samyd S. Bustos, M.D.1, Trishul Kapoor, M.D.1, Jason Lin, B.S.1, Pedro Ciudad, M.D., Ph.D.2, Antonio J. Forte, M.D., Ph.D., M.S.3, Gabriel Del Corral, M.D., F.A.C.S.4, Maria Mani, M.D., Ph.D.5, Michele Maruccia, M.D.6, Andre Terzic, M.D., Ph.D.1, Oscar J. Manrique, M.D., F.A.C.S.1.
1Mayo Clinic, Rochester, MN, USA, 2Arzobispo Loayza National Hospital, Lima, Peru, 3Mayo Clinic, Jacksonville, FL, USA, 4Georgetown University Hospital, Washington, DC, USA, 5Uppsala Universitet, Uppsala, Sweden, 6University of Bari Aldo Moro, Bari, Italy.
PURPOSE: Middle and distal insets of gastroepiploic vascularized lymph node transfer (GE-VLNT) for extremity lymphedema have been described. However, there has been no prior comparison of surgical or patient-reported outcomes between these techniques. We analyzed the outcomes between both insets in patients with extremity lymphedema.
Retrospective review of patients with extremity-lymphedema who underwent GE-VLNT. Two groups were analyzed: middle and distal recipient inset. We analyzed 6-month surgical and patient-reported outcomes using the Lymphedema Life Impact Scale-v2 (LLISv2) and scar satisfaction utilizing the Patient Scar Assessment Questionnaire (PSAQ).
RESULTS: Between 2017 and 2019, 26 patients with stage II unilateral extremity lymphedema underwent laparoscopically-harvested GE-VLNT (13 distal and 13 middle inset). There were no differences in patient demographics between groups. Mean hospital stay for patients with upper extremity lymphedema was 1.3 vs. 4 days (p<0.05), and for lower extremity lymphedema was 1 vs. 4.5 days (p<0.05), middle vs. distal inset respectively. Mean return to daily activities for patients with upper extremity lymphedema was 13.4 vs. 33.4 days (p<0.05), and for lower extremity lymphedema was 16 vs. 29.5 days (p<0.05), middle vs. distal inset respectively. Both middle and distal inset showed significant mean excess volume reduction at 6 months postoperatively for both upper and lower extremity lymphedema (upper extremity: middle inset 23.3%, distal inset: 22%; lower extremity: middle inset 23.3% and distal inset 13.3%). LLISv2 scores showed improved functional outcomes postoperatively in both upper and lower extremity lymphedema with both insets. Scar satisfaction with appearance and symptoms was higher with middle inset (p<0.05).
CONCLUSION: GE-VLNT is an effective surgical treatment for extremity lymphedema. The middle placement showed shorter hospital stay, early return to work and higher patient satisfaction.
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