Non-vascularised lymph node transfer: future directions for the minimally invasive surgical management of lymphoedema

Abstract

Lymphoedema is a common and debilitating condition for which there is no single satisfactory management modality. Physiotherapy is accessible and moderately effective but suffers from the necessity for daily adherence. Surgery is effective in the earlier stages of disease progression but can be morbid and demanding for patients. An evolving surgical technique known as non-vascularised lymph node transfer (NVLNT) aims to tackle the underlying lymphatic drainage deficit in lymphoedema in a minimally invasive manner. Emerging evidence demonstrates promise in animal models and there is very nascent human evidence with mixed results. This is a narrative review that examines the available animal and human literature on NVLNT and draws comparisons between the two to discover methods of translating animal research to human applications. A systematic search was conducted. PubMed and Embase were searched using MeSH terms for NVLNT. Ultimately, 17 papers, including 14 animal and 3 human studies, were found. Within animal studies, NVLNT is efficacious, with results being repeated multiple times. Additionally, methods of optimising lymphangiogenesis, such as the addition of platelet-rich plasma and VEGF-C in addition to fragmentation and pre-inflammation techniques, have been investigated with general success. To date, evidence from human studies is sparse, with few studies, small sample sizes, and variable outcomes. NVLNT is promising as a minimally invasive surgical treatment for lymphoedema; however, further high-quality research in humans with advanced lymphoedema is necessary to prove its validity. Furthermore, adjuvants to grafting explored in animal studies, such as VEGF-C therapy, may increase the efficacy of lymph node grafting in humans.

Keywords

Lymphoedema / plastic surgery / microsurgery / cancer

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