Efficacy of vascularized lymph node transfer for lower extremity lymphedema: A systematic review and meta-analysis of 395 patients from 25 peer-reviewed studies.

Abstract

Lower extremity lymphedema (LEL) is a debilitating disease causing limb enlargement secondary to fluid accumulation. Although vascularized lymph node transfer (VLNT) has emerged as a promising option for refractory cases, data are limited by small samples and inconclusive results. This systematic review and meta-analysis aims to assess metrics of symptom improvement after VLNT and the impact of donor sites on outcomes. This study was performed per the PRISMA guidelines and registered on PROSPERO (#CRD420251243270). The PubMed, Scopus, and CENTRAL databases were searched until February 2026. Studies on lower limb VLNT were included and combined techniques were excluded. Outcomes included circumference reduction rate (CRR), limb volume, and complications. Descriptive statistics, chi-square, and meta-analyses were performed. Risk of bias was assessed using the Newcastle Ottawa and Joanna Briggs Institute Scales RESULTS: Twenty five studies were included and comprised 395 unique patients (70.28% female). Above and below knee CRR were 24.79% and 29.50% with high reduction in flaps using the gastroepiploic donor site (p = 0.002, p < 0.001, respectively). Limb volume was decreased by 25.32% and cellulitis incidence was significantly decreased postoperatively (p < 0.001). Adverse events were low at 12.22%. VLNT is a safe and effective technique for LEL treatment with substantial CRR, limb volume reduction, and cellulitis incidence. Outcomes were significantly improved with gastroepiploic flaps, suggesting that they should be most used for lymphedema treatment. Limitations include potential reporting bias and retrospective nature of studies. Future prospective studies should further evaluate outcomes based on different donor and recipient sites.