Clinical Variables Associated with Lymphedema Surgery: Physiologic versus Excisional.

Background: As surgical interventions for lymphedema become increasingly available, it is important to understand characteristics of patients that undergo lymphedema surgery. The goal of this study was to define clinical variables of patients evaluated at a medical center who underwent lymphedema surgery to better inform which referred patients are surgical candidates.

Methods: A cross-sectional observational study was performed on patients referred to plastic surgery for lymphedema between January 2016 and June 2023. The operative group included patients who underwent lymphedema surgery, including physiologic surgery (PS) and excisional surgery (ES). The non-operative group consisted of patients referred for lymphedema who did not undergo lymphatic surgery. Patient records were collected, and between-group comparisons were performed.

Results: 285 total patients were identified (n=66 operative, n=219 non-operative). The operative cohort had higher body mass index (BMI) than the control (33.5 versus 31.2 kg/m2, p<0.035) and was more likely to have undergone physical therapy/occupational therapy (68.2% versus 53.4%, p=0.005). Within the operative cohort (PS=37, ES=29), PS patients were more likely to be white (91.9% versus 69.0%, p=0.043) and have lower BMI (32 versus 42.7 kg/m2, p=0.007). PS patients were diagnosed for a longer period (8 versus 3 years, p=0.03) before seeing a plastic surgeon, more commonly had upper extremity lymphedema (43.2% versus 13.8%, p=0.016) and presented at an earlier lymphedema stage (stage 1 64.9% versus 27.6%, p=0.002). PS patients were more likely to have prior radiation (56.8% versus 20.7%, p=0.005), previous surgery (75.5% versus 48.3%, p=0.038), and prior lymphatic intervention (67.6% versus 17.2%, p<0.001) near the affected area.

Conclusion: Defining patient characteristics associated with surgical intervention for lymphedema can aid surgeons to increase the proportion of patients seen in clinic who are surgical candidates. Factors relating to oncologic and surgical history in the affected area may suggest a patient is more likely to undergo PS.