Can Surgery Cure Lymphedema?

Introduction

An experienced surgical team is essential.

To date in the U.S. there are no accepted surgical treatments to control lymphedema. Yet on the Internet there are advertisements, or reports about small studies on this topic. In an effort to clarify the risks and benefits, this article, which is based on the National Lymphedema Network (NLN) Treatment Position Paper (reviewed 2009), is presented here. [1]

Can Surgery Cure Lymphedema?

Many patients with lymphedema surf the Internet hopefully seeking a lymphedema cure. Often they come across advertisements for surgical treatments that claim to improve limbs affected by this condition. If the advertisement is providing accurate information, it will state the following facts. This article, which is based on the National Lymphedema Network (NLN) Treatment Position Paper (2009), explains the “facts of life” regarding surgical cures of lymphedema. [1]

• Improvement is not guaranteed.
• Surgical treatment is more effective on the upper limbs than it is on the lower limbs.
• Surgery may provide some improvement, but it will not cure the lymphedema.
• Even if the surgery is considered to be successful, wearing compression garments is still necessary.

The NLN Position Paper on Surgery to Treat Lymphedema

The surgical treatment of lymphedema has been advocated in a few specific circumstances to:

• Reduce the weight of the affected limb.
• Minimize the frequency of infections or inflammatory attacks.
• Improve cosmesis which is the surgical correction of a disfiguring defect.
• Possibly reduce the risk of an angiosarcoma which is a malignant tumor of the walls of blood or lymphatic vessels.

The evidence to date indicates that:

• Surgery may improve the condition, but it does not cure lymphedema.
• Surgery does not remove the need for wearing compression garments.

Benefits versus the Risks

The potential benefits of surgery should be weighed against the risks. The risks are related to the type of surgery are influenced by:

• The extent of the procedure. The more extensive the surgery involved, the greater the risk to the patient.
• Co-morbidities the patient may have. The term co-morbidity describes the presence of two or more health problems the patient may have. Among the most common co-morbidities are obesity, heart disease, or diabetes.
• The expertise and experience of the surgical team. Successfully conducted studies that have been performed surgical teams who have specialized in performing this procedure. When such procedure first become widely performed by surgeons who do not have this experience, the risks increase.

The Types of surgery

The two most frequently performed types of surgical procedures to treat lymphedema are excisional surgery and lymphatic reconstruction.

The term excisional surgery means to surgically remove a mass of tissue using a scalpel, laser, or other instrument.

• Debulking is surgery that involves the surgical removal of excess tissue that hangs in folds.
• Liposuction is an excisional operation during which a tube is inserted under the skin. Through this tube a high-pressure vacuum is applied break up and "suck out" excess fat cells. This procedure often leaves excess skin hanging loose.

The term Lymphatic Reconstruction Surgery describes procedures that attempt to repair damage done during previous surgeries, such as a mastectomy, or to repair tissue damaged by trauma or surgery.

• Lymph node transplant is surgery in which lymph nodes are moved from one part of the body (usually the abdomen) to the lymphedema affected area. The risk is that the transplanted node will not function in the new location.
• Anastomosis formation is a different form of lymphatic reconstruction is which the parts of two damaged lymphatic vessels are surgically joined to restore lymph circulation to replace a junction that has been destroyed by surgery or radiation. (An anastomosis is the surgical creation of a junction between two hollow tubular body structures.) In this surgery the risk is that the new junction is not successfully formed.

Significant Risks Associated with Surgical Treatment

Most reports of the outcomes from surgical treatment for lymphedema are drawn from the experience of a single institution or group of surgeons and focus on small numbers of patients with insufficient objective outcome data and long-term follow-up. None of these surgical approaches has been widely accepted as being successful. In general the most significant risks include:

• Failure of a transplanted lymph nodes to survive.
• The surgical connections (anastomoses) that fail to join properly do not improve the drainage.
• The damage of a surgical procedure can make the lymphedema worse.
• Co-morbidities may become worse due to damage caused by the lymphedema surgery.
• With the passage of time, the long term risk of scaring increases. The result could be that this type of surgery may help initially but make matters worse over the long term due to scarring.
• None of the reportedly successful lymphedema treatment procedures will totally cure the lymphedema.
• None of these procedures eliminate the need for compression garments.

Reference:

[1] The information in this article is based on the National Lymphedema Network (NLN) Treatment Position Paper that was approved 2006 and reviewed 2009. http://www.lymphnet.org/pdfDocs/nlntreatment.pdf

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Category: How Lymphedema is Treated Updated: 2010-04-17