Outcomes analysis of microsurgical physiologic lymphatic procedures for the upper extremity from the United States National Surgical Quality Improvement Program

Abstract

Introduction Physiologic microsurgical procedures to treat lymphedema include vascularized lymph node transfer (VLNT) and lymphovenous bypass (LVB). The purpose of this study was to assess 30‐day outcomes of VLNT and LVB using the National Surgical Quality Improvement Program (NSQIP) database. Methods NSQIP was queried (2012–2018) for lymphatic procedures for upper extremity lymphedema after mastectomy. Prophylactic lymphatic procedures and those for lower extremity lymphedema were excluded. Outcomes were assessed for three groups: LVB, VLNT, and patients who had procedures simultaneously (VLNA+LVB). Primary outcomes measured were operative time, 30‐day morbidities, and hospital length of stay. Results The study included 199 patients who had LVB (n = 43), VLNT (n = 145), or VLNT+LVB (n = 11). There was no difference in co‐morbidities between the groups (p = 0.26). 30‐day complication rates including unplanned reoperation (6.9% VLNT vs. 2.3% LVB) and readmission (0.69% VLNT vs. none in LVB) were not statistically significant (p = 0.54). Surgical site infection, wound complications, deep vein thromboembolism, and cardiac arrest was also similar among the three groups. Postoperative length of stay for VLNT (2.5 days± 2.3), LVB (1.9 days± 1.9), and VLNT+LVB (2.8 days± 0.3) did not differ significantly (p = 0.20). Operative time for LVB (305.4 min ± 186.7), VLNT (254 min ± 164.4), and VLNT+LVB (295.3 min ± 43.2) was not significantly different (p = 0.21). Conclusions Our analysis of the NSQIP data revealed that VLNT and LVB are procedures with no significant difference in perioperative morbidity. Our results support that choice of VLNT versus LVB can be justifiably made per the surgeon's preference and experience as the operations have similar complication rates.

MRI of Lymphedema

“…2). 17 Physiologic procedures such as vascularized lymph node transfer and lymphovenous bypass are aimed at correcting the underlying disease process. These techniques are particularly useful for patients with earlier‐staged lymphedema, as they rely on identifiable and functional lymphatic vessels prior to adipose hypertrophy and fibrosis.…”

Evaluating Operative Times for Intraoperative Conversion of Axillary Node Biopsy to Axillary Lymph Node Dissection with Immediate Lymphatic Reconstruction

“…3 The inflammation resulting in fibroadipose deposition renders the disease difficult to treat. 4 5 6 7 8 9 10 An approach to prevent lymphedema during axillary dissection, termed immediate lymphatic reconstruction (ILR), is performed by anastomosis of disrupted afferent lymphatics to nearby axillary or thoracodorsal veins. 2 Lymphedema rates following ILR have been reported to be reduced to as low as 4% compared with 30% of patients following ALND.…”