26th World Congress of Lymphology

A review by Sarah Ang

The 26th World Congress of Lymphology was held on 25th-29th September, 2017 in Barcelona. It was a conference well attended by delegates from all continents of the world sharing the passion of learning about lymphoedema and improving the care provision for lymphoedema patients.

Lymphoedema needs to be diagnosed, assessed and managed comprehensively much like that of cardiovascular or cancer and this was the common theme throughout the conference. That is to say, lymphoedema is not merely swelling, and to manage oedema well, the cause of oedema needs to be addressed concurrent with the use of CDT. This is reflected by the conference program which dedicated 1 day for each component of lymphoedema management ranging from anatomy and imaging review, conventional lymphoedema management and surgical approaches for lymphoedema management.

The lymphatic system was reviewed with updates on various imaging technique in addition to lymphoscintography by surgeons and therapists. ICG fluoroscopy is the preferred choice for evaluating the lymphatic system when microsurgery is being considered. Professor Leduc and Dr Belgrado, both highlighted the need to rethink how manual lymphatic drainage should be approached with our new understanding of the lymphatics and availability of fluoroscopy clinically. This new appreciation of the lymphatic system is further reiterated by Professor Rockson, whose continuing work on identifying pathways responsible for progression of lymphoedema makes
phase -2 Ultra trial a reality for lymphoedema patients.

Compression remains the corner stone in success of lymphoedema management. Professor Partsch continues to emphasize the importance of compression. This view is further reiterated by Professor Foeldi and Professor Leduc who both use the basic principle of:  some compression is better than none and the compression tolerated by the patient is where they start with any patient who is reluctant about compression.

Lipoedema which is a relatively new disease to the medical fraternity was comprehensively reviewed. Diet and exercise are not currently the gold-standard of care recommended. Dr Birch a lipedema specialist physician from Foeldi clinic strongly discouraged clinicians from advising patients to lose weight, for that is a belief that only compounds the issue! Both the physical and psychological assessment is recommended for optimal management of lipoedema patients.

Sleep apnoea, cardiac disease and obesity with their relationship in lower limb lymphoedema was discussed. Clinicians globally are all starting to see a clinical picture in this group of patients and lower limb oedema development. There is early promising data which shows in this group of patients, when oedema is being managed in conjunction with use of continuous positive airway pressure (CPAPA) machine, not only will oedema reduce, the patients sleep apnoea and cardiac related symptoms improve. Further studies are underway to formulate a more standardised medical management in this group of patients in addition to oedema management.

Surgery for lymphoedema continues to evolve with vascularized lymph node transfer being used as preventative measure whilst liposuction remain a last resort. The determining factor for successful surgical outcome remains to be: appropriate patient selection and team work (i.e. surgeon, therapist and patient). Professor Brorson continues to champion his view about liposuction being reserved for the patient no longer responding to CDT and patients need to be informed of life long wearing of a compression garment. Whilst Professor Koshima and Dr Leong both generously shared their views about why some surgeries failed and the patient’s lymphoedema worsened.

A common consensus among all clinicians (surgeons and therapists) as well as researchers is that to move lymphoedema management forward a more uniform assessment and management guideline is required, so that the field of lymphology will advance sufficiently to provide the care our patients need.

Sarah Ang