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, 19 (1), 177

Long Term Outcomes From Lymphatic Venous Anastomosis After Total Hysterectomy to Prevent Postoperative Lymphedema in Lower Limb

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Long Term Outcomes From Lymphatic Venous Anastomosis After Total Hysterectomy to Prevent Postoperative Lymphedema in Lower Limb

Masahiro Ezawa et al. BMC Surg.

Abstract

Background: Lymphedema in lower limb is one of major postoperative complications followed by a total hysterectomy with lymph node dissection. The objective of this report is to examine a long-term result of lymphaticovenous anastomosis procedure as a preventive surgery.

Methods: Sixteen patients with endometrial cancer underwent an abdominal hysterectomy with a bilateral salpingo-oophorectomy. Just after pelvic lymph node dissection, either end-to-end or sleeve anastomosis utilizing venules and suprainguinal lymph vessels was performed. During the observation period from 4 to 13 years, the symptom of lymphedema in lower extremities has been assessed.

Results: Among 16 patients, 1 presented postoperative lymphedema grade 3 (CTCAE (Common Terminology Criteria for Adverse Events) Ver. 4.0, 10025233) in lower limb, and a second surgery at 7 years after the first one was required. Other 6 patients showed non-severe symptoms of lymphedema, diagnosed as grade 1. The rest 9 patients did not show any symptoms of postoperative lymphedema in a long term (up to 13 years).

Conclusion: From the long term outcomes of our 16 cases, we propose that a direct lymphaticovenous microsurgery immediately after a hysterectomy with lymphadenectomy of external inguinal lymph node is one of the appropriate therapeutic choices to prevent severe lymphedema in lower limb.

Keywords: Lymphaticovenous anastomosis; Lymphedema; Microsurgery.

Conflict of interest statement

The authors have no competing interests to disclose.

Figures

Fig. 1
Fig. 1
Lymphangiography of Case #6 at 7 years and 3 months (87 months) of post-surgery. From front and back side images were shown in lymphatic scintigraphy (740 MBq) in early (left) and delayed (right) phase. MRI contrast agent (tracer) stayed in bilateral lower leg, indicating lymphedema. Note that visualization above the pelvic region is less clear. The arrow indicates grade III lymphedema in the patient

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