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J Reconstr Microsurg 2022; 38(07): 539-548
DOI: 10.1055/s-0041-1740132
Original Article

Axilla versus Wrist as the Recipient Site in Vascularized Lymph Node Transfer for Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis

Yehuda Chocron‡   *
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
,
Alain J. Azzi‡   *
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
,
Gabriel Bouhadana 
2   Faculty of Medicine, McGill University, Montreal, Quebec, Canada
,
George Kokosis
3   Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
,
Joshua Vorstenbosch
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
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Abstract

Background Vascularized lymph node transfers (VLNT) are being used with increasing frequency for the treatment of breast cancer-related lymphedema (BCRL). However, there is a lack of consensus in the surgical field as to which recipient site should be utilized. We, therefore, aim to assess the evidence comparing the wrist and axilla as recipient sites for VLNT in BCRL.

Methods We conducted a systematic literature review to compare the wrist and axilla as recipient sites for VLNT in BCRL. Demographic data, as well as circumference reduction rate (CRR), excess volume reduction (EVR), postoperative decrease in infections per year, postoperative discontinuation of compression garments, and overall pooled complication rate were extracted from included studies. These were compared through a meta-analysis.

Results A total of 37 studies met the inclusion criteria for a total of 689 patients. VLNTs to the wrist and axilla resulted in a decrease in CRR of 42.1 and 51.5%, and a decrease in EVR of 35.6 and 48.8%, respectively. However, our meta-analysis showed no significant differences between CRR or EVR and between wrist and axilla as recipient sites. Similarly, we found no differences in postoperative decrease in infections per year, postoperative discontinuation of compression garments, and overall pooled complication rate.

Conclusion These data suggest noninferiority between the wrist and axilla as recipient sites for VLNT in the context of BCRL. In the absence of randomized, prospective data, we hope these results can be used as an evidence-based reference and facilitate future studies.

Keywords

lymphedema - lymph node transfer - breast cancer

* Equal contribution – co-first authors.


Supplementary Material



Publication History

Received: 26 April 2021

Accepted: 26 September 2021

Article published online:
07 December 2021

© 2021. Thieme. All rights reserved.

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