Document Detail

Early diagnosis and risk factors for lymphedema following lymph node dissection for gynecologic cancer.
MedLine Citation:
PMID:  23357989     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although early diagnosis is important for selecting an effective surgical treatment for secondary lymphedema, an efficient screening test for detecting early-stage lymphedema has not yet been established. Serial changes of lymphatic function before and after lymph node dissection and risk factors for secondary lymphedema are important indicators.
METHODS: A prospective cohort observational study was conducted with 100 consecutive gynecologic cancer patients who underwent pelvic lymph node dissection. Lymphatic function was assessed by noninvasive lymphography using indocyanine green fluorescence imaging on a routine schedule. Earliest findings after lymphadenectomy and risk factors for lower leg lymphedema were investigated.
RESULTS: Atypical transient dermal backflow patterns were observed in an early postoperative period in 50 cases, all of which disappeared within 3 months. Of these patterns, the splash pattern was observed in 31 patients, of which five improved to normal following a natural course. In contrast, the stardust pattern was observed in 27 patients, and none had improved with conservative therapy. Postoperative radiotherapy was a significant risk factor for the stardust pattern.
CONCLUSIONS: All patients who undergo lymphadenectomy for gynecologic malignancies should be examined for secondary lower extremity lymphedema by qualitative evaluation methods on a routine schedule to determine the earliest possible diagnosis. Because the splash pattern on indocyanine green lymphography is a reversible lymphatic disorder following a natural course, surgical treatments are not recommended. The decision regarding surgical treatment can be made after observing the stardust pattern.
Shinsuke Akita; Nobuyuki Mitsukawa; Naoaki Rikihisa; Yoshitaka Kubota; Naoko Omori; Akira Mitsuhashi; Shinichi Tate; Makio Shozu; Kaneshige Satoh
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  131     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-29     Completed Date:  2013-04-01     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  283-90     Citation Subset:  AIM; IM    
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MeSH Terms
Early Diagnosis
Genital Neoplasms, Female / surgery*
Lymph Node Excision / adverse effects*
Lymphedema / diagnosis*,  etiology*
Lymphography* / methods
Middle Aged
Prospective Studies
Comment In:
Plast Reconstr Surg. 2013 Sep;132(3):473e-4e   [PMID:  23985668 ]
Plast Reconstr Surg. 2013 Sep;132(3):471e-2e   [PMID:  23985666 ]
Plast Reconstr Surg. 2013 Sep;132(3):469e-71e   [PMID:  23985665 ]
Plast Reconstr Surg. 2013 Feb;131(2):291-2   [PMID:  23357990 ]
Plast Reconstr Surg. 2013 Sep;132(3):472e-3e   [PMID:  23985667 ]

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