Abstract
Background: There is insufficient clear epidemiological and clinical knowledge about lymphedema patient’s population in Mexico, this limits its investigation. The objective of this study is to present basic lymphedema epidemiological data and its clinical characteristics based on the analysis of lymphedema patients’ data collected from a specialized rehabilitation clinic in Mexico.
 Methods: This is a cohort study developed between 2015 and 2021. The study was carried ou in a private clinic specialized in oncological and peripheral vascular patients’ rehabilitation. Clinical assessments and interviews were performed to collect each case’s clinical history, considering its medical characteristics, physical activity and functionality and socio-demographic information, classified in a matrix, and later statistically evaluated.
 Results: Among 446 lymphedema patients, gender distribution was represented by 81% female and 19% male with a mean age of 50.5 years (±44.5). The population was categorized into the following three different study groups according to diagnosis: Cancer-Related Lymphedema (CRL), Non-Cancer-Related Secondary Lymphedema (NCRSL) and Primary Lymphedema. 60.08% of the patients had CRL; 25.11% had NCRSL and 14.79% had Primary Lymphedema. Among the patients with CRL, 81% of them corresponded to breast cancer diagnosis, the rest were associated to 19 different cancer diagnoses. The most prevalent diagnosis was breast CRL 48.6%; phlebolymphedema 19.4%; congenital and praecox lymphedema 14.1%; lipo-lymphedema 4.8%. The BMI of 64% of the patients ranged in overweight and obesity. 37.6% of patients reported that had experienced pain in limbs affected by lymphedema and 45% of all patients reported some disability to perform one or more activities associated to their limb volume or limb discomfort. 82% of patients had no physical activity or performed less physical activity than what is suggested to their population group’s recommendation.
 Conclusion: This study stablishes a precedent on reporting the broadest available epidemiological and clinical data of lymphedema in Mexico. Further studies are needed to report with a higher precision the epidemiological, clinical, and demographical data about each etiological group for a better understanding of lymphedema in Mexico and Latin America.
Highlights
The BMI of 64% of the patients ranged in overweight and obesity. 37.6% of patients reported that had experienced pain in limbs affected by lymphedema and 45% of all patients reported some disability to perform one or more activities associated to their limb volume or limb discomfort. 82% of patients had no physical activity or performed less physical activity than what is suggested to their population group’s recommendation
Another example of the absence of local lymphedema information to base clinical guidelines is the 2019 and 2020 Mexican Consensus about diagnosis and treatment of breast cancer, which dedicates a chapter to physical therapy for breast cancer patients and includes suggestions about lymphedema management, but its statistics are still based on foreign epidemiological data [18,19]
The population was categorized into three different study groups according to diagnosis: Cancer-Related Lymphedema, Non-CancerRelated Secondary Lymphedema (NCRSL) and primary lymphedema. 60.08% (268) patients had Cancer Related Lymphedema; 25.11% (112) had Non-Cancer-Related Secondary Lymphedema (NCRSL) and 14.79% (66) patients had some type of Primary Lymphedema
Summary
According to Pubmed’s MeSH database and International Society of Lymphology, lymphedema is defined as a chronic-progressive disease which produces rich protein edema, caused by the obstruction of lymph vessels, lymph nodes or lymphatic function disorders [1,2], this produces chronic fibrosclerotic changes in tissues and a chronic inflammatory response [3]; its progression affects physical function, quality of life [4] and the social and economic framework of patients [5,6,7]. Depending on developing onset time, primary lymphedema is subdivided into: ‘congenital’, when present at birth and until two years old; ‘praecox’ between 2 and 35 years old and ‘tarda’ after 35 years old. Secondary lymphedema includes all lymphedema caused by external factors or as consequence of a main disease; here is included Cancer-Related (neoplasm or tumor, lymph node removal surgery, radiotherapy), parasite infection such as filariasis, recurring skin infections or chronic exposure to inflammatory agents such as podoconiosis, direct trauma, obesity, chronic venous disease and chronic edema related to hepatic, nephrotic or cardiac disease, or multiple simultaneous factors in absence of a lymphatic a primary disease [13,14,15].
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