A Prospective Evaluation of Lymphedema-Specific Quality of Life Outcomes Following Vascularized Lymph Node Transfer
Ketan M. Patel, M.D, Ming-Huei Cheng, MD, FACS.
Chang Gung Memorial Hospital, Taipei, Taiwan.
Surgical options for the treatment of extremity lymphedema are continuing to expand. Now, microsurgical treatment involving vascularized lymph node (VLN) transfer techniques have gained rapid popularity. Despite published studies investigating outcomes related to surgical success, limited studies have investigated the influence of microsurgical treatment on health related quality of life (HRQoL) parameters. Therefore, the purpose of this study was to prospectively evaluate the changes to HRQoL following VLN transfer for upper and lower extremity lymphedema using a validated instrument.
An IRB-approved review of a prospective database was performed for patients who presented for surgery related to symptomatic upper (ULL) or lower limb (LLL) lymphedema. Patients who underwent vascularized lymph node (VLN) transfer were isolated. Patient demographics and operative details were reviewed. A validated lymphedema-specific questionnaire, LYMQOL, was utilized to assess overall quality of life and four quality of life domains; function, appearance, symptoms, and mood. Questionnaires were administered at 7 time points; pre-operatively, and 1, 3, 6, 9, 12, and 24 months post-operatively. For comparison of HRQoL metrics, limb circumference measurements were used to calculate and assess circumference differentiation. An a priori value of 0.05 was considered statistically significant.
Fifty-eight patients met criteria for study inclusion. Within this group, 28 patients (48.3%) underwent VLN transfer for ULL, while 30 patients (51.7%) underwent surgery for LLL. Average age and BMI were 55.2 years and 26.4 kg/m2. Most patients were female (98.3%). Post-surgical lymphedema was the most common etiology (91.4%), while congenital conditions comprised the remaining cases (8.6%). On limb circumference analysis, significant improvements following VLN transfer were found as soon as 1 month post-operatively (p<0.01) with continued and steady improvement during the study period (p<0.01 at all post-operative time points). These improvements were mirrored by improvements in all HRQoL domains as well as overall quality of life. Function, body appearance, symptom, and mood domains were all significantly improved by 1 month post-operatively (p<0.01), with continued improvement throughout the study period (p<0.01 at all post-operative time points). Within the domain groups, greatest improvements were seen in the function and body appearance domains.
Microsurgical treatment of lymphedema with vascularized lymph node transfer procedures is effective at decreasing limb circumference. The improvements in limb circumference are mirrored by improvements in patient-reported outcomes and quality of life measures. These changes can be seen as soon as one month post-operatively and continued steady improvement can be expected.
Back to Program