NCT06815705

Reconstruction of Cervical Lymphatic System During Head and Neck Squamous Cell Carcinoma Surgery

An Exploratory Study of Reconstruction of Cervical Lymphatic System by Vascularized Lymphoid Tissue Transplantation During Head and Neck Squamous Cell Carcinoma Surgery

• Status: Not Yet Recruiting
• Phase: N/A
• Study type: Interventional
• Enrollment: 23 (estimated)
• Sponsor: Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University · Academic / Other
• Sex: All
• Age: 18 Years – 75 Years
• Healthy volunteers: Not accepted

Summary

Head and neck squamous cell carcinoma is one of the most common malignant tumors. At present, the standard treatment of head and neck squamous cell carcinoma recommended by the National Comprehensive Cancer Network(NCCN) treatment guideline in the United States and the Chinese Society of Clinical Oncology(CSCO) treatment guideline in China is a comprehensive treatment model based on surgery, supplemented by radiotherapy, chemotherapy, immunization and targeted therapy. Neck lymph dissection is one of the most important surgical procedures for the treatment of head and neck squamous cell carcinoma. The injury of surgery and postoperative adjuvant radiotherapy leads to inadequate drainage of lymphatic system, leading to head and neck lymphedema. Vascularized lymph node transplantation is successfully used in the treatment of upper and lower limb lymphedema, but has not been reported in the treatment of head and neck lymphedema. At present, neck lymph dissection is the standard surgical protocol for head and neck squamous cell carcinoma, and there is no clear evidence that neck lymph dissection can be avoided. The dorsal thoracic artery flap can be used to make the flap of chimeric axillary lymph node, and can also be used as one of the vascularized lymph transplantation donor areas for the treatment of lymphedema without increasing the risk of upper limb lymphedema in the donor area. Therefore, the investigators propose: Can the function of the head and neck lymphatic system be reconstructed by transplanting normal lymph nodes from other parts of the body into the neck to form new lymphatic pathways at the same time of operation for head and neck squamous cell carcinoma? In our previous operation for head and neck squamous cell carcinoma, thoracic dorsal artery flap with partial axillary lymphoid tissue transplantation was used to repair head and neck defects. Retrospective analysis showed that the lymph node transplantation in the previous cases survived. Therefore, this project designed a prospective exploratory clinical study to clarify the activity and donor safety of cervical vascularized lymphatic transplantation, and further explore the effect of vascularized lymphatic tissue transplantation to rebuild the cervical lymphatic system in reducing the incidence of postoperative head and neck lymphedema, alleviating cervical fibrosis after radiotherapy and even improving the prognosis of patients.

Detailed description

Head and neck squamous cell carcinoma is one of the most common malignant tumors. At present, the standard treatment of head and neck squamous cell carcinoma recommended by the NCCN treatment guideline in the United States and the CSCO treatment guideline in China is a comprehensive treatment model based on surgery, supplemented by radiotherapy, chemotherapy, immunization and targeted therapy. Neck lymph dissection is one of the most important surgical procedures for the treatment of head and neck squamous cell carcinoma. The injury of surgery and postoperative adjuvant radiotherapy leads to inadequate drainage of lymphatic system, leading to head and neck lymphedema. Lymphedema is a progressive process that includes features such as lymphatic stasis, lymphatic vessel remodeling and dysfunction, inflammation, fatty tissue deposition, and eventually fibrosis. Therefore, in addition to edema, complications such as cervical fibrosis may occur, which seriously affects the quality of life of patients with head and neck squamous cell carcinoma. In addition, the absence of lymphatic tissue in the neck after cervical lymph dissection may damage the local lymphatic immune monitoring function of the head and neck, and affect the postoperative therapeutic effect and prognosis of patients. Surgical treatment of head and neck lymphedema includes lymphatic venous shunt and vascularized lymph node transplantation, which involves the transfer of healthy lymph nodes from unaffected parts of the body to the site of lymphedema. Vascularized lymph node transplantation is successfully used in the treatment of upper and lower limb lymphedema, but has not been reported in the treatment of head and neck lymphedema. At present, neck lymph dissection is the standard surgical protocol for head and neck squamous cell carcinoma, and there is no clear evidence that neck lymph dissection can be avoided. Therefore, head and neck lymphedema after head and neck squamous cell carcinoma is a common surgical complication. In our previous study, the investigators collected the data of 71 patients with head and neck squamous cell carcinoma undergoing surgical treatment, and found that the greater the scope of cervical lymph dissection, the more serious the degree of lymphedema after surgery. In addition, our research group has successfully implemented thoracic dorsal artery flap to repair oral cancer defects in more than 100 cases in the early stage, which proved that the success rate of thoracic dorsal artery flap is high and the functional injury of the donor area is small. The dorsal thoracic artery flap can be used to make the flap of chimeric axillary lymph node, and can also be used as one of the vascularized lymph transplantation donor areas for the treatment of lymphedema without increasing the risk of upper limb lymphedema in the donor area. There are no effective preventive measures for head and neck lymphedema and neck fibrosis in patients with head and neck squamous cell carcinoma after comprehensive treatment. In order to reduce the pain, cost and possibility of reoperation caused by postoperative treatment, the prevention of head and neck lymphedema after the operation of head and neck squamous cell carcinoma has become an important clinical problem to be solved in this project. Therefore, the investigators propose: Can normal lymph nodes from other parts of the body be transplanted into the neck to form new lymphatic pathways during head and neck squamous cell carcinoma surgery to rebuild the function of the head and neck lymphatic system and avoid postoperative complications such as lymphedema? In our previous study, 6 patients with head and neck squamous cell carcinoma were successfully transplanted with dorsal thoracic artery flap carrying part of armpit lymphoid tissue during operation to reconstruct the neck lymphatic system. Postoperative Magnetic Resonance(MR) And ultrasound showed that the size and structure of the transplanted lymph nodes were normal, no lymph node necrosis was observed, and blood flow was lymphatic portal type. No upper limb lymphedema occurred in the donor area. In this study, patients with head and neck squamous cell carcinoma with clinical stages of T2-3,N0-3,M0 and T4a,N0-3,M0 requiring surgical treatment and repair by skin flap transplantation were selected, and were enrolled by Simon stage II, and the intervention measures were based on the recommended surgical methods in the guidelines and the vascularization axillary lymphatic transplantation at the same time. The main study endpoints were the survival of transplanted lymph nodes, the incidence and degree of lymphedema in the head and neck, and the incidence and degree of lymphedema in the upper limb of the donor area. Secondary endpoints were 2-year disease-free survival, 2-year overall survival, patient quality of life evaluation, and safety evaluation.

Conditions

• Head and Neck Squamous Cell Carcinoma
• Lymphedema, Secondary
• Neck Lymph Dissection
• Vascularized Lymph Node Transplantation

Interventions

Type	Name	Description
PROCEDURE	Vascularized lymphatic transplantation	Preoperative ultrasonography was performed to check the distribution, quantity and size of axillary lymph nodes. During the operation, methylene blue was injected subcutaneously into the elbow fossa to make the axillary lymph nodes in area B and D chromogenic, and avoid damage to the arm drainage lymph nodes. Adjusting the flap design according to the size of the defect. The perforating branches of lymphoid tissue in areas A and C of grade I were located about 3-5cm above the perforating branches of the skin, and moved towards the thoracic side to the lymphatic adipose tissue. Finally, the pedicle of the thoracic dorsal artery was separated, and the blood transport of the flap and the lymphatic adipose tissue was examined by fluorescence imaging and other methods. The lymphoid adipose tissue was placed in the neck area I and II, and fixed by suture. The arteriovenous microvessels in the thoracic dorsal were anastomosed to the vessels in the receiving area of neck.

Timeline

• Start date: 2025-03-20
• Primary completion: 2027-01-01
• Completion: 2027-12-01
• First posted: 2025-02-07
• Last updated: 2025-02-07

Locations

1 site across 1 country: China