Early Diagnosis of Lymphedema and Indication of Preventive Lymphatic Venous Anastomosis

Lymphedema often develops as a postoperative complication of breast and uterine cancer. Lymphadenectomy and radiation therapy increase the rate of onset of lyphedema. We have reported that we can improve the prognosis of lymphedema by performing LVAs as early as possible. Preventive LVAs also have good results. However, it is difficult to detect lyphedema at an early stage, often resulting in developed lymphedema ath the initial visit. To address this issue, we cooperated with gynecology department, and we established the diagnostic guideline and found high-risk group of lymphedema.

Methods.

Lymphangiography using ICG (indocyanine green) dye was performed on nineteen patients who had gynecological operation requiring pelvic lymphadenectomy. The assessment was done a day before surgery and at 1 week, 1 month after the procedure, and every month thereafter.

Results.

Immediately after operation, most patients were swollen from the pubic region to the thighs, which were compatible with findings on the lymphangiography. The swelling improved subsequently in patients with good lymphatic flow in preoperative lymphangiopraphy. In contrast, those with poor flow had no improvement and developed lymphedema. LVAs were performed on those patients, which showed good postoperative results.

Discussion.

The lymphangiography image in lymphedema  showing “dermal back flow” is different from the ICG pooling just after operation. Although it is reported that 30% of patients who underwent lymphadenectomy develop lymphedema, it is not dependent on congenital lymphatic function. In this study, lymphedema was shown to develop in patients with poor preoperative lymphatic flow, which could be indication for preventive LVA.