Vascularized lymph node transfer (VLNT) versus lymphaticovenous anastomosis (LVA) for chronic breast cancer-related lymphedema (BCRL): a retrospective cohort study of effectiveness over time.

Autor: Kappos EA; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland. elisabeth.kappos@usb.ch.; Faculty of Medicine, University of Basel, Basel, Switzerland. elisabeth.kappos@usb.ch.; Breast Center, University Hospital of Basel, Basel, Switzerland. elisabeth.kappos@usb.ch., Fabi A; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.; Faculty of Medicine, University of Zurich, Zurich, Switzerland., Halbeisen FS; Surgical Outcome Research Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland., Abu-Ghazaleh A; Department of Plastic, Reconstructive and Aesthetic Surgery, Sana Hospital Düsseldorf, Düsseldorf, Germany., Stoffel J; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.; Faculty of Medicine, University of Basel, Basel, Switzerland., Aufmesser-Freyhardt B; Department of Plastic, Reconstructive and Aesthetic Surgery, Sana Hospital Düsseldorf, Düsseldorf, Germany., Bukowiecki J; Department of Plastic, Reconstructive and Aesthetic Surgery, Sana Hospital Düsseldorf, Düsseldorf, Germany.; Faculty of Health, University Witten-Herdecke, Witten, Germany., Handschin TM; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.; Faculty of Medicine, University of Basel, Basel, Switzerland., Andree C; Department of Plastic, Reconstructive and Aesthetic Surgery, Sana Hospital Düsseldorf, Düsseldorf, Germany., Haug MD; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.; Faculty of Medicine, University of Basel, Basel, Switzerland., Schaefer DJ; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.; Faculty of Medicine, University of Basel, Basel, Switzerland., Fertsch S; Department of Plastic, Reconstructive and Aesthetic Surgery, Sana Hospital Düsseldorf, Düsseldorf, Germany.; Faculty of Health, University Witten-Herdecke, Witten, Germany., Seidenstücker K; Department of Plastic, Reconstructive and Aesthetic Surgery, Sana Hospital Düsseldorf, Düsseldorf, Germany.; Breast Center, University Hospital Düsseldorf, Düsseldorf, Germany.
Jazyk: angličtina
Zdroj: Breast cancer research and treatment [Breast Cancer Res Treat] 2024 Dec 10. Date of Electronic Publication: 2024 Dec 10.
DOI: 10.1007/s10549-024-07567-5
Abstrakt: Purpose: Microsurgical reconstruction, including vascularized lymph node transfer (VLNT) and lymphaticovenous anastomosis (LVA), have emerged as promising treatment options for chronic breast cancer-related lymphedema (BCRL). Despite their clinical relevance, the precise timelines for patient improvement following these interventions remain rather unexplored. Therefore, the goal of this study was to compare the long-term outcomes and improvement patterns over time of VLNT versus LVA to lay open potential differences and aid in personalized counseling of future patients.
Methods: A prospectively maintained, encrypted database was analyzed for patients with chronic BCRL treated with either VLNT or LVA with a minimum follow-up of one year. Patient-specific variables, such as body weight and circumferential arm measurements at distinct locations on both arms were documented preoperatively and on regular postoperative outpatient follow-ups.
Results: This study comprised 112 patients, of which 107 patients fully completed the one-year follow-up period. Both VLNT and LVA achieved significant arm size reductions. LVA showed an early peak in effectiveness within the first three months, followed by a subsequent decrease and eventual stabilization. Contrarily, VLNT exhibited a distinct pattern with two significant peaks at three and eighteen months.
Conclusions: VLNT and LVA are both effective in long-term lymphedema management, yet they demonstrate marked differences in the timing of improvement. VLNT shows a delayed but more durable response, in contrast to the greater but shorter-lasting surge in effectiveness achieved by LVA. Interestingly, VLNT demonstrates an earlier onset of therapeutic impact than previously understood.
Competing Interests: Declarations. Conflict of interests: The authors declare no competing interests. Ethics approval: This study was conducted in accordance with the principles of the Declaration of Helsinki and was granted ethics approval by the local ethics committee “Ethikkommission Nordwest und Zentralschweiz EKNZ” (BASEC-ID: 2020–01307). The study has been registered in the publicly accessible ClinicalTrials.gov registry (Registration Number: NCT06374745). Consent to participate: All participants gave informed consent before inclusion in this study. Consent to publish: Not applicable.
(© 2024. The Author(s).)
Databáze: MEDLINE
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