Lymphatic vessel diameter in female pelvic cancer-related lower extremity lymphedematous limbs

Lymphaticovenular anastomosis (LVA) has become one of the useful surgical treatments for compression-refractory lower extremity lymphedema (LEL). It is important to anastomose larger lymphatic vessels with abundant lymph flows in LVA surgery. This study aimed to clarify factors associated with lymphatic vessel diameter.

One hundred thirty-four LEL patients who underwent pre-operative indocyanine green (ICG) lymphography and LVA from June 2009 to August 2014 in a single institution were included in this retrospective observational study. Clinical, ICG lymphography, and intraoperative findings were collected from medical charts. A lymphatic vessel with external diameters of 0.5 mm or larger was defined as a large lymphatic vessel (LLV). Independent factors associated with LLV were identified using logistic regression analysis.

Nine hundred sixty-two lymphatic vessels were identified, among which 438 (45.5%) were LLVs. Independent factors associated with LLV were older age (odds ration [OR], 1.408; 95% confidence interval [CI], 1.026-1.931; P = 0.034), positive history of radiation (OR, 1.634; 95%CI 1.228-2.173; P = 0.001), incision site in the thigh/lower leg compared with in the groin (OR, 1.617/1.685; 95%CI 1.076-2.432/1.148-2.473; P = 0.021/0.008). Inverse associations were observed in S-region/D-region on ICG lymphography compared with L-region (OR, 0.537/0.048; 95%CI, 0.397-0.726/0.006-0.371; P < 0.001/0.004).

D-region on ICG lymphography had the lowest OR to find LLV, representing that lymphatic vessels found in D-region on ICG lymphography would be significantly smaller than those in L-region. In LVA surgery, D-region should be avoided.