The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up.

Luigi Losco,Alessandro De Sire,Jonathan Velazquez-Mujica,Shih-Heng Chen,Gokhan Sert,Marco Invernizzi,Hung-Chi Chen,Emanuele Cigna,Alberto Bolletta,Dicle Aksoyler

doi:10.3390/jcm11030570

Abstract

Background: Bilateral lower extremity lymphedema is a rare and invalidating condition that poses a great challenge to the scientific community, and deeply affects the quality of life (QoL) of affected patients. A combined protocol consisting of lymph node transfer and a reductive method have never been reported for the treatment of this condition, except for small case series with brief follow-up periods. Methods: This retrospective study analyzed data of 29 patients, mean age 51 ± 17.1 years, who had been diagnosed with bilateral lower extremity lymphedema. Gastroepiploic vascularized lymph node transfer was performed in all the patients, and an excisional procedure was associated according to the clinical stage. Clinical history, circumferential limb measurements, complications, episodes of cellulitis, and responses to the Lymphedema Quality of Life Questionnaire were analyzed. Results: The mean follow-up was 38.4 ± 11.8 months. A significant reduction in the episodes of cellulitis per year was observed (p < 0.001). In our series, BMI and duration of symptoms were significantly related to the development of cellulitis during the postoperative period, p = 0.006 and p = 0.020, respectively. The LYMQoL questionnaire showed a significant quality of life improvement from 3.4 ± 0.9 to 6.2 ± 0.8 (p < 0.05). Conclusions: An integrated approach is essential for the treatment of bilateral lower extremity lymphedema: reductive and reconstructive methods are complementary to achieve a successful outcome. Timely treatment and BMI reduction are relevant in order to decrease the number of episodes of cellulitis. An attentive follow-up is necessary to identify recurrence and treat affected patients in time.

Highlights

Bilateral lower extremity lymphedema is a major source of morbidity
Patients were classified as stage II or III lower limb lymphedema, as defined by the International Society of Lymphology (ISL) [18]
To the best of our knowledge, this is the largest account on a bilateral lower limb lymphedema cohort managed in a single center; the patients were treated with our integrated approach and showed improvement of both clinical conditions and quality of life

Summary

Introduction

Bilateral lower extremity lymphedema is a major source of morbidity. It is a rare condition that poses a great challenge to the scientific community, and deeply affects the quality of life (QoL) of affected patients [1,2,3]. Lymphedema is usually not life threatening, but because of the swelling of the affected limb, discomfort, pain, loss of function, and recurrent infections may occur It has a very deleterious effect on self-esteem, and causes impairments in body perception [4,5]. The impairment of the lymphatic system could be caused by direct trauma, infection, surgery for cancer, or radiotherapy It leads to a disruption of the lymphatic channels and a subsequent compromised flow of lymph from the limb; it is a major cause of distress for patients and frustration for physicians. Bilateral lower extremity lymphedema is a rare and invalidating condition that poses a great challenge to the scientific community, and deeply affects the quality of life (QoL) of affected patients. A combined protocol consisting of lymph node transfer and a reductive method have never been reported for the treatment of this condition, except for small case series with brief follow-up periods

Methods

Discussion

Conclusion