[Clinical efficacy of vascularized lymph node transfer combined with lymphatico-venous anastomosis in treating unilateral upper limb lymphedema after radical mastectomy for breast cancer].

Objective: To investigate the clinical efficacy of vascularized lymph node transfer (VLNT) combined with lymphatico-venous anastomosis (LVA) in treating unilateral upper limb lymphedema after radical mastectomy for breast cancer. Methods: This study was a retrospective cohort study. Forty female patients aged 35-75 years with unilateral upper limb lymphedema after radical mastectomy for breast cancer who met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University from April 2021 to January 2024. Based on the treatment method, patients were divided into LVA group (18 cases) who underwent LVA treatment only and VLNT+LVA group (22 cases) who underwent VLNT combined with LVA treatment. The volumes of the affected limbs in both groups of patients were measured before treatment and 3, 6, and 12 months after treatment. The differences in affected limb volumes at each time point before and after treatment (i.e., the volume differences of affected limbs at each time point after treatment) were calculated. Analysis of covariance (ANCOVA) was used to control the influence of confounding factors such as baseline data on the volume differences of affected limbs at each time point after treatment. The quality of life was assessed using the Lymphedema Quality of Life Questionnaire before treatment and 12 months after treatment. During the follow-up period, the occurrence of infectious complications in patients of both groups were monitored. Ultrasonography or radionuclide imaging was performed 12 months after treatment to evaluate the survival of lymph nodes in patients in VLNT+LVA group. Results: The volume differences of affected limbs in patients in VLNT+LVA group 6 and 12 months after treatment were (521±193) and (694±355) cm³, respectively, which were significantly greater than (377±92) and (452±229) cm³ in LVA group (with mean differences of 144 and 242 cm³, respectively, 95% confidence intervals of 44-244 and 46-438 cm³, respectively, t values of 2.90 and 2.49, respectively, both P values <0.05). ANCOVA showed that after adjusting for baseline data, the volume difference of affected limb of patients in VLNT+LVA group 6 and 12 months after treatment were significantly greater than those in LVA group (with F values of 6.52 and 5.26, respectively, P<0.05). Twelve months after treatment, the quality of life scores of patients in LVA group and VLNT+LVA group were 8 (4, 9) and 7 (4, 9), respectively, which were significantly higher than 6 (3, 7) and 5 (2, 7) before treatment (with Z values of -2.97 and -3.46, respectively, both P values <0.05). However, there was no statistically significant difference in quality of life score of patients between the two groups 12 months after treatment (P>0.05). During the 12-month post-treatment follow-up, patients in neither group developed infectious complications such as erysipelas, cellulitis, or lymphangitis. Transplanted lymph nodes of patients survived well in VLNT+LVA group 12 months after treatment. Conclusions: Compared with LVA alone, VLNT combined with LVA also improves the volume of affected limb and the quality of life of patients with unilateral upper limb lymphedema following radical mastectomy for breast cancer with better mid- and long-term efficacy, which is worthy of clinical promotion.