Surgical Prevention of Lymphedema

Purpose of Review: Secondary lymphedema is a feared complication of cancer treatment that can lead to poor quality of life and life-threatening infections. True incidence of lymphedema is difficult to determine, but as the number of cancer survivors increases, lymphedema is becoming a significant health concern. Lymphedema is a progressive and debilitating disease that has no cure. While nonoperative and operative approaches to lymphedema management are available, they can only limit or slow the disease progression. However, with the recent advent of lymphedema microsurgery, the focus has shifted to the surgical prevention of lymphedema via immediate lymphatic reconstruction (ILR). Recent Findings: Recent studies including a meta-analysis have shown that ILR may be effective in preventing the development of both upper and lower extremity lymphedema if the lymphatic system is prophylactically repaired at the time of lymphadenectomy. In the upper extremity, the rate of lymphedema after ILR has been reported as low as 4% at 4-year follow up as compared to 30% in the control group. In the lower extremity, similar results in lower lymphedema incidence after ILR are noted, although fewer studies exist with smaller sample sizes. Summary: Immediate lymphatic reconstruction is a safe and well-tolerated procedure with very promising outcomes in decreasing the incidence of lymphedema in cancer survivors. More research is needed to continue to evaluate the technical details of ILR and how it can be used most effectively to prevent lymphedema, as well as explore additional surgical techniques.