Prophylactic lymphedema surgery in lower limb soft tissue sarcomas : A clinical paradigm in a promising field
Zamora Alarcón, Paúl (Institut de Recerca Sant Pau)
Torrano, Laura (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Ibarra, Andree (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Fernández Garrido, Manuel (Institut de Recerca Sant Pau)
Pons Playa, Gemma (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Masià, Jaume (Universitat Autònoma de Barcelona. Departament de Cirurgia)

Date:	2024
Abstract:	Introduction: Oncological treatments, such as radiotherapy and surgery, are high-risk factors for the development of secondary lymphedema in the upper and lower limbs, as well as the genitalia. Prophylactic lymphedema surgery (PLS) has previously demonstrated promising results in reducing secondary lymphedema in breast cancer and urogenital cancer patients. We conducted a study to adapt this principle for patients with lower-extremity sarcomas. Material and methods: Inclusion criteria included patients with tumors on the medial aspect of the thigh and leg and tumor size larger than 5 cm. Group A (19 patients) comprised a prospective cohort (2020-2023) in which a PLS protocol was executed. Lymphaticovenous anastomosis (LVA) was performed when lymphatic channels were interrupted due to tumor resection, intraoperatively verified by indocyanine green. Lymph node transfer was employed exclusively in cases involving preoperative radiotherapy and inguinal lymph node resection. Measurements were collected both preoperatively and at 1, 3, 6, and 12 months postoperatively. Group B (26 patients) constituted a retrospective cohort (2017-2020) without PLS reconstruction, where the prevalence of lymphedema was determined. Results: In total, we enrolled 45 patients with soft tissue sarcomas located on the inner aspect of the thigh and leg (26 in the control group vs. 19 in the prophylactic group). In the control group, lymphedema was observed in 10 out of 27 patients (37. 04%). In the prophylactic group, two patients exhibited signs of lower-extremity lymphedema (2/19, 10. 52%) with a median follow-up of 14. 15 months (6 months-33months), demonstrating statistically significant differences between the two groups (p = 0. 02931). Conclusions: PLS for lower limb soft tissue sarcomas shows promising results, although it is premature to reach solid conclusions. Multicentre studies, standardization of criteria, larger sample sizes and longer-term follow-up are imperative for further validation.
Rights:	Aquest material està protegit per drets d'autor i/o drets afins. Podeu utilitzar aquest material en funció del que permet la legislació de drets d'autor i drets afins d'aplicació al vostre cas. Per a d'altres usos heu d'obtenir permís del(s) titular(s) de drets.
Language:	Anglès
Document:	Article ; recerca ; Versió acceptada per publicar
Subject:	Lymphedema ; Soft tissue sarcoma ; Secondary lymphedema ; Lymphovenous anastomosis ; Vascularised lymph node transfer ; Supramicrosurgery
Published in:	Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol. 88 (January 2024) , p. 524-534, ISSN 1878-0539

DOI: 10.1016/j.bjps.2023.11.036

15 p, 385.0 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles