Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2012

01-02-2012 | Reconstructive Oncology

The Surgical Treatment of Lymphedema: A Systematic Review of the Contemporary Literature (2004–2010)

Authors: Janice N. Cormier, MD, MPH, Loren Rourke, MD, Melissa Crosby, MD, David Chang, MD, Jane Armer, RN, PhD

Published in: Annals of Surgical Oncology | Issue 2/2012

Login to get access

Abstract

Purpose

A systematic review of the literature was performed to examine contemporary peer-reviewed literature (2004–2010) evaluating the surgical treatment of lymphedema.

Methods

A comprehensive search of 11 major medical indices was performed. Selected articles were sorted to identify those related to the surgical treatment of lymphedema. Extracted data included the number of patients, specific surgical procedure performed, length of follow-up, criteria for defining lymphedema, measurement methods, volume or circumference reduction, and reported complications.

Results

A total of 20 studies met inclusion criteria; procedures were categorized as excisional procedures (n = 8), lymphatic reconstruction (n = 8), and tissue transfer (n = 4). The reported incidence of volume reduction of lymphedema in these studies varied from 118% reduction to a 13% increase over the follow-up intervals ranging from 6 months to 15 years. The largest reported reductions were noted after excisional procedures (91.1%), lymphatic reconstruction (54.9%), and tissue transfer procedures (47.6%). Procedure complications were rarely reported.

Conclusions

A number of surgical approaches have demonstrated beneficial effects for select patients with lymphedema. Most of these reports, however, are based on small numbers of patients, use nonstandardized or inconsistent measurement techniques, and lack long-term follow-up. The proposed benefits of any surgical approach should be evaluated in the context of the potential morbidity to the individual patient and the availability of surgical expertise. In addition, although these surgical techniques have shown promising results, nearly all note that the procedures do not obviate the need for continued use of conventional therapies, including compression, for long-term maintenance.
Literature
1.
Rockson SG, Rivera KK. Estimating the population burden of lymphedema. Ann N Y Acad Sci. 2008;1131:147–54.PubMedCrossRef
2.
Lawenda BD, Mondry TE, Johnstone PA. Lymphedema: a primer on the identification and management of a chronic condition in oncologic treatment. CA Cancer J Clin. 2009;59:8–24.PubMedCrossRef
3.
Cormier JN, Askew RL, Mungovan KS, et al. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer. 2010;116:5138–49.PubMedCrossRef
4.
Morgan PA, Franks PJ, Moffatt CJ. Health-related quality of life with lymphoedema: a review of the literature. Int Wound J. 2005;2:47–62.PubMedCrossRef
5.
Shih YC, Xu Y, Cormier JN, et al. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. J Clin Oncol. 2009;27:2007–14.PubMedCrossRef
6.
7.
8.
Charles H. Elephantiasis of the leg. In: Latham A, English TC, editors. A system of treatment. Vol. 3. London: Churchill; 1912.
9.
Sistrunk WE. Modification of the operation for elephantiasis. JAMA. 1918;71:800–3.CrossRef
10.
Homans J. Treatment of elephantiasis of the leg. N Engl J Med. 1936;215:1099.CrossRef
11.
Gloviczki P. Principles of surgical treatment. In: Browse N, Burnand K, Mortimer P, editors. Diseases of the lymphatics. London: Arnold; 2003. p. 179–204.
12.
Brorson H, Ohlin K, Olsson G, Karlsson MK. Breast cancer-related chronic arm lymphedema is associated with excess adipose and muscle tissue. Lymphat Res Biol. 2009;7:3–10.PubMedCrossRef
13.
Brorson H, Ohlin K, Olsson G, Nilsson M. Adipose tissue dominates chronic arm lymphedema following breast cancer: an analysis using volume rendered CT images. Lymphat Res Biol. 2006;4:199–210.PubMedCrossRef
14.
O’Brien BM, Mellow CG, Khazanchi RK, et al. Long-term results after microlymphaticovenous anastomoses for the treatment of obstructive lymphedema. Plast Reconstr Surg. 1990;85:562–72.PubMedCrossRef
15.
Campisi C, Boccardo F. Role of microsurgery in the management of lymphoedema. Int Angiol. 1999;18:47–51.PubMed
16.
17.
Campisi C, Boccardo F, Zilli A, et al. Long-term results after lymphatic-venous anastomoses for the treatment of obstructive lymphedema. Microsurgery. 2001;21:135–9.PubMedCrossRef
18.
Olszewski WL. The treatment of lymphedema of the extremities with microsurgical lympho-venous anastomoses. Int Angiol. 1988;7:312–21.PubMed
19.
Baumeister RG, Siuda S. Treatment of lymphedemas by microsurgical lymphatic grafting: what is proved? Plast Reconstr Surg. 1990;85:64–74.PubMedCrossRef
20.
Koshima I, Nanba Y, Tsutsui T, et al. Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg. J Reconstr Microsurg. 2003;19:209–15.PubMedCrossRef
21.
Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg. 2000;16:437–42.PubMedCrossRef
22.
Kleinhaus E, Baumeister RGH, Hahn D. Evaluation of transport kinetics in lymphoscintigraphy: follow-up study in patients with transplanted lymphatic vessels. Eur J Nucl Med. 1985;10:349–62.
23.
Baumeister RG, Siuda S, Bohmert H, Moser E. A microsurgical method for reconstruction of interrupted lymphatic pathways: autologous lymph-vessel transplantation for treatment of lymphedemas. Scand J Plast Reconstr Surg. 1986;20:141–6.PubMedCrossRef
24.
Baumeister RG, Frick A, Hofmann T. 10 years experience with autogenous microsurgical lymphvessel-transplantation. Eur J Lymphol. 1991;27:787.
25.
Baumeister RG, Fink U, Tatsch K, Frick A. Microsurgical lymphatic grafting: first demonstration of patent grafts by indirect lymphography and long term follow-up studies. Progr Lymphol. 1994;27:787.
26.
Campisi C, Boccardo F, Zilli A, et al. The use of vein grafts in the treatment of peripheral lymphedemas: long-term results. Microsurgery. 2001;21:143–7.PubMedCrossRef
27.
Classen DA, Irvine L. Free muscle flap transfer as a lymphatic bridge for upper extremity lymphedema. J Reconstr Microsurg. 2005;21:93–9.PubMedCrossRef
28.
Slavin SA, Van den Abbeele AD, Losken A, et al. Return of lymphatic function after flap transfer for acute lymphedema. Ann Surg. 1999;229:421–7.PubMedCrossRef
29.
Medgyesi S. A successful operation for lymphoedema using a myocutaneous flap as a “wick.” Br J Plast Surg. 1983;36:64–6.PubMedCrossRef
30.
Slavin SA, Upton J, Kaplan WD, Van den Abbeele AD. An investigation of lymphatic function following free-tissue transfer. Plast Reconstr Surg. 1997;99:730–41.PubMedCrossRef
31.
Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain. 1998;77:1–13.PubMedCrossRef
32.
Kuijpers T, van der Windt DA, van der Heijden GJ, Bouter LM. Systematic review of prognostic cohort studies on shoulder disorders. Pain. 2004;109:420–31.PubMedCrossRef
33.
Scholten-Peeters GG, Verhagen AP, Bekkering GE, et al. Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies. Pain. 2003;104:303–22.PubMedCrossRef
34.
Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3:25.PubMedCrossRef
35.
Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV. Quality of life among long-term breast cancer survivors: a systematic review. Eur J Cancer. 2005;41:2613–9.PubMedCrossRef
36.
Matsubara S, Sakuda H, Nakaema M, Kuniyoshi Y. Long-term results of microscopic lymphatic vessel-isolated vein anastomosis for secondary lymphedema of the lower extremities. Surg Today. 2006;36:859–64.PubMedCrossRef
37.
Narushima M, Mihara M, Yamamoto Y, et al. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg. 2010;125:935–43.PubMedCrossRef
38.
Belcaro G, Errichi BM, Cesarone MR, et al. Lymphatic tissue transplant in lymphedema—a minimally invasive, outpatient, surgical method: a 10-year follow-up pilot study. Angiology. 2008;59:77–83.PubMedCrossRef
39.
Becker C, Assouad J, Riquet M, Hidden G. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg. 2006;243:313–5.PubMedCrossRef
40.
Lee BB, Kim YW, Kim DI, et al. Supplemental surgical treatment to end stage (stage IV–V) of chronic lymphedema. Int Angiol. 2008;27:389–95.PubMed
41.
Salgado CJ. Radical reduction of upper extremity lymphedema with preservation of perforators. Ann Plast Surg. 2009;63:302–6.PubMedCrossRef
42.
Modolin M, Mitre AI, da Silva JC, et al. Surgical treatment of lymphedema of the penis and scrotum. Clinics (Sao Paulo). 2006;61:289–94.CrossRef
43.
Brorson H, Ohlin K, Olsson G, et al. Quality of life following liposuction and conservative treatment of arm lymphedema. Lymphology. 2006;39:8–25.PubMed
44.
Damstra RJ, Voesten HG, Klinkert P, Brorson H. Circumferential suction-assisted lipectomy for lymphoedema after surgery for breast cancer. Br J Surg. 2009;96:859–64.PubMedCrossRef
45.
Liu Q, Zhou X, Wei Q. Treatment of upper limb lymphedema after radical mastectomy with liposuction technique and pressure therapy. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005;19:344–5.PubMed
46.
Qi F, Gu J, Shi Y, Yang Y. Treatment of upper limb lymphedema with combination of liposuction, myocutaneous flap transfer, and lymph-fascia grafting: a preliminary study. Microsurgery. 2009;29:29–34.PubMedCrossRef
47.
Damstra RJ, Voesten HG, van Schelven WD, van der Lei B. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Res Treat. 2009;113:199–206.
48.
Demirtas Y, Ozturk N, Yapici O, Topalan M. Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Microsurgery. 2009;29:609–18.PubMedCrossRef
49.
Chang DW. Lymphaticovenular bypass for lymphedema management in breast cancer patients: a prospective study. Plast Reconstr Surg. 2010;126:752–8.PubMedCrossRef
50.
Campisi C, Davini D, Bellini C, et al. Lymphatic microsurgery for the treatment of lymphedema. Microsurgery. 2006;26:65–9.PubMedCrossRef
51.
Hou C, Wu X, Jin X. Autologous bone marrow stromal cells transplantation for the treatment of secondary arm lymphedema: a prospective controlled study in patients with breast cancer related lymphedema. Jpn J Clin Oncol. 2008;38:670–4.PubMedCrossRef
52.
Lin CH, Ali R, Chen SC, et al. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Plast Reconstr Surg. 2009;123:1265–75.PubMedCrossRef
53.
Maegawa J, Mikami T, Yamamoto Y, et al. Types of lymphoscintigraphy and indications for lymphaticovenous anastomosis. Microsurgery. 2010;30:437–42.PubMedCrossRef
54.
Campisi C, Bellini C, Accogli S, et al. Microsurgery for lymphedema: clinical research and long-term results. Microsurgery. 2010;30:256–60.PubMed
55.
Brorson H. Liposuction in arm lymphedema treatment. Scand J Surg. 2003;92:287–95.PubMed
56.
Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S, Fujitsu M. Minimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema: is it effective for stage III and IV? Ann Plast Surg. 2004;53(3):261–6.PubMedCrossRef
57.
Logmans A, Kruyt RH, de Bruin HG, et al. Lymphedema and lymphocysts following lymphadenectomy may be prevented by omentoplasty: a pilot study. Gynecol Oncol. 1999;75:323–7.PubMedCrossRef
58.
Benoit L, Boichot C, Cheynel N, et al. Preventing lymphedema and morbidity with an omentum flap after ilioinguinal lymph node dissection. Ann Surg Oncol. 2005;12:793–9.PubMedCrossRef
59.
Ngan HY, Tam KF, Ng TY. Prevention of lymphoedema using omentoplasty after pelvic lymphadenectomy: a prospective randomised controlled trial. Hong Kong Med J. 2008;14(5 Suppl):43–6.PubMed
60.
Orefice S, Conti AR, Grassi M, Salvadori B. The use of lympho-venous anastomoses to prevent complications from ilio-inguinal dissection. Tumori. 1988;74:347–51.PubMed
61.
Takeishi M, Kojima M, Mori K, et al. Primary intrapelvic lymphaticovenular anastomosis following lymph node dissection. Ann Plast Surg. 2006;57:300–4.PubMedCrossRef
62.
Campisi C, Davini D, Bellini C, et al. Is there a role for microsurgery in the prevention of arm lymphedema secondary to breast cancer treatment? Microsurgery. 2006;26:70–2.PubMedCrossRef
63.
Boccardo F, Casabona F, De Cian F, et al. Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy. Ann Surg Oncol. 2009;16:703–8.PubMedCrossRef
64.
Dardarian TS, Gray HJ, Morgan MA, et al. Saphenous vein sparing during inguinal lymphadenectomy to reduce morbidity in patients with vulvar carcinoma. Gynecol Oncol. 2006;101:140–2.PubMedCrossRef
65.
Boccardo FM, Ansaldi F, Bellini C, et al. Prospective evaluation of a prevention protocol for lymphedema following surgery for breast cancer. Lymphology. 2009;42:1–9.PubMed
66.
Torres Lacomba M, Yuste Sanchez MJ, Zapico Goni A, et al. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ. 2010; 340: b5396.PubMedCrossRef
67.
Nakamura K, Rockson SG. Molecular targets for therapeutic lymphangiogenesis in lymphatic dysfunction and disease. Lymphat Res Biol. 2008;6:181–9.PubMedCrossRef
68.
Maby-El Hajjami H, Petrova TV. Developmental and pathological lymphangiogenesis: from models to human disease. Histochem Cell Biol. 2008;130:1063–78.PubMedCrossRef
69.
Jin da P, An A, Liu J, et al. Therapeutic responses to exogenous VEGF-C administration in experimental lymphedema: immunohistochemical and molecular characterization. Lymphat Res Biol. 2009;7:47–57.PubMedCrossRef
70.
Unno N, Nishiyama M, Suzuki M, et al. A novel method of measuring human lymphatic pumping using indocyanine green fluorescence lymphography. J Vasc Surg. 2010;52:946–52.PubMedCrossRef
71.
Suami H, Pan WR, Taylor GI. Changes in the lymph structure of the upper limb after axillary dissection: radiographic and anatomical study in a human cadaver. Plast Reconstr Surg. 2007;120:982–91.PubMedCrossRef
72.
Rasmussen JC, Tan IC, Marshall MV, et al. Human lymphatic architecture and dynamic transport imaged using near-infrared fluorescence. Transl Oncol. 2010;3:362–72.PubMed
73.
Baker A, Kim H, Semple JL, et al. Experimental assessment of pro-lymphangiogenic growth factors in the treatment of post-surgical lymphedema following lymphadenectomy. Breast Cancer Res. 2010;12:R70.PubMedCrossRef
74.
Avraham T, Daluvoy S, Zampell J, et al. Blockade of transforming growth factor-beta1 accelerates lymphatic regeneration during wound repair. Am J Pathol. 2010;177:3202–14.PubMedCrossRef
75.
Liu Y, Fang Y, Dong P, et al. Effect of vascular endothelial growth factor C (VEGF-C) gene transfer in rat model of secondary lymphedema. Vascul Pharmacol. 2008;49:44–50.PubMedCrossRef
76.
Tobbia D, Semple J, Baker A, et al. Lymphedema development and lymphatic function following lymph node excision in sheep. J Vasc Res. 2009;46:426–34.PubMedCrossRef
77.
Jiang Z, Lu Q, Kretlow JD, et al. Evaluation of lymphatic function by means of dynamic Gd-BOPTA-enhanced MRL in experimental rabbit limb lymphedema. Med Sci Monit. 2010;16:BR313.PubMed
78.
Blum KS, Hadamitzky C, Gratz KF, Pabst R. Effects of autotransplanted lymph node fragments on the lymphatic system in the pig model. Breast Cancer Res Treat. 2009;120:59–66.PubMedCrossRef
79.
Wallmichrath J, Baumeister RG, Deglmann CJ, et al. Technique and proof of patency of microsurgical lympho-lymphonodular anastomoses: a study in the rat model. Microsurgery. 2009;29:303–9.PubMedCrossRef
80.
Warren AG, Brorson H, Borud LJ, Slavin SA. Lymphedema: a comprehensive review. Ann Plast Surg. 2007;59:464–72.PubMedCrossRef
Metadata
Title
The Surgical Treatment of Lymphedema: A Systematic Review of the Contemporary Literature (2004–2010)
Authors
Janice N. Cormier, MD, MPH
Loren Rourke, MD
Melissa Crosby, MD
David Chang, MD
Jane Armer, RN, PhD
Publication date
01-02-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-2017-4

Other articles of this Issue 2/2012

Annals of Surgical Oncology 2/2012 Go to the issue

Endocrine Tumors

A Meta-analysis of Preoperative Localization Techniques for Patients with Primary Hyperparathyroidism

Thoracic Oncology

Sublobectomy Versus Lobectomy for Stage I Non-Small-Cell Lung Cancer, A Meta-Analysis of Published Studies

Hepatobiliary Tumors

Colorectal Liver Metastasis in the Setting of Lymph Node Metastasis: Defining the Benefit of Surgical Resection

Gastrointestinal Oncology

Sentinel Node Biopsy in Early Gastric Cancer: Constant Exertion for Clinical Application

Hepatobiliary Tumors

EGFR Nuclear Import in Gallbladder Carcinoma: Nuclear Phosphorylated EGFR Upregulates iNOS Expression and Confers Independent Prognostic Impact

Healthcare Policy and Outcomes

Use of Multimodality Neoadjuvant Therapy for Esophageal Cancer in the United States: Assessment of 987 Hospitals