Vascularised lymph node transfer and lymphatic growth factors in the treatment of lymphedema

Abstract

Lymphedema is a progressive disease that can significantly deteriorate the quality of life of patients if not treated appropriately. The conventional treatment for lymphedema has been conservative, with the continuous use of compression garments and physiotherapy. My dissertation aims to further assess the possibilities, limitations and proper indications for lymph node transfer surgery in patients with lymphedema.

Lymph node transfer and lymphaticovenous anastomosis have been considered as a possible a cure for lymphedema. Conservative treatment is not intended to be a cure, only for alleviating the symptoms of lymphedema. During lymph node transfer surgery, excess scar tissue from the axillary area of the affected arm is removed, and new immunologically active adipose and lymphatic tissues are transferred to the site to restore the lymphatic environment of the axilla and the lymphatic flow of the affected arm. The transferred lymph nodes function as pumps to further activate the lymph flow.

Lymph node transfer improves the volumetry results of the affected arm, lymphoscintigraphy results, tissue dielectric constant results, and decreases rate of cellulitis infections. Treatment with a specific lymphatic growth factor (adenoviral vascular growth factor C (VEGF-C)) was further assessed in a phase II multicenter prospective study after one year of follow-up. This experimental medicinal treatment showed beneficial results in ameliorating lymphedema, but the results were inconclusive.

Lymph node transfer seems to benefit patients with early stage lymphedema. Lymph node transfer seems to increase the quality of life in lymphedema patients and improve lymphedema symptoms more than clinical measurements would suggest. Patient selection is a key factor for successful lymph node transfer surgery. Lymph node transfer has shown both objective and subjective benefits for lymphedema patients, and it is a possible cure for lymphedema when patient selection is performed properly.