Quantification and Effectiveness of Vascularized Neck Lymph Node Transfer for Lymphedema: a Systematic Review and Meta-Analysis

This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched up to March 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The primary outcome was the quantity of neck lymph nodes, and the secondary outcomes included postoperative cellulitis, Lymphedema Quality of Life Tool (LYMQOL), reduction of the extremity circumference, circumference differentiation, donor site morbidity, and lymphedema recurrence. The raw mean or proportion with a 95% confidence interval (CI) was calculated to conduct a single-arm meta-analysis. All analyses were performed using R\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R$$\end{document} software v4.0.3. Newcastle–Ottawa Scale was used to assess for quality of included studies. Eighteen studies comprising 510 patients were included in the single-arm meta-analysis. Mean neck VLNs were 3.80, 95% CI [2.48, 5.11], mean postoperative cellulitis was 0.70%, 95% CI [0.22, 1.18], mean postoperative LYMQOL was 6.84, 95% CI [5.39, 8.30], mean postoperative reduction of the extremity circumference 43.57%, 95% CI [27.81, 59.33], and mean circumference differentiation was 11.37%, 95% CI [7.51, 15.23]. The overall proportion of donor site morbidity events was 0.06, 95% CI [0.04, 0.11], and lymphedema recurrence was 0.12, 95% CI [0.05, 0.24]. The neck lymph node flap has an arsenal of lymph nodes present, carries no risk of iatrogenic edema, and has a low risk of other complications. Low donor site morbidity, patient satisfaction with the cosmetic scar, significant lymphedema reduction, and improvement of LYMQOL postoperatively are some positive outcomes that should be considered by surgeons.