Vascularized lymph node transfer for secondary lymphedema: A comprehensive systematic review of clinical outcomes and advances

Secondary lymphedema, a long-term disorder as a consequence of cancer treatments (dissection of lymph nodes or radiation), severely handicaps quality of life (QoL) because of the constant swelling and frequent infections. Such a microsurgical procedure is called vascularized lymph node transfer (VLNT) and is used to reestablish lymphatic drainage and improve symptoms. This systematic review assesses the effectiveness, safety and innovations in VLNT of secondary lymphedema. Used the guidelines of PRISMA to search PubMed, MEDLINE, Embase, the Cochrane central library, Scopus, or the Web of Science for articles published between January 2000 and December 2024. The study criteria included human studies (n = 5 and above) that reported the number of adult patients whose clinical outcomes (e.g., limb volume reduction, cellulitis episodes) or patient-reported outcomes (e.g., LYMQOL scores) were assessed. The meta-analysis was done on the rate of limb circumference reduction (CRR) and the rate of infection and QoL measures by utilizing random effect models and subgroup analysis done by donor/ recipient sites and lymphedema stage. VLNT shows a considerable volume decrease of the limbs (mean CRR ~40% upper limb, 50-60% lower limb), the occurrence of cellulitis remains reduced (p < 0.05), and QoL also improved. Intra-peritoneal donor sites (i.e., omental, jejunal mesenteric) and composite procedures (i.e., combined with liposuction) have improved results with low complications (donor-site ~1.4%, recipient-site ~3.2%). Technological advancements, such as the use of indocyanine green lymphography and the injection of hyaluronidase, enhance operative accuracy. VLNT is an effective and safe method of treating secondary lymphedema; however, a gap in research remains that has not been addressed, including the need for uniform outcomes measurement and multicenter, randomized controlled trials.