Abstract: A Prospective Evaluation of Health Related Quality of Life in Lymphedema Treatment

Abstract

INTRODUCTION: The vascularized lymph node transfer (VLNT) is one of the flap of choices for lower extremity lymphedema. Although physical rehabilitation is important for lymphedema treatment, there is no standardized procedure for different stage lymphedema. This study was conducted to investigate the long term outcome using VLNT and complete decongestive therapy (CDT) in lymphedema. METHODS: An IRB approved prospective study was performed of patients who underwent vascularized lymph node transfer for symptomatic upper (ULL) or lower limb (LLL) lymphedema. Patients who had either submental or groin VLNT for upper or lower limb lymphedema were included. Outcomes were assessed using improvement of circumference reduction, decreased number of episodes of cellulitis and health related quality of life (HRQoL) metric. RESULTS: A total 138 patients were identified and met the inclusion criteria. Almost equal patients underwent VLN (50.7%) as compared to CDT (49.3%) for lymphedema. Patients’ age, BMI, tobacco use, diabetes, hypertension, lymphedema grading and lymphedema reason were similar between groups (p=0.4; p=0.2; p=0.6, p=0.5, p=0.5, p=0.7, p=0.7, respectively). Circumference reduction was statistically higher in the VLNT group (35.3%) as compared to the CDT group (23.4%); and postoperative episodes of cellulitis was statistically lower in VLN group (1.4 ± 1.3 times per years) compared to CDT group (4 ± 1.5 times per years) at a 12-month of follow up (p= 0.03 and p= 0.04, respectively). In HRQoL part, overall quality of life and function, body appearance, symptom, and mood domains were all significantly improved in the VNL group (p< 0.01 within each domain). CONCLUSION: The vascularized lymph node transfer and complete decongestive therapy and are both valuable treatment options in treating lymphedema with different grading. VLN transferred is much more effective in severe lymphedema (Grade III to IV) in the functional recovery. These functional improvements are mirrored by improvements in patient reported outcomes and quality of life measures. These changes can be seen at a 12- month of follow-up and continued steady improvement can be expected.