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
