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

Yumiko Watanabe, Masafumi Koshiyama, Keiko Seki, Miwa Nakagawa, Eri Ikuta, Makiko Oowaki, Shin-Ichi Sakamoto, Yumiko Watanabe, Masafumi Koshiyama, Keiko Seki, Miwa Nakagawa, Eri Ikuta, Makiko Oowaki, Shin-Ichi Sakamoto

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.

Keywords: diagnosis; gynecologic cancer; lymphedema; treatment.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Under normal conditions, venous capillaries reabsorb 90% of the interstitial fluid and lymphatic channels absorb the remaining 10% of lymph fluid and proteins. Pelvic lymphadenectomy or irradiation can induce the destruction or obstruction of the central lymphatic vessels. Lymph stasis results in the accumulation of protein in the extracellular space, which increase the tissue colloid osmotic pressure, causing edema formation.

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