Prophylactic Surgery for Gynecologic Cancer-Related Lower Extremity Lymphedema

Lower extremity lymphedema (LEL) is a frequent and debilitating complication following gynecologic cancer surgery. While prophylactic lymph node-to-vein anastomosis (LNVA) may offer a preventive strategy, its efficacy has not been well established.

In this controlled study, 26 gynecologic cancer patients undergoing lymph node clearance received simultaneous prophylactic LNVA (prospective intervention group) from July 2022 to January 2024. A retrospective control group comprised 88 patients who underwent radical lymphadenectomy between April 2018 and February 2019. Patients were evaluated over an average of two-year follow-up using limb circumference, imaging-based measurements of subcutaneous thickness, and bioimpedance analysis to assess the incidence of LEL.

Baseline demographics were similar between the control group and the LNVA group, except for a higher proportion of patients who received adjuvant radiotherapy in the LNVA group and a higher cancer recurrence rate in the control group. At the one-year follow-up, the incidence of lymphedema was significantly lower in the LNVA group compared with the control group (8% vs. 49%; p<0.001). Additionally, the LNVA group exhibited minimal changes in limb volume and bioimpedance values during the one-year follow-up, suggesting preservation of lymphatic drainage.

Prophylactic LNVA performed concurrently with gynecologic cancer surgery was associated with a markedly reduced incidence of lower extremity lymphedema over an average of 2-year period. This preventive strategy may improve patient outcomes by mitigating LEL, a frequent and life-long complication of cancer treatment.