Microsurgical treatment of lower extremity lymphedema: A multidisciplinary approach to improve morbidity in advanced penile cancer patients.

MedStar author(s):
Citation: Urologic Oncology. 40(3):113.e1-113.e8, 2022 03.PMID: 35042662Institution: MedStar Washington Hospital CenterDepartment: MedStar Georgetown University Hospital/MedStar Washington Hospital Center | Surgery/Plastic Surgery | Urology | Urology Residency-CategoricalForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Lymphatic Vessels | *Lymphedema | *Penile Neoplasms | Humans | Lower Extremity/su [Surgery] | Lymphedema/et [Etiology] | Lymphedema/pc [Prevention & Control] | Lymphedema/su [Surgery] | Male | Morbidity | Penile Neoplasms/su [Surgery]Year: 2022Name of journal: Urologic oncologyAbstract: CONCLUSION: This early proof of concept study shows that these procedures should be considered and studied further in the treatment and prevention of debilitating lymphedema in the penile cancer population. Copyright (c) 2021 Elsevier Inc. All rights reserved.INTRODUCTION: Lower extremity lymphedema is a major source of morbidity in up to 70% of penile cancer patients. Lymphedema is often thought to be incurable, though surgical treatments have started to emerge. This study is the first to apply lymphovenous bypass specifically to penile cancer patients status post lymphadenectomy.METHODS: We performed microsurgical lymphovenous bypass in 3 patients who underwent inguinal lymphadenectomy for advanced penile cancer, and later lymph node transplant in 1 patient.RESULTS: The lymphovenous bypass was performed by a trained microsurgeon: Two patients were treated as outpatients for lymphedema, and 1 patient underwent prophylactic lymphovenous bypass simultaneously with initial lymphadenectomy. We saw significant improvement in patient's clinical lymphedema as well as lymphatic drainage on infared imaging for 2 of 3 patients at 12 months, however 1 of these patients did require later lymph node transfer at 24 months.All authors: Goldman C, Krasnow R, Lee H, Tom LOriginally published: Urologic Oncology. 2022 Jan 15Fiscal year: FY2022Digital Object Identifier: Date added to catalog: 2022-02-21
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CONCLUSION: This early proof of concept study shows that these procedures should be considered and studied further in the treatment and prevention of debilitating lymphedema in the penile cancer population. Copyright (c) 2021 Elsevier Inc. All rights reserved.

INTRODUCTION: Lower extremity lymphedema is a major source of morbidity in up to 70% of penile cancer patients. Lymphedema is often thought to be incurable, though surgical treatments have started to emerge. This study is the first to apply lymphovenous bypass specifically to penile cancer patients status post lymphadenectomy.

METHODS: We performed microsurgical lymphovenous bypass in 3 patients who underwent inguinal lymphadenectomy for advanced penile cancer, and later lymph node transplant in 1 patient.

RESULTS: The lymphovenous bypass was performed by a trained microsurgeon: Two patients were treated as outpatients for lymphedema, and 1 patient underwent prophylactic lymphovenous bypass simultaneously with initial lymphadenectomy. We saw significant improvement in patient's clinical lymphedema as well as lymphatic drainage on infared imaging for 2 of 3 patients at 12 months, however 1 of these patients did require later lymph node transfer at 24 months.

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