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

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.