Prophylactic lymphedema surgery in lower limb soft tissue sarcomas: A clinical paradigm in a promising field

Abstract

IntroductionOncological treatments, such as radiotherapy and surgery, are high-risk factors for the development of secondary lymphedema in the upper and lower limbs, as well as the genitalia. Prophylactic lymphedema surgery (PLS) has previously demonstrated promising results in reducing secondary lymphedema in breast cancer and urogenital cancer patients. We conducted a study to adapt this principle for patients with lower extremity sarcomas. Material and MethodsInclusion criteria included patients with tumors on the medial aspect of the thigh and leg, tumor size larger than 5cm. Group A (19 patients) comprised a prospective cohort (2020-2023) in which a PLS protocol was executed. Lymphaticovenous anastomosis (LVA) was performed when lymphatic channels were interrupted due to tumor resection, intraoperatively verified by indocianine green (ICG). Lymph node transfer (LNT) was employed exclusively in cases involving preoperative radiotherapy and inguinal lymph node resection. Measurements were collected both preoperatively and at 1, 3, 6, and 12 months postoperatively. Group B (26 patients) constituted a retrospective cohort (2017-2020) without PLS reconstruction, where the prevalence of lymphedema was determined. ResultsIn total, we enrolled 45 patients with soft tissue sarcomas located on the inner aspect of the thigh and leg (26 in the control group vs. 19 in the prophylactic group). In the control group, lymphedema was observed in 10 out of 27 patients (37.04%). In the prophylactic group, two patients exhibited signs of lower extremity lymphedema (2/19, 10.52%) with a median follow-up of 14.15 months (6 months - 33months), demonstrating statistically significant differences between the two groups (p=0.02931). ConclusionsPLS for lower limb soft tissue sarcomas shows promising results, although it is premature to reach solid conclusions. Multicenter studies, standardization of criteria, larger sample sizes, and longer-term follow-up are imperative for further validation.