An Abnormal Buildup of Fluid

Over 250 million people worldwide have lymphedema, mostly as a result of parasitic infection from roundworm. However, in developed countries, the leading cause is damage to the lymphatic system because of cancer treatment. The condition can arise after surgery or radiation treatment for nearly any type of cancer but is most commonly linked to breast, prostate and pelvic area cancers (such as bladder, penile, testicular, endometrial, vulvar and cervical cancers), lymphoma, melanoma, and head and neck cancers.

The lymphatic system consists of a complex network of vessels, tissues and organs that helps the body maintain fluid balance and defend against infection. Lymph fluid travels through the system similarly to how blood travels through the circulatory system. Lymphedema occurs when lymph fluid can no longer flow normally due to damage or a blockage in the system. Fluid builds up in the tissues and causes regional swelling; consequently, patients feel discomfort, heaviness, tightness and a loss of mobility. They also have a higher likelihood of infection from cuts, scratches or insect bites, because their lymph fluid is unable to effectively filter out bacteria and toxins.

Growing Demand for Surgical Options

Three surgical procedures exist for lymphedema, which can also be combined to improve effectiveness: lymphovenous bypass, vascularized lymph node transplant and suction-assisted lipectomy, also known as liposuction. Lymphovenous bypass, which connects lymphatic vessels to small adjacent veins to bypass the damaged area, is a minimally invasive procedure with 1- to 2-centimeter-long incisions. The surgery takes two to three hours under general anesthesia, with a hospital stay of less than 24 hours. Risks are minimal, Schaverien says. The surgery was first described by Japanese surgeon Yukio Yamada in 1969.

A major risk of lymph node transplant is that it simply may not work for everyone, for reasons yet unknown. Schaverien says about 1% of transplants fail to reestablish circulation. Additional risks depend on where in the body the harvest occurred. For instance, lymph node removal from the abdomen involves risks that come with any abdominal surgery, such as bowel obstruction, hernia, intra-abdominal injury and ileus; however, there appears to be no risk of causing lymphedema from where the lymph nodes are taken.

Taking lymph nodes from under the arm, groin or neck may cause lymphedema in those areas, so surgeons today sometimes employ an innovative technique called reverse lymphatic mapping. This strategy involves injecting different-colored dyes into the body to determine which lymph nodes can be safely removed. Lymph nodes draining the limb are avoided, while those draining the trunk may be harvested.

Media Contact

John Mathews
Journal Manager
Journal of Phlebology and Lymphology
Email: phlebology@eclinicalsci.com