Liposuction for advanced lymphedema: a multidisciplinary approach for complete reduction of arm and leg swelling

John Boyages, Katrina Kastanias, Louise A. Koelmeyer, Caleb J. Winch, Thomas C. Lam, Kerry A. Sherman, David Alex Munnoch, Håkan Brorson, Quan D. Ngo, Asha Heydon-White, John S. Magnussen, Helen Mackie

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Purpose: This research describes and evaluates a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities. Methods: A prospective clinical study was conducted at an Advanced Lymphedema Assessment Clinic (ALAC) comprised of specialists in plastic surgery, rehabilitation, imaging, oncology, and allied health, at Macquarie University, Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the ALAC. Eligibility criteria for liposuction included (i) unilateral, non-pitting, International Society of Lymphology stage II/III lymphedema; (ii) limb volume difference greater than 25 %; and (iii) previously ineffective conservative therapies. Of 55 eligible patients, 21 underwent liposuction (15 arm, 6 leg) and had at least 3 months postsurgical follow-up (85.7 % cancer-related lymphedema). Liposuction was performed under general anesthesia using a published technique, and compression garments were applied intraoperatively and advised to be worn continuously thereafter. Limb volume differences, bioimpedance spectroscopy (L-Dex), and symptom and functional measurements (using the Patient-Specific Functional Scale) were taken presurgery and 4 weeks postsurgery, and then at 3, 6, 9, and 12 months postsurgery. Results: Mean presurgical limb volume difference was 45.1 % (arm 44.2 %; leg 47.3 %). This difference reduced to 3.8 % (arm 3.6 %; leg 4.3 %) by 6 months postsurgery, a mean percentage volume reduction of 89.6 % (arm 90.2 %; leg 88.2 %) [p < 0.001]. All patients had improved symptoms and function. Bioimpedance spectroscopy showed reduced but ongoing extracellular fluid, consistent with the underlying lymphatic pathology. Conclusions: Liposuction is a safe and effective option for carefully selected patients with advanced lymphedema. Assessment, treatment, and follow-up by a multidisciplinary team is essential.

LanguageEnglish
PagesS1263-S1270
Number of pages8
JournalAnnals of Surgical Oncology
Volume22
DOIs
Publication statusPublished - 1 Dec 2015

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Lipectomy
Lymphedema
Leg
Arm
Extremities
Spectrum Analysis
Rehabilitation
Clothing
Extracellular Fluid
Plastic Surgery
General Anesthesia
Lower Extremity
Prospective Studies
Pathology
Health
Research
Neoplasms

Bibliographical note

Copyright the Author(s) 2015. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Cite this

@article{3969e6f5201846adbd8f2b2d9378b91c,
title = "Liposuction for advanced lymphedema: a multidisciplinary approach for complete reduction of arm and leg swelling",
abstract = "Purpose: This research describes and evaluates a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities. Methods: A prospective clinical study was conducted at an Advanced Lymphedema Assessment Clinic (ALAC) comprised of specialists in plastic surgery, rehabilitation, imaging, oncology, and allied health, at Macquarie University, Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the ALAC. Eligibility criteria for liposuction included (i) unilateral, non-pitting, International Society of Lymphology stage II/III lymphedema; (ii) limb volume difference greater than 25 {\%}; and (iii) previously ineffective conservative therapies. Of 55 eligible patients, 21 underwent liposuction (15 arm, 6 leg) and had at least 3 months postsurgical follow-up (85.7 {\%} cancer-related lymphedema). Liposuction was performed under general anesthesia using a published technique, and compression garments were applied intraoperatively and advised to be worn continuously thereafter. Limb volume differences, bioimpedance spectroscopy (L-Dex), and symptom and functional measurements (using the Patient-Specific Functional Scale) were taken presurgery and 4 weeks postsurgery, and then at 3, 6, 9, and 12 months postsurgery. Results: Mean presurgical limb volume difference was 45.1 {\%} (arm 44.2 {\%}; leg 47.3 {\%}). This difference reduced to 3.8 {\%} (arm 3.6 {\%}; leg 4.3 {\%}) by 6 months postsurgery, a mean percentage volume reduction of 89.6 {\%} (arm 90.2 {\%}; leg 88.2 {\%}) [p < 0.001]. All patients had improved symptoms and function. Bioimpedance spectroscopy showed reduced but ongoing extracellular fluid, consistent with the underlying lymphatic pathology. Conclusions: Liposuction is a safe and effective option for carefully selected patients with advanced lymphedema. Assessment, treatment, and follow-up by a multidisciplinary team is essential.",
author = "John Boyages and Katrina Kastanias and Koelmeyer, {Louise A.} and Winch, {Caleb J.} and Lam, {Thomas C.} and Sherman, {Kerry A.} and Munnoch, {David Alex} and H{\aa}kan Brorson and Ngo, {Quan D.} and Asha Heydon-White and Magnussen, {John S.} and Helen Mackie",
note = "Copyright the Author(s) 2015. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",
year = "2015",
month = "12",
day = "1",
doi = "10.1245/s10434-015-4700-3",
language = "English",
volume = "22",
pages = "S1263--S1270",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer, Springer Nature",

}

Liposuction for advanced lymphedema : a multidisciplinary approach for complete reduction of arm and leg swelling. / Boyages, John; Kastanias, Katrina; Koelmeyer, Louise A.; Winch, Caleb J.; Lam, Thomas C.; Sherman, Kerry A.; Munnoch, David Alex; Brorson, Håkan; Ngo, Quan D.; Heydon-White, Asha; Magnussen, John S.; Mackie, Helen.

In: Annals of Surgical Oncology, Vol. 22, 01.12.2015, p. S1263-S1270.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Liposuction for advanced lymphedema

T2 - Annals of Surgical Oncology

AU - Boyages,John

AU - Kastanias,Katrina

AU - Koelmeyer,Louise A.

AU - Winch,Caleb J.

AU - Lam,Thomas C.

AU - Sherman,Kerry A.

AU - Munnoch,David Alex

AU - Brorson,Håkan

AU - Ngo,Quan D.

AU - Heydon-White,Asha

AU - Magnussen,John S.

AU - Mackie,Helen

N1 - Copyright the Author(s) 2015. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Purpose: This research describes and evaluates a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities. Methods: A prospective clinical study was conducted at an Advanced Lymphedema Assessment Clinic (ALAC) comprised of specialists in plastic surgery, rehabilitation, imaging, oncology, and allied health, at Macquarie University, Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the ALAC. Eligibility criteria for liposuction included (i) unilateral, non-pitting, International Society of Lymphology stage II/III lymphedema; (ii) limb volume difference greater than 25 %; and (iii) previously ineffective conservative therapies. Of 55 eligible patients, 21 underwent liposuction (15 arm, 6 leg) and had at least 3 months postsurgical follow-up (85.7 % cancer-related lymphedema). Liposuction was performed under general anesthesia using a published technique, and compression garments were applied intraoperatively and advised to be worn continuously thereafter. Limb volume differences, bioimpedance spectroscopy (L-Dex), and symptom and functional measurements (using the Patient-Specific Functional Scale) were taken presurgery and 4 weeks postsurgery, and then at 3, 6, 9, and 12 months postsurgery. Results: Mean presurgical limb volume difference was 45.1 % (arm 44.2 %; leg 47.3 %). This difference reduced to 3.8 % (arm 3.6 %; leg 4.3 %) by 6 months postsurgery, a mean percentage volume reduction of 89.6 % (arm 90.2 %; leg 88.2 %) [p < 0.001]. All patients had improved symptoms and function. Bioimpedance spectroscopy showed reduced but ongoing extracellular fluid, consistent with the underlying lymphatic pathology. Conclusions: Liposuction is a safe and effective option for carefully selected patients with advanced lymphedema. Assessment, treatment, and follow-up by a multidisciplinary team is essential.

AB - Purpose: This research describes and evaluates a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities. Methods: A prospective clinical study was conducted at an Advanced Lymphedema Assessment Clinic (ALAC) comprised of specialists in plastic surgery, rehabilitation, imaging, oncology, and allied health, at Macquarie University, Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the ALAC. Eligibility criteria for liposuction included (i) unilateral, non-pitting, International Society of Lymphology stage II/III lymphedema; (ii) limb volume difference greater than 25 %; and (iii) previously ineffective conservative therapies. Of 55 eligible patients, 21 underwent liposuction (15 arm, 6 leg) and had at least 3 months postsurgical follow-up (85.7 % cancer-related lymphedema). Liposuction was performed under general anesthesia using a published technique, and compression garments were applied intraoperatively and advised to be worn continuously thereafter. Limb volume differences, bioimpedance spectroscopy (L-Dex), and symptom and functional measurements (using the Patient-Specific Functional Scale) were taken presurgery and 4 weeks postsurgery, and then at 3, 6, 9, and 12 months postsurgery. Results: Mean presurgical limb volume difference was 45.1 % (arm 44.2 %; leg 47.3 %). This difference reduced to 3.8 % (arm 3.6 %; leg 4.3 %) by 6 months postsurgery, a mean percentage volume reduction of 89.6 % (arm 90.2 %; leg 88.2 %) [p < 0.001]. All patients had improved symptoms and function. Bioimpedance spectroscopy showed reduced but ongoing extracellular fluid, consistent with the underlying lymphatic pathology. Conclusions: Liposuction is a safe and effective option for carefully selected patients with advanced lymphedema. Assessment, treatment, and follow-up by a multidisciplinary team is essential.

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U2 - 10.1245/s10434-015-4700-3

DO - 10.1245/s10434-015-4700-3

M3 - Article

VL - 22

SP - S1263-S1270

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

ER -