Ciudad Pedro, Forte Antonio J, Huayllani Maria T, Boczar Daniel, Manrique Oscar J, Bustos Samyd S, Bustamante Atenas, Chen Hung-Chi
Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru.
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung.
Gland Surg. 2020 Apr;9(2):603-613. doi: 10.21037/gs.2020.03.13.
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.
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.
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).
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.
带血管蒂淋巴结转移术（VLNT）是一种治疗淋巴水肿备受关注的外科手术。体重指数（BMI）是一个已被充分描述的增加淋巴水肿风险的因素，但对于其对接受VLNT的淋巴水肿患者手术结局的影响知之甚少。本研究的目的是分析术前BMI对淋巴水肿患者VLNT术后长期手术结局的影响。
我们回顾性收集了2010年7月至2016年7月在中国医科大学附属第一医院接受VLNT治疗的国际淋巴学会（ISL）II期或III期淋巴水肿患者的数据。回顾术前和术后的人口统计学和临床数据，如肢体周长和感染发作次数。进行统计分析，比较术前BMI类别之间的周长减少率和感染发作次数减少情况。此外，分析基于定量术前BMI的结局预测。
共有83例患者符合纳入标准。9例（10.8%）体重正常，43例（51.8%）超重，31例（37.3%）肥胖。与体重正常的患者相比，超重患者（P=0.005）和肥胖患者（P=0.02）的平均周长减少率显著更低，但定量BMI与周长减少率无关（P=0.96）。然而，肥胖患者的感染发作次数减少明显多于体重正常的患者（P=0.03）。此外，更高的BMI预测VLNT术后感染发作次数减少更多（P=0.02）。
VLNT是一种有效的外科治疗方法，尤其适用于术前BMI较高的淋巴水肿患者。我们的研究结果表明，该手术可显著减少肥胖患者每年术后感染发作次数，尽管术前BMI不影响周长减少率。
