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

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.

Lymphatic Complications Following Sentinel Node Biopsy or Pelvic Lymphadenectomy for Endometrial Cancer

“…Because of the uncertainty in the methods and criteria for LEL diagnosis, the previous reports do not all have a similar occurrence rate of LEL. Diagnostic procedures for LEL include physical examination, ultrasonography, magnetic resonance imaging, magnetic resonance lymphography, computed tomography lymphography, lymphoscintigraphy, and indocyanine green lymphography [ 41 ]. It has been reported that the Gynecologic Cancer Lymphedema Questionnaire is useful as a subjective assessment to evaluate patients for LEL [ 42 ].…”

Cerebrospinal Fluid Dynamics: Uncovering Alternative Blood Vessel Clearance Mechanisms

“…The contribution of blood vessels and lymphatic vessels to ISF absorption may vary depending on the local tissue conditions, including vascular densities and in ammation (20). However, it is generally agreed that, under normal circumstances, the absorption of interstitial uid is predominantly accomplished by the blood vessels (blood capillaries) (21)(22)(23), while the lymphatic vessels help to remove any excess uid that is not absorbed by the blood capillaries (21)(22)(23). Despite the evidence, the direct blood vessel contribution to CSF/ISF absorption has never been addressed in the nasal cavity.…”

Usage criteria, effectiveness, and limitations of biker shorts-type elastic garment for the treatment of secondary lower limb lymphedema

“…Currently, secondary lymphedema that occurs after cancer treatment is a major problem owing to an increase in the number of cancer survivors. Its reported incidence is 7-77% following treatment for breast cancer [1][2][3] and 0-70% following treatment for gynecologic cancers [4][5][6]. It is intractable as it progresses; however, its progress can be prevented using early treatments and interventions [7].…”