Facial Vein Ligation is Associated with Lymphedema Among Patients with Head and Neck Cancer Undergoing Surgery and Radiation.

Abstract

Head and neck lymphedema (HNL) is common after head and neck cancer (HNC) treatments. For unclear reasons, it is more likely to develop after lymphadenectomy and radiation than after either alone. Therefore, we investigated associations between facial vein ligation and HNL among patients who underwent lymphadenectomy and radiation. This was a retrospective cohort study of treatment-naïve patients who underwent cervical lymphadenectomy and completed adjuvant radiation at a single, tertiary center. Preoperative and 1-year postoperative computed tomography scans were reviewed to assess the patency of the facial veins in each neck. The presence of lymphedema was determined clinically by a lymphedema therapist 1 year after treatment and classified according to the MD Anderson Cancer Center Lymphedema Rating Scale. In total, 84 patients were included, 44 had lymphedema 1 year after treatment. At least one facial vein was ligated in 88.6% of those with lymphedema and in 57.5% of those without lymphedema (p < 0.001). Those with lymphedema had fewer patent facial veins than those without lymphedema (mean 0.81 vs. 1.23, p = 0.009) and ligation of at least one facial vein was associated with an odds ratio for lymphedema of 5.77 (95% confidence interval 1.88-17.71; p < 0.001). Multivariable logistic regression analysis confirmed a significant difference in lymphedema among those with at least one facial vein ligated (odds ratio 8.87; 95% confidence interval 2.46-31.99; p < 0.001). Facial vein ligation is associated with lymphedema among patients with HNC who undergo lymphadenectomy and radiation. This suggests that veins may help the body compensate for the disruption of cervicofacial lymphatics that occur as a result of these treatments.