Synchronous Supraclavicular Vascularized Lymph Node Transfer and Liposuction for Gynecological Cancer-Related Lower Extremity Lymphedema: A Clinical Comparative Analysis of Three Different Procedures

Abstract

Gynecological cancer-related lower extremity lymphedema (GC-LEL), a chronic, progressive condition, lacks a standardized treatment. Currently, Supraclavicular vascularized lymph node transfer (SC-VLNT) is a favoured approach in the treatment of lymphedema, and there is a trend toward combination technology. This study conducts a comparative analysis of three techniques for treating GC-LEL with simultaneous SC-VLNT and liposuction. A cohort of 35 patients with GC-LEL was examined, comprising thirteen patients underwent single lymph nodes flap with a skin paddle (SLNF+P), twelve received single lymph nodes flap without a skin paddle (SLNF), and ten accepted dual lymph nodes flap without a skin paddle (DLNF). Patient demographics and outcomes were meticulously documented, covering intra- and post-operative variables. The median limb volume reduction were 56.4% (SLNF+P), 60.8% (SLNF), and 50.5% (DLNF) in stage II, and 54.0% (SLNF+P), 59.8% (SLNF), and 54.4% (DLNF) in stage III. DLNF group procedures entailed longer flap harvesting and transplantation times. The SLNF+P group, on average, had an 8-day postoperative hospitalization, longer than others. All patient noted subjective improvements in Lymphedema Quality of Life (LYMQOL) scores, with lymphoscintigraphy revealing enhanced lymphatic flow in 29 of the 35 cases. A notable decrease in cellulitis incidence was observed. Additionally, the occurrence of cellulitis decreased significantly, except for DLNF (Stage Ⅱ). The median follow-up time was 16 months (range, 12 to 36 months), with no reported severe postoperative complications. For advanced GC-LEL, SLNF combined with liposuction is a preferred treatment, offering fewer complications, shorter operative time, and hospitalization.