Development and Themes of Diagnostic and Treatment Procedures for Secondary Leg Lymphedema in Patients with Gynecologic Cancers.

Watanabe Watanabe,Seki Seki,Ikuta Ikuta,Koshiyama Koshiyama,Nakagawa Nakagawa,Oowaki Oowaki,Sakamoto Sakamoto

doi:10.3390/healthcare7030101

Watanabe Watanabe, Seki Seki + Show 5 more

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https://doi.org/10.3390/healthcare7030101

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Abstract

Patients with leg lymphedema sometimes suffer under constraint feeling leg heaviness and pain, requiring lifelong treatment and psychosocial support after surgeries or radiation therapies for gynecologic cancers. We herein review the current issues (a review of the relevant literature) associated with recently developed diagnostic procedures and treatments for secondary leg lymphedema, and discuss how to better manage leg lymphedema. Among the currently available diagnostic tools, indocyanine green lymphography (ICG-LG) can detect dermal lymph backflow in asymptomatic legs at stage 0. Therefore, ICG-LG is considered the most sensitive and useful tool. At symptomatic stage ≥1, ultrasonography, magnetic resonance imaging-lymphography/computed tomography-lymphography (MRI-LG/CT-LG) and lymphosintiography are also useful. For the treatment of lymphedema, complex decongestive physiotherapy (CDP) including manual lymphatic drainage (MLD), compression therapy, exercise and skin care, is generally performed. In recent years, CDP has often required effective multi-layer lymph edema bandaging (MLLB) or advanced pneumatic compression devices (APCDs). If CDP is not effective, microsurgical procedures can be performed. At stage 1–2, when lymphaticovenous anastomosis (LVA) is performed, lymphaticovenous side-to-side anastomosis (LVSEA) is principally recommended. At stage 2–3, vascularized lymph node transfer (VLNT) is useful. These ingenious procedures can help maintain the patient’s quality of life (QOL) but unfortunately cannot cure lymphedema. The most important concern is the prevention of secondary lymphedema, which is achieved through approaches such as skin care, weight control, gentle limb exercises, avoiding sun and heat, and elevation of the affected leg.

Highlights

After radical surgeries for cervical, endometrial and ovarian cancers, patients often suffer from chronic leg lymphedema
The combination of the modified Charles procedure with vascularized transfer of the lymph node flap is effective [115]. These ingenious approaches can reduce leg swelling and pain and maintain the quality of life (QOL) of afflicted patients. Such techniques are limited as treatments because they cannot cure lymphedema completely
The most important point is preventing the occurrence of secondary lymphedema altogether

Summary

Introduction

After radical surgeries for cervical, endometrial and ovarian cancers, patients often suffer from chronic leg lymphedema. These patients often suffer leg heaviness, erythema, ulcers and pain, requiring lifelong treatment and psychosocial support [1]. Such lymphedema is the result of lymphatic system insufficiency and impaired lymph transport due to lymphadenectomy or radiation therapy [2]. Ki et al reported that the incidence of lower-limb lymphedema (LLL) was 11.1% after surgery for ovarian cancer [3]. In Japan, 16.6% of patients with cervical cancer suffer from LLL after pelvic lymph node removal [4].

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