A meta-analysis of the efficacy of vascularised lymph node transfer in reducing limb volume and cellulitis episodes in patients with cancer treatment-related lymphoedema

2021 ◽  
Author(s):  
Joseph Ward ◽  
Ian King ◽  
Maria Monroy-Iglesias ◽  
Beth Russell ◽  
Mieke van Hemelrijck ◽  
...  
Keyword(s):  
Lymph Node ◽  
Cancer Treatment ◽  
Meta Analysis ◽  
Limb Volume ◽  
Patients With Cancer ◽  
Lymph Node Transfer

Limb volume reduction and infection outcomes following vascularized lymph node transfer for cancer treatment-related lymphoedema: A systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24040-e24040
Author(s):  
Joseph Alexander Ward ◽  
Ian CC King ◽  
Maria J Monroy-Iglesias ◽  
Beth Russell ◽  
Mieke Van Hemelrijck ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Lymph Node ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Lower Limbs ◽  
Limb Volume ◽  
Lymph Node Transfer ◽  
Vascularized Lymph Node Transfer

e24040 Background: Cancer treatment-related lymphoedema (CTRL) is a chronic and disabling complication that carries a significant health burden during cancer survivorship. Vascularized lymph node transfer (VLNT) is employed increasingly to microsurgically reconstruct physiological lymphatic flow in affected limbs. We set out to synthesise and assess the efficacy of VLNT for reducing limb volume and infection outcomes in CTRL. Methods: A systematic review was conducted by searching PubMed, Medline and EMBASE databases during early 2020. All full-text English-language articles reporting VLNT as the sole therapeutic intervention for the management of CTRL that provided volumetric limb and/or patient-reported lymphatic quality of life and/or cellulitis-related outcomes were included. All studies were scored for methodological quality (STROBE and CONSORT checklists) and lymphoedema-specific data reporting quality. Using a random-effects model, we estimated the pooled limb volume reduction and 95% CI for upper and lower limbs stratifying according to site of measurement and VLNT donor. We also estimated the pooled reduction in cellulitis episodes and mean improvement in lymphoedema-related quality of life. PROSPERO ID: CRD42020204080. Results: The search strategy identified 277 articles. Thirty-one studies encompassing 581 patients were included with the overall methodological quality of studies assessed to be low. Meta-analysis demonstrated that performing VLNT for CTRL led to limb volume reductions in both upper limb (above elbow circumferential reduction rates (CRR) = 42.7 % (95% CI: 36.5-48.8, I2: 94.3 %, p = 0.000, 153 patients, 10 studies); below elbow CRR = 34.1 % (95% CI: 33.0-35.1, I2: 0.0 %, p = 0.919, 144 patients, 9 studies)) and lower limb (above knee CRR = 46.8 % (95% CI: 43.2-50.4, I2: 92.4 %, p = 0.000 26 patients, 3 studies); below knee CRR = 54.6 % (95% CI: 39.0-70.2, I2: 97.6%, p = 0.000, 26 patients, 3 studies)) CTRL. Similarly, extra-abdominal VLNT, abdominal VLNT and autologous breast reconstruction with VLNT reduced CTRL by CRRs of 49.5 % (95% CI: 46.5-52.5, I2: 8.3 %, p = 0.365, 7 studies, 108 patients), 39.6 % (95% CI: 37.2-42.0, I2: 89.5 %, p = 0.000, 3 studies, 15 patients) and 32.7 % (95% CI: 11.1-54.4, I2: 96.9 %, p = 0.000 3 studies, 29 patients). VLNT reduced mean annual cellulitis episodes by 2.1 (95% CI: -2.7- -1.4) episodes per annum and improved lymphoedema-specific quality of life was improved by 4.26 (LYMQOL “overall domain” scale). Conclusions: Performing VLNT for CTRL results in reductions of limb volume and cellulitis episodes for both upper and lower limbs. However, published studies were methodologically heterogeneous and of low quality highlighting the need for standardized outcome reporting and further well-designed randomized controlled trials comparing VLNT against existing therapies.

scholarly journals Prognostic Value of Albumin/Globulin Ratio in Survival and Lymph Node Metastasis in Patients with Cancer: A Systematic Review and Meta-analysis

2018 ◽  
Vol 9 (13) ◽  
pp. 2341-2348 ◽  
Author(s):  
Jieshan Chi ◽  
Qizhi Xie ◽  
Jingjing Jia ◽  
Xiaoma Liu ◽  
Jingjing Sun ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Patients With Cancer ◽  
Node Metastasis

Axilla versus Wrist as the Recipient Site in Vascularized Lymph Node Transfer for Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Yehuda Chocron ◽  
Alain J. Azzi ◽  
Gabriel Bouhadana ◽  
George Kokosis ◽  
Joshua Vorstenbosch
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Complication Rate ◽  
Meta Analysis ◽  
Demographic Data ◽  
Reduction Rate ◽  
Compression Garments ◽  
Recipient Site ◽  
Breast Cancer Related Lymphedema ◽  
Lymph Node Transfer

Abstract Background Vascularized lymph node transfers (VLNT) are being used with increasing frequency for the treatment of breast cancer-related lymphedema (BCRL). However, there is a lack of consensus in the surgical field as to which recipient site should be utilized. We, therefore, aim to assess the evidence comparing the wrist and axilla as recipient sites for VLNT in BCRL. Methods We conducted a systematic literature review to compare the wrist and axilla as recipient sites for VLNT in BCRL. Demographic data, as well as circumference reduction rate (CRR), excess volume reduction (EVR), postoperative decrease in infections per year, postoperative discontinuation of compression garments, and overall pooled complication rate were extracted from included studies. These were compared through a meta-analysis. Results A total of 37 studies met the inclusion criteria for a total of 689 patients. VLNTs to the wrist and axilla resulted in a decrease in CRR of 42.1 and 51.5%, and a decrease in EVR of 35.6 and 48.8%, respectively. However, our meta-analysis showed no significant differences between CRR or EVR and between wrist and axilla as recipient sites. Similarly, we found no differences in postoperative decrease in infections per year, postoperative discontinuation of compression garments, and overall pooled complication rate. Conclusion These data suggest noninferiority between the wrist and axilla as recipient sites for VLNT in the context of BCRL. In the absence of randomized, prospective data, we hope these results can be used as an evidence-based reference and facilitate future studies.

Thrombosis in Cancer Patients Treated with Hematopoietic Growth Factors - A Meta-Analysis

1996 ◽  
Vol 75 (02) ◽  
pp. 368-371 ◽  
Author(s):  
T Barbul ◽  
G Finazzi ◽  
A Grassi ◽  
R Marchioli
Keyword(s):  
Cancer Patients ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Hematopoietic Growth Factors ◽  
Patients With Cancer ◽  
Cytotoxic Treatment ◽  
Pertinent Data ◽  
Thrombotic Complications ◽  
Vascular Occlusions

SummaryHematopoietic colony-stimulating factors (CSFs) are largely used in patients with cancer undergoing cytotoxic treatment to accelerate neutrophil recovery and decrease the incidence of febrile neutropenia. Clinical practice guidelines for their use have been recently established (1), taking into account clinical benefit, but also cost and toxicity. Vascular occlusions have been recently reported among the severe reactions associated with the use of CSFs, in anedoctal case reports (2, 3), consecutive case series (4) and randomized clinical trial (5, 6). However, the role of CSFs in the pathogenesis of thrombotic complications is difficult to ascertain, because pertinent data are scanty and widely distributed over a number of heterogenous investigations. We report here a systematic review of relevant articles, with the aims to estimate the prevalence of thrombosis associated with the use of CSFs and to assess if this rate is significantly higher than that observed in cancer patients not receiving CSFs.

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