Lymphedema and obesity: is there a link?

Abstract

Lymphedema is a chronic disorder that, in developed countries, occurs most commonly after lymph node dissection for cancer treatment. Although the pathophysiology of lymphedema is unknown, the disease is characterized histologically by fibrosis and abnormal adipose deposition. Clinical studies have provided evidence that obesity and postoperative weight gain are significant risk factors for the development of lymphedema. In fact, recent studies have shown that extreme obesity can result in markedly impaired lymphatic function and primary lymphedema. The aim of this Special Topic article is to review evidence linking obesity and lymphedema. In addition, the authors review recent studies that have analyzed the cellular mechanisms that may be responsible for this relationship, with a goal of highlighting areas of research that may have significant translational potential.

Fig. 1

End-stage lymphedema is associated with subcutaneous adipose deposition and “regional” obesity. (Left) Bilateral magnetic resonance imaging scan of a patient with severe left leg lymphedema after groin lymph node dissection for melanoma 15 years previously. Note significant adipose deposition in the subcutaneous compartment of the affected leg (blue brackets) compared with the normal limb. (Right) Photograph of a young patient with grade II lymphedema of the left leg 2 years after treatment for cervical cancer. Note adipose deposition in the entire left leg.

Fig. 2

Obesity-induced lower extremity lymphedema. A body mass index threshold appears to exist between 53 and 59 when lymphatic dysfunction occurs. (Above, left) A woman with a body mass index of 53.3. (Above, right) A woman with a body mass index of 78.3. (Below, left) Lymphoscintigram from the patient shown above, left with a body mass index of 53.3. Note normal transit of technetium to inguinal nodes 20 minutes after injection. Arrows indicate inguinal nodes, black arrowheads show tortuous lymphatic channels and dermal backflow, and white arrowheads mark the feet where the radiolabeled tracer was injected. (Below, right). Lymphoscintigram from the superobese patient shown above, right (body mass index of 78.3). Note the delayed transit of tracer to inguinal nodes 3 hours after injection, tortuous collateral lymphatic channels, and dermal backflow consistent with lymphedema.

Fig. 3

Hypothetical model of adipose deposition and effect of obesity on lymphedema.