Predictors of severity of lymphosclerosis in extremity lymphedema

Abstract

Background: Lymphovenous anastomosis (LVA) is an accepted method for treating lymphedema, and its efficacy could be greatly affected by the severity of lymphosclerosis. In the present study, we analyzed the intraoperative findings of lymphatic ducts in our patients who had undergone LVA to find predictive factors for the severity of lymphosclerosis.

Methods: The medical records of the patients who had undergone LVA for managing extremity lymphedema from September 2017 to December 2020 were reviewed. The severity of lymphosclerosis was evaluated intraoperatively under a surgical microscope and stratified using the NECST (normal, ectasia, contraction, sclerosis type) classification. Patient age, gender, body mass index (BMI), lymphoscintigraphy stage, and lymphatic duct locations were included for analysis.

Results: Multivariate linear regression analysis showed that location in a lower extremity (regression coefficient, -0.38; P = .03) and more advanced Taiwan lymphoscintigraphy stage (regression coefficient, 0.27; P < .001) were associated with more severe lymphosclerosis. In a subgroup analysis of lower extremity lymphedema, in addition to the Taiwan lymphoscintigraphy stage (regression coefficient, 0.24; P < .001), age (regression coefficient, 0.02; P = .001), and BMI (regression coefficient, 0.04; P = .005) were also associated with the severity of lymphosclerosis.

Conclusions: The severity of lymphosclerosis in extremity lymphedema correlated positively with the Taiwan lymphoscintigraphy stage and was more severe in lower limb lymphedema. In lower limb lymphedema, a higher BMI and older age also contributed to more severe lymphosclerosis.

Keywords: Age; Body mass index; Lymphedema; Lymphosclerosis; Lymphovenous anastomosis; Taiwan lymphoscintigraphy stage.