Staged surgical treatment of extremity lymphedema with dual gastroepiploic vascularized lymph node transfers followed by suction-assisted lipectomy-A prospective study

Mouchammed Agko, Pedro Ciudad, Hung-Chi Chen

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Both physiologic and excisional procedures have been described for the treatment of lymphedema. However, there exist few reports that combine these procedures. The objective of this study was to evaluate the effectiveness of combining vascularized lymph node transfer (VLNT) with suction-assisted lipectomy (SAL) in a staged manner for the treatment of extremity lymphedema.

METHODS: Patients with unilateral late stage II lymphedema (International Society of Lymphology), who consented to staged surgical treatment, were evaluated prospectively. Between 2014 and 2015, 12 female patients with upper (n = 6) or lower (n = 6) extremity lymphedema completed the treatment protocol. Primary outcomes evaluated included limb size and number of infectious episodes. In addition, compression garment usage was analyzed.

RESULTS: The overall circumference reduction rate was on average 37.9% after VLNT and increased to 96.4% after SAL. While all patients had experienced at least one infectious episode prior to surgical treatment, only one patient did so after VLNT and none after SAL. All patients were able to eventually discontinue compression therapy.

CONCLUSION: VLNT followed by SAL can allow patients with late Stage II lymphedema achieve near normal limb size and eradication of infectious episodes. At follow-up, these desirable outcomes were maintained well after discontinuation of compression therapy.

Original languageEnglish (US)
Pages (from-to)1148-1156
Number of pages9
JournalJournal of Surgical Oncology
Volume117
Issue number6
DOIs
StatePublished - May 2018
Externally publishedYes

Fingerprint

Lipectomy
Lymphedema
Extremities
Lymph Nodes
Prospective Studies
Therapeutics
Clothing
Clinical Protocols

Keywords

  • Abdomen/surgery
  • Adult
  • Aged
  • Extremities/surgery
  • Female
  • Follow-Up Studies
  • Gastroepiploic Artery
  • Humans
  • Lipectomy/methods
  • Lymph Nodes/blood supply
  • Lymphedema/surgery
  • Middle Aged
  • Postoperative Complications/surgery
  • Prognosis
  • Prospective Studies
  • Suction

Cite this

@article{d31ea3f0f0f54a0cb19e72ecac813e1f,
title = "Staged surgical treatment of extremity lymphedema with dual gastroepiploic vascularized lymph node transfers followed by suction-assisted lipectomy-A prospective study",
abstract = "BACKGROUND: Both physiologic and excisional procedures have been described for the treatment of lymphedema. However, there exist few reports that combine these procedures. The objective of this study was to evaluate the effectiveness of combining vascularized lymph node transfer (VLNT) with suction-assisted lipectomy (SAL) in a staged manner for the treatment of extremity lymphedema.METHODS: Patients with unilateral late stage II lymphedema (International Society of Lymphology), who consented to staged surgical treatment, were evaluated prospectively. Between 2014 and 2015, 12 female patients with upper (n = 6) or lower (n = 6) extremity lymphedema completed the treatment protocol. Primary outcomes evaluated included limb size and number of infectious episodes. In addition, compression garment usage was analyzed.RESULTS: The overall circumference reduction rate was on average 37.9{\%} after VLNT and increased to 96.4{\%} after SAL. While all patients had experienced at least one infectious episode prior to surgical treatment, only one patient did so after VLNT and none after SAL. All patients were able to eventually discontinue compression therapy.CONCLUSION: VLNT followed by SAL can allow patients with late Stage II lymphedema achieve near normal limb size and eradication of infectious episodes. At follow-up, these desirable outcomes were maintained well after discontinuation of compression therapy.",
keywords = "Abdomen/surgery, Adult, Aged, Extremities/surgery, Female, Follow-Up Studies, Gastroepiploic Artery, Humans, Lipectomy/methods, Lymph Nodes/blood supply, Lymphedema/surgery, Middle Aged, Postoperative Complications/surgery, Prognosis, Prospective Studies, Suction",
author = "Mouchammed Agko and Pedro Ciudad and Hung-Chi Chen",
note = "{\circledC} 2018 Wiley Periodicals, Inc.",
year = "2018",
month = "5",
doi = "10.1002/jso.24969",
language = "English (US)",
volume = "117",
pages = "1148--1156",
journal = "Journal of Surgical Oncology",
issn = "0022-4790",
publisher = "Wiley-Liss Inc.",
number = "6",

}

TY - JOUR

T1 - Staged surgical treatment of extremity lymphedema with dual gastroepiploic vascularized lymph node transfers followed by suction-assisted lipectomy-A prospective study

AU - Agko, Mouchammed

AU - Ciudad, Pedro

AU - Chen, Hung-Chi

N1 - © 2018 Wiley Periodicals, Inc.

PY - 2018/5

Y1 - 2018/5

N2 - BACKGROUND: Both physiologic and excisional procedures have been described for the treatment of lymphedema. However, there exist few reports that combine these procedures. The objective of this study was to evaluate the effectiveness of combining vascularized lymph node transfer (VLNT) with suction-assisted lipectomy (SAL) in a staged manner for the treatment of extremity lymphedema.METHODS: Patients with unilateral late stage II lymphedema (International Society of Lymphology), who consented to staged surgical treatment, were evaluated prospectively. Between 2014 and 2015, 12 female patients with upper (n = 6) or lower (n = 6) extremity lymphedema completed the treatment protocol. Primary outcomes evaluated included limb size and number of infectious episodes. In addition, compression garment usage was analyzed.RESULTS: The overall circumference reduction rate was on average 37.9% after VLNT and increased to 96.4% after SAL. While all patients had experienced at least one infectious episode prior to surgical treatment, only one patient did so after VLNT and none after SAL. All patients were able to eventually discontinue compression therapy.CONCLUSION: VLNT followed by SAL can allow patients with late Stage II lymphedema achieve near normal limb size and eradication of infectious episodes. At follow-up, these desirable outcomes were maintained well after discontinuation of compression therapy.

AB - BACKGROUND: Both physiologic and excisional procedures have been described for the treatment of lymphedema. However, there exist few reports that combine these procedures. The objective of this study was to evaluate the effectiveness of combining vascularized lymph node transfer (VLNT) with suction-assisted lipectomy (SAL) in a staged manner for the treatment of extremity lymphedema.METHODS: Patients with unilateral late stage II lymphedema (International Society of Lymphology), who consented to staged surgical treatment, were evaluated prospectively. Between 2014 and 2015, 12 female patients with upper (n = 6) or lower (n = 6) extremity lymphedema completed the treatment protocol. Primary outcomes evaluated included limb size and number of infectious episodes. In addition, compression garment usage was analyzed.RESULTS: The overall circumference reduction rate was on average 37.9% after VLNT and increased to 96.4% after SAL. While all patients had experienced at least one infectious episode prior to surgical treatment, only one patient did so after VLNT and none after SAL. All patients were able to eventually discontinue compression therapy.CONCLUSION: VLNT followed by SAL can allow patients with late Stage II lymphedema achieve near normal limb size and eradication of infectious episodes. At follow-up, these desirable outcomes were maintained well after discontinuation of compression therapy.

KW - Abdomen/surgery

KW - Adult

KW - Aged

KW - Extremities/surgery

KW - Female

KW - Follow-Up Studies

KW - Gastroepiploic Artery

KW - Humans

KW - Lipectomy/methods

KW - Lymph Nodes/blood supply

KW - Lymphedema/surgery

KW - Middle Aged

KW - Postoperative Complications/surgery

KW - Prognosis

KW - Prospective Studies

KW - Suction

U2 - 10.1002/jso.24969

DO - 10.1002/jso.24969

M3 - Article

VL - 117

SP - 1148

EP - 1156

JO - Journal of Surgical Oncology

JF - Journal of Surgical Oncology

SN - 0022-4790

IS - 6

ER -