Donor-site Safety in Microvascular Lymph Node Transfer for Breast Cancer-Related Lymphedema Using Reverse Lymphatic Mapping- A Prospective Study

Abstract

BackgroundVascularized lymph node transfer (VLNT) is one option among other surgical treatments in the management of breast cancer-related lymphedema (BCRL). The cause of concern regarding VLNT harvested from the groin has been the potential development of secondary lower-extremity lymphedema. This study explored the risk of donor-site morbidity following groin VLNT, with or without concomitant breast reconstruction. MethodThe cohort comprised data from the Lymfactin® Phase I and II trials during 2016–2019, using perioperative reverse lymphatic mapping. The volume of the lower extremities was measured preoperative and at 3, 6, and 12 months postoperative, and adverse events were documented during study visits. ResultsAltogether, 51 women with a mean age of 55.5 years were recruited. The mean duration of BCRL was 31.8 months. Of these, 25 (49%) underwent VLNT (VLNT-group) and 26 (51%) underwent VLNT in combination with breast reconstruction (VLNT-BR group). The groups were similar in terms of age (p=0.766), BMI (p=0.316), and duration of BCRL (p=0.994). Across one year, the volume difference between the lower extremities changed by 22.6ml (ranging from -813 to 860.2ml) (p=0.067). None of the patients had a lower-extremity volume difference exceeding 10% at the 12-month follow-up visit. The most frequent adverse events were postoperative pain (17.7%), wound healing issues (11.8%), and seroma formation (11.8%). Most adverse events (64.6%) were classified as minor. ConclusionsThis prospective study demonstrated that groin VLNT with reverse lymphatic mapping appears safe and does not increase the risk of secondary donor-site lymphedema within one year postoperatively.