The role of immediate lymphatic surgery after sarcoma resection

Background: The surgical excision of sarcoma tumors in the upper and lower limbs often inevitably leads to large defects that may impair the lymphatic system. Damage in these settings may involve both lymphatic vessels and lymph nodes, and their consequences can be evident at the immediate end of the procedure. In order to prevent short- and long-term lymphatic complications, it is important to address these damages at the time of primary reconstruction. Methods: In our clinical practice, we implemented the combination of lymphatic reconstructive surgeries for all patients who underwent a surgical resection of soft tissue sarcoma with obvious iatrogenic lymphatic system damage (either surgical or radiotherapy-induced) and were retrospectively enrolled. The soft tissue reconstruction was combined with lymphatic procedures intended to restore lymph drainage. Lymphovenous anastomoses (LVA), either in the conventional distal fashion or as lymphatic flow-through with the flap’s veins, were always used. Results: All patients were treated successfully without any perioperative complications. The follow-up period varied widely, averaging over a year. In a few cases, infected seromas were observed but were effectively managed using debridement and vacuum-assisted closure therapy. Subclinical and postoperative lymphedema were identified and treated with secondary procedures as needed. Overall, the outcomes were favorable in terms of both functionality and esthetics. Conclusions: Surgical lymphatic drainage restoration showed encouraging results in different settings and could be safely integrated into sarcoma surgery. LVA represents a minimally invasive technique that can immediately reduce lymph stasis and provide effective restoration of lymphatic drainage. Vascularized lymph node transfer may further enhance the drainage potential for long-standing results.