Omental Lymph Node Transfer for Lymphedema Patients: A Systematic Review

Abstract

Lymph node transfer is a surgical treatment that is becoming more prevalent. The lymph nodes from the groin and neck are most frequently used. Iatrogenic lymphedema can be a consequence of the dissection of the groin nodes; thus, some surgeons prefer to use the neck as a donor site. Literature reporting surgical algorithms for the treatment of lymphedema is scarce. Thus, we conducted a systematic review of vascularized omentum lymph node transfer (VOLT) in patients with lymphedema to provide more information about this increasingly common procedure. We hypothesize that the analyzed studies will show that VOLT has positive outcomes. Two reviewers (G.J.C., D.B.) performed independent searches using the PubMed database without timeframe limitations initially through title and abstract descriptions and then by full-text review. The search was done using the following keywords: Breast cancer lymphedema OR lymphedema AND lymph node transfer OR lymph node flap OR lymph node graft AND omental OR omentum OR gastroepiploic. Eligibility criteria included publications evaluating patients with lymphedema in the upper extremity and lower extremity, who underwent VOLT. Our search yielded 35 potential papers in the literature, but only six studies fulfilled the study eligibility criteria. The total number of patients was 137. Three studies described single VOLT, two studies described double VOLT and one study described two cohort patients, one that was treated with single VOLT and another one that was treated with double VOLT. Postoperative reduction of arm circumference, arm volume, and symptoms of the upper extremity were reported in all patients. Nonetheless, in one study, seven patients did not notice any extremity circumference reduction during the follow-up period and four patients noticed an increase in arm volume. Flap loss was reported by two authors in a total of two patients. Overall, patients experienced successful lymphedema treatment with VOLT. All authors presented results with reduced circumferential size of the affected upper and lower limbs, as well as reduction of the infectious intercurrences, such as cellulitis, with a small incidence of associated complications.

Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review

“…19 The combination of recent advancements in laparoscopic technique and the advantageous lymphatics and vasculature of the omentum have made it a safe alternative to the more commonly used inguinal, supraclavicular, submental, and lateral thoracic sites. 3,15,16 However, intra-abdominal harvest comes with risks of visceral injury and incisional hernia. 26 Therefore, donor site selection must account for the potential benefits and risks of each site.…”

“…Lymphedema is a progressively debilitating disease process that results from the accumulation of protein‐rich interstitial fluid from insufficient or impaired lymphatic system function (Figure 1 ). 1 , 2 , 3 Further characterization is defined by the etiology of the disease, with primary lymphedema being a result of congenital abnormalities in the lymphatic system and secondary lymphedema being a result of injury, disease, or iatrogenic processes causing lymphatic dysfunction. 2 In developed countries, the most common cause of lymphedema is cancer and related treatment (eg, radiation, lymph node dissection).…”

“…15,16 While the success of VOLT in the treatment of lymphedema has been reported previously, several questions remain. 3 For example, appropriate application of VOLT, proper patient selection, and harvest technique have not yet been clearly identified. Further, the specific role of VOLT in upper extremity lymphedema is of interest.…”

Operative Therapiemöglichkeiten in der Lymphologie

“…Auch bei der Empfänger-Lokalisation existieren verschiedene angewandte Verfahren. Die Lymphknotenpakete können sowohl an der Defektstelle eingesetzt werden, um die geschädigten oder entfernten Lymphknoten zu ersetzen, oder peripher, wo sie als "Pumpe" fungieren und die Lymphe an der Stelle der größten Ansammlung mobilisieren [21]. Ciudad et al beschreiben den kombinierten Einsatz des lymphatischen Lappens im Zentrum der Extremität und am distalen Ende, um die Pumpfunktion an mehreren Stellen nutzen zu können und die Lymphangiogenese so breit wie möglich anzuregen [22].…”

Lymphedema: Conventional to Cutting Edge Treatment

“…Various donor sites have been described for harvesting of vascularized lymph node flaps, including the inguinal, thoracic, submental, supraclavicular, mesenteric, and omental lymph node basins. [43][44][45][46][47][48] Each of these flaps have their own advantages and disadvantages. The donor site is typically chosen based on surgeon preference, scar location, risks of donor site lymphedema, and the amount of lymphatic tissue required.…”