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Autologous Lymph Node Transfer: Does It Work?
Constance M. Chen, MD, MPH1, Joshua Levine, MD1, Julie Vasile, MD1, Corinne Becker, MD2.
1New York Eye & Ear Infirmary, New York, NY, USA, 2University Hospital Pompidou, Paris, France.
PURPOSE: Over the last several years, there has been interest in a surgical treatment for lymphedema. Both upper and lower extremity lymphedema, whether primary or secondary, is disfiguring and painful, and can cause enduring physical, emotional, social and economic problems. One potential surgical solution, autologous lymph node transfer (ALNT), has been performed for more than 20 years, but little data has been published on the efficacy of this procedure. To test the effectiveness of ALNT for chronic lymphedema, we collected pre- and post-surgical anthropometric data.
METHODS: A prospective study of chronic recalcitrant lymphedema patients treated with ALNTs was performed. Twenty-eight patients with upper extremity lymphedema, lower extremity lymphedema, primary lymphedema, or secondary lymphedema were enrolled from 2011- 2012. All patients had exhausted conservative treatment including complete decongestive therapy (CDT). Successful revascularization of all ALNT flaps was confirmed intraoperatively with use of the SPY imaging device. Patient characteristics analyzed included age, body mass index (BMI), previous episodes of cellulitis, and iatrogenic causes of disease. The affected and unaffected limb was measured preoperatively and postoperatively using circumferential tape measurements. The difference in preoperative and postoperative measurements between the affected limb was compared and graphed. This was calculated using the following formula: (postoperative measurement - preoperative measurement)/preoperative measurement) * 100 = % change. Preoperative and postoperative photographs were also taken to document visual outcomes.
RESULTS: From 2011-2012, 28 consecutive ALNTs were performed for treatment of chronic recalcitrant lymphedema. Mean follow-up time was 5.5 months (range 2-17 months). Of the 28 ALNTs, there were 13 ALNTs performed for upper extremity lymphedema (46.4%), 15 ALNTs for lower extremity lymphedema (53.5%), 3 ALNTs for primary lymphedema (10.7%), 20 ALNTs for secondary lymphedema (71.4%), and 5 ALNT for lymphedema of unknown etiology (17.9%). The mean age was 51.8 years (range 28-65 years). The mean BMI was 28.4 (range 18.2-51.4). Of the 28 ALNTs, 6 patients had experienced previous bouts of cellulitis due to their lymphedema (21.4%). The average postoperative reduction in extremity circumference was 7.3% (range 5.6-9.9%).
CONCLUSION: In order to better understand the effectiveness ALNT, we objectively quantified pre- and postoperative anthropometric extremity measurements. While the ultimate goal of ALNT for treatment of lymphedema is the complete resolution of lymphedema obviating the need for compression garments and/or lymphedema therapy, this goal was not realized during the mean follow-up period of 5.5 months; however patients did experience an average 7.3% reduction in extremity circumference. Longer-term follow-up will be necessary to determine the efficacy of ALNT.
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