Lymphedema is a common complication that can occur after lymph node removal during cancer surgery. In particular, patients undergoing surgery for breast or gynecologic cancers frequently require regional lymph node dissection to assess metastasis and reduce the risk of recurrence, and approximately 20–30% of these patients develop lymphedema following surgery.
In the early stages, many patients improve with rehabilitation therapies such as manual lymphatic drainage and compression therapy. However, when symptoms fail to improve after three to six months of conservative treatment or when swelling progresses, surgical intervention may be considered. One of the most widely performed procedures is vascularized lymph node transfer, in which lymph nodes are harvested from another part of the body and transplanted to the affected area.
Despite its clinical use, patients have often faced difficulty deciding on surgery due to the lack of objective studies evaluating whether transplanted lymph nodes truly function after surgery and how this relates to symptom improvement.
A research team led by Professor Kyong Je Woo of the Department of Plastic Surgery at Samsung Medical Center has provided new insights through a simple nuclear medicine imaging approach.
In a collaborative study, Professor Kyong Je Woo and Professor Hai Jeon Yoon of the Department of Nuclear Medicine at Ewha Womans University Mokdong Hospital analyzed the relationship between the functional status of transplanted lymph nodes and clinical outcomes using postoperative lymphoscintigraphy in patients who underwent lymph node transfer surgery for lymphedema. The findings were recently published in the international nuclear medicine journal Clinical Nuclear Medicine (Impact Factor 9.6).
The research team evaluated 55 patients who underwent lymph node transfer surgery between March 2019 and September 2023. Lymphoscintigraphy was performed 12 months after surgery to assess the function of the transplanted lymph nodes. Lymphoscintigraphy is a nuclear medicine imaging technique that visualizes lymphatic flow using a gamma camera after the injection of a radioactive tracer into the skin.
The analysis revealed radiotracer uptake in the transplanted lymph nodes in 54.4% of patients, indicating that the transplanted nodes were functionally integrated with surrounding tissues and actively participating in lymphatic circulation.
Patients with confirmed functional transplanted lymph nodes demonstrated a twofold higher rate of subjective symptom improvement compared with those without functional uptake (77.4% vs. 38.5%).
Notably, a significant difference was also observed in the incidence of cellulitis, a representative complication of lymphedema.
Professor Woo stated, “This is the first study to objectively evaluate the function of transplanted lymph nodes using nuclear medicine imaging after lymph node transfer surgery and to analyze its association with clinical outcomes. Many patients have hesitated to undergo surgery due to uncertainty about treatment effectiveness, but our findings may help predict surgical outcomes and support clinical decision-making regarding treatment strategies.”