FF001/#556 An innovative method to prevent lymphedema after gynecological cancer surgery: prophylactic, concurrent lymph node to vein anastomosis (LNVA)

Introduction

Lower limb lymphedema (LLL) is a chronic condition that requires long-term treatment and affects quality of life by causing symptoms such as pain, heaviness, discomfort, and restriction of movement. And it is one of the common complications in patients undergoing gynecological cancer surgery including pelvic lymph node dissection (PLND). Lymph node to vein anastomosis (LNVA) has been performed as one of the treatment techniques for LLL after gynecological cancer treatment. We performed prophylactic LNVA during gynecological cancer surgery to evaluate the preventive effect on LLL.

Description

Prophylactic LNVA was done in patients at high risk for LLL, such as those with extensive lymph node dissection or expected postoperative radiation therapy. LNVA was performed after conventional cancer surgery and lymph node dissection, regardless of the type of cancer (Ovarian, Endometrial, Cervical Cancer) or method of surgery (open, laparoscopic, robotic). After injecting Indocyanine green (ICG), ICG lymphangiography is used to locate a functioning inguinal lymph node. Functional lymph node is dissected and anastomosed to an adjacent vein of appropriate size.

Conclusion/Implications

From September 2022 to the time of abstract submission, 21 patients underwent the concurrent prophylactic LNVA surgery. Patients are scheduled for periodic follow-up through 24 months, and to date, there have been no lymphedema and complications from the surgery. We expect that this concurrent prophylactic LNVA will have a significant impact on the prevention of postoperative lymphedema in gynecological cancer patients.