Treatment of Early-Stage Gynecological Cancer-Related Lower Limb Lymphedema by Lymphaticovenular Anastomosis—The Triple Incision Approach
<i>Background and Objectives</i>: Lower extremity lymphedema (LEL) is one of the most relevant chronic and disabling sequelae after gynecological cancer therapy involving pelvic lymphadenectomy (PL). Supermicrosurgical lymphaticovenular anastomosis (LVA) is a safe and effective procedure...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-05-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/5/631 |
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| author | Anna Amelia Caretto Gianluigi Stefanizzi Giorgia Garganese Simona Maria Fragomeni Alex Federico Luca Tagliaferri Bruno Fionda Alessandro Cina Giovanni Scambia Stefano Gentileschi |
| author_facet | Anna Amelia Caretto Gianluigi Stefanizzi Giorgia Garganese Simona Maria Fragomeni Alex Federico Luca Tagliaferri Bruno Fionda Alessandro Cina Giovanni Scambia Stefano Gentileschi |
| author_sort | Anna Amelia Caretto |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Lower extremity lymphedema (LEL) is one of the most relevant chronic and disabling sequelae after gynecological cancer therapy involving pelvic lymphadenectomy (PL). Supermicrosurgical lymphaticovenular anastomosis (LVA) is a safe and effective procedure to treat LEL, particularly indicated in early-stage cases when conservative therapies are insufficient to control the swelling. Usually, preoperative assessment of these patients shows patent and peristaltic lymphatic vessels that can be mapped throughout the limb to plan the sites of skin incision to perform LVA. The aim of this study is to report the efficacy of our approach based on planning LVA in three areas of the lower limb in improving early-stage gynecological cancer-related lymphedema (GCRL) secondary to PL. <i>Materials and Methods</i>: We retrospectively reviewed the data of patients who underwent LVA for the treatment of early-stage GCRL following PL. Patients who had undergone groin dissection were excluded. Our preoperative study based on indocyanine green lymphography (ICG-L) and color doppler ultrasound (CDU) planned three incision sites located in the groin, in the medial surface of the distal third of the thigh, and in the upper half of the leg, to perform LVA. The primary outcome measure was the variation of the mean circumference of the limb after surgery. The changes between preoperative and postoperative limbs’ measures were analyzed by Student’s <i>t</i>-test. <i>p</i> values < 0.05 were considered significant. <i>Results</i>: Thirty-three patients were included. In every patient, three incision sites were employed to perform LVA. A total of 119 LVA were established, with an average of 3.6 for each patient. The mean circumference of the operated limb showed a significant reduction after surgery, decreasing from 37 cm ± 4.1 cm to 36.1 cm ± 4.4 (<i>p</i> < 0.01). <i>Conclusions</i>: Our results suggest that in patients affected by early-stage GCRL secondary to PL, the placement of incision sites in all the anatomical subunits of the lower limb is one of the key factors in achieving good results after LVA. |
| first_indexed | 2024-03-10T03:28:00Z |
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| id | doaj.art-7705ed62399a48978a672993e45fd317 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T03:28:00Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj.art-7705ed62399a48978a672993e45fd3172023-11-23T12:03:39ZengMDPI AGMedicina1010-660X1648-91442022-05-0158563110.3390/medicina58050631Treatment of Early-Stage Gynecological Cancer-Related Lower Limb Lymphedema by Lymphaticovenular Anastomosis—The Triple Incision ApproachAnna Amelia Caretto0Gianluigi Stefanizzi1Giorgia Garganese2Simona Maria Fragomeni3Alex Federico4Luca Tagliaferri5Bruno Fionda6Alessandro Cina7Giovanni Scambia8Stefano Gentileschi9Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyDipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyFacoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyDipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyDipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyDipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyDipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyDipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyFacoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyFacoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy<i>Background and Objectives</i>: Lower extremity lymphedema (LEL) is one of the most relevant chronic and disabling sequelae after gynecological cancer therapy involving pelvic lymphadenectomy (PL). Supermicrosurgical lymphaticovenular anastomosis (LVA) is a safe and effective procedure to treat LEL, particularly indicated in early-stage cases when conservative therapies are insufficient to control the swelling. Usually, preoperative assessment of these patients shows patent and peristaltic lymphatic vessels that can be mapped throughout the limb to plan the sites of skin incision to perform LVA. The aim of this study is to report the efficacy of our approach based on planning LVA in three areas of the lower limb in improving early-stage gynecological cancer-related lymphedema (GCRL) secondary to PL. <i>Materials and Methods</i>: We retrospectively reviewed the data of patients who underwent LVA for the treatment of early-stage GCRL following PL. Patients who had undergone groin dissection were excluded. Our preoperative study based on indocyanine green lymphography (ICG-L) and color doppler ultrasound (CDU) planned three incision sites located in the groin, in the medial surface of the distal third of the thigh, and in the upper half of the leg, to perform LVA. The primary outcome measure was the variation of the mean circumference of the limb after surgery. The changes between preoperative and postoperative limbs’ measures were analyzed by Student’s <i>t</i>-test. <i>p</i> values < 0.05 were considered significant. <i>Results</i>: Thirty-three patients were included. In every patient, three incision sites were employed to perform LVA. A total of 119 LVA were established, with an average of 3.6 for each patient. The mean circumference of the operated limb showed a significant reduction after surgery, decreasing from 37 cm ± 4.1 cm to 36.1 cm ± 4.4 (<i>p</i> < 0.01). <i>Conclusions</i>: Our results suggest that in patients affected by early-stage GCRL secondary to PL, the placement of incision sites in all the anatomical subunits of the lower limb is one of the key factors in achieving good results after LVA.https://www.mdpi.com/1648-9144/58/5/631gynecological cancerendometrial cancercervical cancerlymphedemapelvic lymphadenectomysupermicrosurgery |
| spellingShingle | Anna Amelia Caretto Gianluigi Stefanizzi Giorgia Garganese Simona Maria Fragomeni Alex Federico Luca Tagliaferri Bruno Fionda Alessandro Cina Giovanni Scambia Stefano Gentileschi Treatment of Early-Stage Gynecological Cancer-Related Lower Limb Lymphedema by Lymphaticovenular Anastomosis—The Triple Incision Approach Medicina gynecological cancer endometrial cancer cervical cancer lymphedema pelvic lymphadenectomy supermicrosurgery |
| title | Treatment of Early-Stage Gynecological Cancer-Related Lower Limb Lymphedema by Lymphaticovenular Anastomosis—The Triple Incision Approach |
| title_full | Treatment of Early-Stage Gynecological Cancer-Related Lower Limb Lymphedema by Lymphaticovenular Anastomosis—The Triple Incision Approach |
| title_fullStr | Treatment of Early-Stage Gynecological Cancer-Related Lower Limb Lymphedema by Lymphaticovenular Anastomosis—The Triple Incision Approach |
| title_full_unstemmed | Treatment of Early-Stage Gynecological Cancer-Related Lower Limb Lymphedema by Lymphaticovenular Anastomosis—The Triple Incision Approach |
| title_short | Treatment of Early-Stage Gynecological Cancer-Related Lower Limb Lymphedema by Lymphaticovenular Anastomosis—The Triple Incision Approach |
| title_sort | treatment of early stage gynecological cancer related lower limb lymphedema by lymphaticovenular anastomosis the triple incision approach |
| topic | gynecological cancer endometrial cancer cervical cancer lymphedema pelvic lymphadenectomy supermicrosurgery |
| url | https://www.mdpi.com/1648-9144/58/5/631 |
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