The clinical characteristics of lower extremity lymphedema in 440 patients.
Level 4 - case-series / case-control
Retrospective case series from a single center without a control group.
PubMed 31992537 · doi:10.1016/j.jvsv.2019.11.014
What was done
A 3-year retrospective study analyzed the demographic and clinical characteristics of 440 patients with lower extremity lymphedema who presented for lymphatic physiotherapy at a university medical center's cancer-based physical therapy department.
What was found
The most common causes of lower extremity lymphedema were chronic venous insufficiency (phlebolymphedema; 41.8%), cancer-related lymphedema (33.9%), primary lymphedema (12.5%), and lipedema with secondary lymphedema (11.8%). Overall, 71.1% of patients were female (P < .0001), 78.9% were white (P < .0001), 74.5% presented with bilateral distribution (P < .0001), and left-leg involvement was common (69.1% in bilateral cases [P < .0001]; 58.9% in unilateral cases [P = .0588]). The cohort had a high prevalence of morbid obesity (mean weight 115.8 kg, mean BMI 40.2 kg/m²), which was significantly higher in stage III (mean weight 169.2 kg, mean BMI 57.3 kg/m²) than in stage II (mean weight 107.8 kg, mean BMI 37.5 kg/m²; P < .0001). Overall, 35.7% of patients had at least one cellulitis episode, occurring in 61.7% of stage III patients compared with 31.8% of stage II patients (P < .001). Multifactorial lymphedema was present in 25.0% of patients, and total knee arthroplasty was the most frequent noncancer surgery linked to worsening swelling.
Why it matters
The findings challenge the dogma that cancer is the primary cause of lower extremity lymphedema in Western referral settings, identifying chronic venous disease, morbid obesity, and multifactorial etiology as major drivers.
Limits
The study is a single-center retrospective analysis, which introduces potential referral and selection biases. It lacks a comparative control cohort, relies strictly on chart-recorded clinical characteristics, and provides no data on longitudinal outcomes or treatment response.
Cited by
- contradicts Lymphedema typically occurs on one side of the body rather than bilaterally.