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A Decade Of Vascularized Lymph Node Transplant (VLNT) For The Treatment Of Lymphedema: A Meta-analysis Of Prospective Clinical Trials
Tal Brown, BS1, Stav Brown, MD2, Michelle Coriddi, MD2, Babak J. Mehrara, MD2, Joseph H. Dayan, MD2.
1Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Purpose: Despite the increasing popularity of Vascularized Lymph Node Transplant (VLNT), there is a lack of prospective long-term data and standardized outcome metrics. The purpose of this meta-analysis was to analyze the long-term, prospective outcomes of VLNT using all available outcome measures.
Methods: Outcome data included limb-measurements, bio-impedance, Patient-Reported-Outcome-Measures (PROMs), cellulitis episodes and complications.
Results: Eighteen studies (2013-2022) were included, comprising a total of 1687 patients undergoing VLNT with a mean follow-up time of 20.112 months. VLNT was associated with significantly reduced limb-volumes with 20.78% (95% CI 20.44-21.12; p<0.001) and 32.45% (95% CI 31.85-33.05; p<0.001) mean reduction in volume-differential 1- and 2-years after VLNT, respectively. This was corroborated by significant 28.95% (95% CI 28.40-29.50; p<0.001) and 42.38% (95% CI 41.37-28.57; p<0.001) decreases in L-DEX scores 1- and 2-years after VLNT, respectively. A significant improvement in Lymphedema-Life-Impact-Scale (LLIS) scores manifested as 28.70% (95% CI 28.6-28.81; p<0.001) and 37.89% (95% CI 37.41-38.531; p<0.001) decreases was recorded 1- and 2-years after VLNT, respectively. Additionally, VLNT dramatically decreased the total number of cellulitis episodes by 86.66% (95% CI 84.22-87.02; p<0.001).
Conclusion: This is the largest study to evaluate the long-term safety and efficacy of VLNT, summarizing a decade of prospective experience. The use of standardized outcome measures, consisting of volume-measurements alongside validated PROMs is indicated to reflect the totality of the limb condition. The combination of objective and subjective measures is fundamental for unlocking the pathophysiological mysteries behind the variability in patient presentation and disease progression in order to guide patient selection for VLNT.


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