Vascularized Lymph Node Transfer and Lymphovenous Bypass Provide Relief from Lymphedema

The TOPLINE

  • In vascularized lymph node transplant, the surgeon transplants healthy lymph nodes into the area affected by lymphedema
  • Lymphatic fluid collecting in the affected extremity drains into the venous circulation, reducing swelling
  • In lymphovenous bypass, the surgeon connects lymphatic vessels to small blood vessels to drain fluid

Fox Chase surgical oncologists Sameer A. Patel, MD, FACS, and Eric I. Chang, MD, are offering vascularized lymph node transfer, an innovative surgical procedure for treating lymphedema, a common condition for patients who have had their lymph nodes removed during cancer treatment. With lymphedema occurring in the arms of up to about half of breast cancer patients and in the lower extremities of nearly a third of gynecologic cancer patients, the procedure can benefit a wide range of patients who suffer from pain, swelling, and discomfort.

“Lymphedema can cause a significant decrease in patients’ quality of life and serves as a constant reminder of their battle against cancer,” Patel says. “Vascularized lymph node surgery can help these patients have a better quality of life.”

Sameer A. Patel, MD, FACS

Sameer A. Patel, MD, FACS

During the procedure, lymph nodes are transplanted from one part of the body to the part that is affected by lymphedema. The procedure ensures that the lymph nodes are alive by reestablishing blood flow to the transplanted lymph nodes, which then helps divert the lymphatic fluid in the affected extremity to the venous circulation. There is a theoretical risk of developing lymphedema in the donor extremity, although very few cases have been reported. The surgeon can prevent this from happening by selecting the proper lymph nodes for transfer, which can be done by analyzing anatomical studies and using a nuclear medicine injection to identify lymph nodes that are less crucial to the donor site.

Eric I. Chang, MD

Eric I. Chang, MD

While vascularized lymph node transfer is starting to become more commonly available, Fox Chase is one of only two institutions in the Philadelphia region currently offering the procedure. Fox Chase will also soon be the only facility in Philadelphia to offer lymphovenous bypass, another option for treating lymphedema. The procedure, which features a shorter operative time and hospital admission, involves connecting the lymphatic vessels directly to small blood vessels in order to allow fluid to drain. ■

Vascularized lymph node transfer. Photo: Jessica Hui.

Vascularized lymph node transfer. Photo: Jessica Hui.