Impact of body mass index on long-term surgical outcomes of vascularized lymph node transfer in lymphedema patients

Pedro Ciudad; Antonio J Forte; Maria T Huayllani; Daniel Boczar; Oscar J Manrique; Samyd S Bustos; Atenas Bustamante; Hung-Chi Chen

doi:10.21037/gs.2020.03.13

Impact of body mass index on long-term surgical outcomes of vascularized lymph node transfer in lymphedema patients

Gland Surg. 2020 Apr;9(2):603-613. doi: 10.21037/gs.2020.03.13.

Authors

Pedro Ciudad^{1

2}, Antonio J Forte³, Maria T Huayllani³, Daniel Boczar³, Oscar J Manrique⁴, Samyd S Bustos⁴, Atenas Bustamante¹, Hung-Chi Chen²

Affiliations

¹ Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru.
² Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung.
³ Division of Plastic Surgery, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA.
⁴ Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.

Abstract

Background: Vascularized lymph node transfer (VLNT) is a surgical procedure with high interest to treat lymphedema. Body mass index (BMI) is a well-described factor that increases the risk of lymphedema, but little is known about its influence on the surgical outcomes of lymphedema patients who undergo VLNT. The aim of this study was to analyze the impact of preoperative BMI on the long-term surgical outcomes after VLNT in lymphedema patients.

Methods: We retrospectively compiled data of patients with International Society of Lymphology (ISL) stage II or III lymphedema who were treated with VLNT from July 2010 to July 2016 at China Medical University Hospital. Preoperative and postoperative demographic and clinical data, such as limb circumference and number of infection episodes were reviewed. Statistical analyses compared circumference reduction rates and infection episode reduction between preoperative BMI categories was done. In addition, prediction of outcomes based on quantitative preoperative BMI was analyzed.

Results: A total of 83 patients met the inclusion criteria. Nine patients (10.8%) were normal weight, 43 (51.8%) were overweight, and 31 (37.3%) were obese. Compared with normal-weight patients, mean circumference reduction rates were significantly lower in overweight (P=0.005) and obese patients (P=0.02), but quantitative BMI was not correlated with circumference reduction rate (P=0.96). However, obese patients had a significantly greater reduction in infection episodes than normal-weight patients (P=0.03). In addition, greater BMI predicted greater reduction in infection episodes after VLNT (P=0.02).

Conclusions: VLNT is an effective surgical treatment, especially for lymphedema patients with higher preoperative BMIs. The results of our study suggest that this procedure considerably decreases the number of postoperative infection episodes per year in obese patients, even though preoperative BMI does not influence circumference reduction rate.

Keywords: Body mass index (BMI); lymph node transfer; lymphedema; obesity; surgical outcomes.