Lymphovenous anastomosis for the treatment of lower extremity lymphedema in patients with gynecologic malignancy = Lymphovenous anastomosis for the treatment of lower extremity lymphedema in patients with gynecologic malignancy

다국어 초록 (Multilingual Abstract)

Objective: We investigated the feasibility and efficacy of lymphovenous anastomosis (LVA) for the treatment of lower extremity lymphedema resulting from lymphadenectomy or radiation therapy in treatment of gynecologic malignancies.
Methods: Between December, 2017 and July, 2019, 55 patients with secondary lower extremity lymphedema underwent lymphovenous anastomosis in the groin area. Campisi staging was used for the clinical staging of lymphaedema. All patients underwent lymphoscintigraphy to ensure accurate diagnosis of lymphatic edema. Surgery was performed on patients with a modified transport index (TI)> 10 calculated by lymphscintigraphy or patients with recurrent lymphangitis. Indocyanine green (ICG) was injected into dorsal subcutaneous space (between 1st and 2nd toes) 12 hours before the operation to assess Yamamoto stage. Lymphatic vessels afferent to the blue dye or ICG stained nodes were used to perform LVA using a collateral branch of the great saphenous vein.Treatment effects were assessed using lower extremity lymphedema index (LELI) before and 3 months after surgery.
Results: There were 7 patients with stage II, 30 patients with stage III, 15 patients with stage IV, 3 patient with stage V. Thirteen patients had recurrent lymphangitis. Mean preoperative transport index by lymphoscintigraphy was 36.3 Mean operation time was 189 minutes. Forty eight patients achieved reduction in affected leg volume (87.3%). Among these cases, 31 (56.4%)patients showed reduction of over 3 cm in the circumference of the lower leg. Mean reduction rate of excessive volume 3 months after surgery was 36.3% (7.2-90%) by LELI measurement. Pitting edemas were improved in 51 paitients (92.3%).
Conclusion: Lymphovenous anastomosis is a feasible and effective surgical procedure for those struggling with lower extremity lymphedema arising from the treatment of gynecologic malignancies This approach could be a reasonable choice for the treatment of secondary lymphedema refractory to complex physical therapy.