Localized lymphedema after treatment for soft tissue sarcoma in the lower limbs: Comparison of improvement according to duration before lymphaticovenular anastomosis

Yoshida, Shuhei; Koshima, Isao; Imai, Hirofumi; Uchiki, Toshio; Sasaki, Ayano; Fujioka, Yoshimi; Nagamatsu, Shogo; Yokota, Kazushige; Harima, Mitsunobu; Yamashita, Shuji

doi:10.1002/ccr3.2278

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…While the efficacy of LVAs in treatment of lymphedema after oncologic surgery could already be demonstrated there is further consensus that treatment should be initiated as early as possible to improve the clinical outcome of these patients (Li et al, 2013). In a recently published case series Yoshida et al could show that patients recover from lymphedema more quickly the earlier LVA is performed in the affected limb (Yoshida et al, 2019). Accordingly, Kobayashi reported the ability of LVAs to reduce lymphorrhea and lymphedema and improve dead space management after resection of soft tissue tumors of the thigh to be improved if performed at early time points after primary surgery (Kobayashi et al, 2017).…”

Section: Resultsmentioning

confidence: 99%

Prophylactic lymphaticovenous anastomoses for resection of soft tissue tumors of the thigh to prevent secondary lymphedema–a retrospective comparative cohort analysis

et al. 2021

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Background: Patients with soft tissue tumors of extremities are at risk to develop secondary lymphedema after tumor resection caused by disruption of lymphatic vessels and sclerosis. Subsequently, this study aimed to evaluate the beneficial effects of lymphaticovenous anastomoses (LVAs) after soft tissue tumor resection of the thigh in a prophylactic approach. Methods: In a retrospective cohort study, we compared eight patients with a median age of 68.5 years (49-80) who received LVAs in combination with tumor resection for treatment of soft tissue tumors of the thigh region with a prior cohort of 20 patients with a median age of 63.0 years (23-84) who received soft tissue sarcoma resection of the thigh region. All patients of LVA cohort received 1-2 LVAs (mean 1.25 ± 0.49) at the dorsum of the foot and three patients at the SEKI-point (mean 0.375 ± 0.51). Mean maximum tumor diameter of LVA group was 19.5 ± 5.2 cm and 12.3 ± 6.6 cm of control group. All patients receiving LVA were assessed for development of lymphedema via bilateral measurements of circumference and assessment of lymphedema quality of life index (LyQLI). Results: One of the eight patients who received LVAs showed moderate impairment in the LyQLI at a follow-up of 12 months while 45% of the control cohort complained about symptoms of secondary lymphedema at a median follow-up of 22 months (p-values LyQLI: p = .018 [physical domain]; p = .018 [psychosocial domain]; p = .020 [practical domain]). Conclusion: LVAs performed in combination with tumor resection of thigh soft tissue tumors reduce negative consequences of lymph stasis and prevent development of secondary lymphedema.

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Section: Resultsmentioning

confidence: 99%

Prophylactic lymphaticovenous anastomoses for resection of soft tissue tumors of the thigh to prevent secondary lymphedema–a retrospective comparative cohort analysis

et al. 2021

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“…Surgical options for preventing lower limb lymphedema have been used in patients that underwent an inguinal lymphonodectomy. Lymphatic-venous anastomoses or a lymph node transfer are surgical options to prevent or treat post-therapeutic lymphedema; however, it is not a standard procedure [ 28 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

The Lymph-Sparing Quotient: A Retrospective Risk Analysis on Extremity Radiation for Soft Tissue Sarcoma Treatment

Sarif

Elsayad

Rolf

et al. 2021

Cancers

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Radiation therapy (RT) for extremity soft tissue sarcoma is associated with lymphedema risk. In this study, we analyzed the influence of lymph-sparing volume on the lymphedema occurrence in patients who received adjuvant extremity RT. The lymph-sparing quotient (LSQ) was calculated by dividing the lymph-sparing volume by the total extremity volume with double weightingfor the narrowest lymph-sparing region. A total of 34 patients were enrolled in this analysis. The median applied total radiation dose was 66.3 Gy in 36 fractions. Acute lymphedema appeared in 12 patients (35%). Most of them (n = 8) were lymphedema grade 1 and five patients had grade 2 to 3 lymphedema. Chronic lymphedema appeared in 22 patients (65%). 17 of these patients had at least a grade 2 lymphedema. In 13 of 14 patients with an LSQ ≤ 0.2 and 11 of 20 patients with an LSQ > 0.2, an acute or chronic lymphedema ≥ grade 2 was observed. A Kaplan–Meier Analysis of the two groups with the endpoint of a two-year lymph edema-free survival (=2-YLEFS) was estimated with an univariate, significant result (2-YLEFS LSQ ≤ 0.2 vs. LSQ > 0.2: 0% vs. 39%; p = 0.006; hazard ratio LSQ ≤ 0.2 vs. > 0.2 2-YLEFS 2.822 (p = 0.013); 95% confidence interval (CI): 1.24–6.42). Maximizing the potential oncologically-justifiable lymph-sparing volume should be considered to reduce the risk of high-grade lymphedema when applying RT to extremities.

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Localized lymphedema after treatment for soft tissue sarcoma in the lower limbs: Comparison of improvement according to duration before lymphaticovenular anastomosis

Cited by 2 publications

References 11 publications

Prophylactic lymphaticovenous anastomoses for resection of soft tissue tumors of the thigh to prevent secondary lymphedema–a retrospective comparative cohort analysis

Prophylactic lymphaticovenous anastomoses for resection of soft tissue tumors of the thigh to prevent secondary lymphedema–a retrospective comparative cohort analysis

The Lymph-Sparing Quotient: A Retrospective Risk Analysis on Extremity Radiation for Soft Tissue Sarcoma Treatment

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