Vascularised lymph node surgery shown to cut cancer treatment related lymphoedema swelling by almost half

Mr Kelvin Ramsey, Consultant (right) and Mr Aadil Khan, Consultant (middle)

Vascularised lymph node transfer (VLNT), a promising microsurgery procedure, has been suggested to significantly reduce the amount of limb swelling in patients with cancer treatment-related lymphoedema, according to a review led by The Royal Marsden NHS Foundation Trust.

The study, a meta-analysis conducted by the Plastic and Reconstructive Surgery team at The Royal Marsden, reports benefits of VLNT in reducing swelling and risk of infection, significantly improving quality of life for this group of patients. The findings have been published in the European Journal of Cancer, and The American Society of Clinical Oncology (ASCO) conference proceedings.

Lymphoedema - swelling in the body’s tissue - is a chronic and disabling complication which can occur after cancer surgery. Removal of lymph nodes as part of cancer treatment can cause fluid to build up in surrounding tissues, resulting in swelling of the limb. VLNT is a surgical technique which reconstructs lymphatic function, by taking lymph nodes containing tissue (a lymph node flap) from an unaffected part of the body and transplanting it into the affected limb.

This meta-analysis was the first to focus exclusively on the efficacy of VLNT in cancer treatment-related lymphoedema and included data from 581 patients and 31 studies across 15 different countries. The study evaluated the efficacy of VLNT in patients with both upper limb and lower limb lymphoedema following cancer treatments for breast, gynaecological, urological cancers and melanoma.  Focused on one specific measure known as the circumferential reduction rate (CRR), results showed a 40% reduction in excess limb volume in patients who had undergone VLNT in the upper limb and 34% for patients with lower limb lymphoedema. Based on the significance of these findings, the Royal Marsden is now exploring the opening of a new randomised trial in VLNT.

Patients with lymphoedema are also more likely to contract infections of the skin such as cellulitis. Results from this meta-analysis showed that patients who have undergone lymph node transfer had a reduction in the annual number of episodes of cellulitis by approximately two episodes a year.

At The Royal Marsden, we’re always looking to improve the lives of patients with cancer, and having patient input into the design of any research trial is critical to it’s success.

Mr Aadil Khan, Consultant Plastic Surgeon at The Royal Marsden NHS Foundation Trust

The Royal Marsden is pioneering a new surgical technique called lymphaticovenous anastomosis (LVA), with the world’s first randomised control trial on this procedure. LVA aims to relieve swelling from lymphoedema in breast cancer patients and surgeons at The Royal Marsden believe this technique has the potential to become the standard of care for breast cancer patients with cancer-related lymphoedema.

Mr Kelvin Ramsey, Consultant Plastic Surgeon and Clinical Lead in the Department of Plastic and Reconstructive Surgery at The Royal Marsden NHS Foundation Trust was joint senior author on this study. He said:

“There have been hundreds of studies published on lymph node transfer to date, but our review is the first to quantify the potential therapeutic benefit of VLNT in reducing both limb volumes and the risk of infection in patients with lymphoedema after cancer treatment. The Royal Marsden is a leader in complex microsurgery and our teams are already conducting a number of lymphoedema trials.”

Mr Aadil Khan, Consultant Plastic Surgeon at The Royal Marsden NHS Foundation Trust and joint senior author for the study said:

“We are encouraged by the findings of our meta-analysis and are currently developing a randomised clinical trial to formally evaluate the benefit this technique might bring to patients with lymphoedema. We are very keen to work with lymphoedema patients in developing the trial, to ensure it captures meaningful outcomes for them and improves their quality of life. To get their input, we will be hosting a series of digital patient engagement events over the next couple of months. At The Royal Marsden, we’re always looking to improve the lives of patients with cancer, and having patient input into the design of any research trial is critical to it’s success.”

Specialist surgical equipment at The Royal Marsden, including surgical microscopes which are used to carry out complex microsurgery and advanced surgical techniques such as lymphaticovenous anastomosis (LVA), is supported by funding from The Royal Marsden Cancer Charity.