J Reconstr Microsurg 2020; 36(07): 471-479
DOI: 10.1055/s-0040-1710047
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Microsurgical Strategies for Prophylaxis of Cancer-Related Extremity Lymphedema: A Comprehensive Review of the Literature

Jose Ramon Rodriguez
1  Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan
2  Department of Plastic and Reconstructive Surgery, Clinica Las Condes, Santiago, Chile
,
Yuma Fuse
1  Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan
,
Takumi Yamamoto
1  Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

12 December 2019

21 March 2020

Publication Date:
29 April 2020 (online)

Abstract

Background Cancer-related lymphedema represents the first cause of noninfectious secondary extremity lymphedema. This entity is a progressive and debilitating disease with no curative treatment available. With the advent of lymphedema microsurgery, focus has turned into risk reduction and prevention of the disease progression.

Methods Literature review was conducted to clarify current microsurgical approach to prophylaxis of cancer treatment-related extremity lymphedema.

Results Prophylactic approach could be classified into primary and secondary prevention; microsurgical procedures were performed simultaneously with cancer ablation in primary prevention, and secondary prevention was performed secondarily after cancer treatment for selected high-risk subclinical cases. Indocyanine green lymphography was the most useful method for lymphedema screening after cancer treatment and to diagnose subclinical lymphedema. Several lymphovenous shunt operations were performed as prophylactic procedures, and classified into microsurgical lymphovenous implantation and supermicrosurgical lymphovenous intima-to-intima coaptation. Both showed clinically significant prophylactic effects.

Conclusion This review provides a comprehensive overview of the literature regarding microsurgical interventions for the prevention of cancer-related extremity lymphedema. There are several methods for lymphedema prophylaxis and further studies are required to clarify indication of each method.