Lymphovenous anastomosis and complex decongestive therapy for severe deformed lymphedema with recurrent infection: A case report

Abstract

BACKGROUND

Lower extremity lymphedema is a common complication following treatment for gynecological malignancies. Its incidence rate can reach up to 70%, affecting ~20 million people worldwide. However, specialized treatment centers are scarce, and there is a lack of consensus on treatment approaches. Furthermore, there are even fewer reports on the systematic and effective treatment of severe lymphedema with malformations. Effective management of this condition remains a significant challenge for clinicians.

CASE SUMMARY

A 40-year-old woman developed bilateral leg swelling 6 years after receiving treatment for endometrial cancer. Since August 2018, she experienced > 30 episodes of lymphangitis. Upon presentation, she exhibited bilateral leg swelling and deformation, with four large swellings in the posterior thigh that impeded movement, and pain in the limbs. Skin manifestations included lichenoid lesions and features of deep sclerosis. Radionuclide lymphoscintigraphy confirmed the diagnosis of lower limb lymphedema. After 6 mo of complex decongestive therapy (CDT) and three lymphaticovenous anastomosis (LVA) treatments, the patient lost 49 kg in weight. She also experienced a maximum circumference reduction of 35.2 cm in the left lower limb and 37.5 cm in the right lower limb. The leg pain disappeared, her swelling significantly decreased, and she regained the ability to walk, cycle, and run normally.

CONCLUSION

The combined application of CDT and LVA therapy demonstrates significant positive effects in the treatment of severe, deformed stage III lymphedema.

Keywords: Lower extremity lymphedema; Endometrial cancer; Lymphaticovenous anastomosis; Complex decongestive therapy; Gynecological malignancies; Recurrent infection; Case report

Core Tip: We report a 40-year-old woman who developed severe lower extremity lymphedema following treatment for endometrial cancer. She underwent a combination of complex decongestive therapy (CDT) and lymphaticovenous anastomosis (LVA). This significantly improved lower limb motor function, with the near-complete resolution of discomfort and a substantial return to normal limb appearance. This case suggests that combined application of CDT and LVA offers a promising therapeutic approach for severe, deformed lymphedema. This minimally invasive strategy, with its associated benefits of minimal surgical trauma and good postoperative aesthetics, has the potential to equip future clinicians with improved management strategies for severely deformed lower extremity lymphedema.