NATURAL HISTORY OF LYMPH PUMPING PRESSURE AFTER PELVIC LYMPHADENECTOMY

Abstract

Lower limb lymphedema is difficult toprevent and diagnose early because its naturalhistory is unclear. Therefore, the aim of thisstudy was to clarify its pathogenesis and toidentify risk factors that may lead to earlydiagnosis. In 29 patients, aged 25 to 74 yearswith cervical, uterine, or ovarian cancer whounderwent pelvic lymphadenectomy, indocyaninegreen fluorescence lymphangiographywas performed with an infrared camerasystem, and lymph pumping pressure wasmeasured indirectly preoperatively, and one,two, three, and six months postoperatively. Ofthese 29 patients, 22 (75.9%) completed theexaminations. In the non-lymphedema group,the average lymph pumping pressure did notchange significantly at postoperative follow-upcompared with preoperative values. On theother hand, lymph pumping pressure increasedat various time points in five patients whodeveloped early lymphatic changes withdermal diffusion at the level of the proximalfemur. An increase in lymph flow pathresistance due to pelvic lymphadenectomyresulted in an initial increase in lymphpumping pressure, followed by a subsequentdecrease, in the early lymphatic changesgroup. This trend in the pressure changesignifies that the lymph vessels becamedysfunctional as they were overwhelmed bythe overload condition and this feature maybe a clinically useful signal for the earlydiagnosis of developing lymphedema.