Isao Koshima
Current Position
Plast Surg & International Center for Lymphedema , Hiroshima Univ Hp
Lymphatic Session

Topic: Evolution of lymphatic surgery: personal experience for 32 years over 2500 cases


For the past 29 years we have undergone surgical treatment for about 2,500 patients with lymphedema. As a result, it has been clarified that functional preservation or reconstruction of lymphatic smooth muscle cell using super-microsurgical technique leads to the prevention and reduction of edema. This concept is now popularized in the world. Recent topics are how to prevent lymphatic diseases and prevent deterioration. In recent years various diseases related to lymphedema have been clarified. In severe lymphedema, it was found frequent infection often develop severe and progressive to septicemia (lethal edema), and it is known that at 10 years edema, some develop to angiosarcoma (Stewart-Treves Syndrome). Meanwhile, Mono-MAC syndrome due to GATA 2 gene abnormality, which is a primary immunodeficiency syndrome, has also been noted as a lethal disease associated with leg lymphedema. It was also found that LVA could rescue cases with such lethal lymphedema. Regarding surgical treatment of lymphedema, there are methods for restoring physiological lymph circulation (lymph-venular anastomosis (LVA), functional vascularized lymph channel transfer etc.) and reduction of irreversibly accumulated soft tissue (reduction surgery). LVA is effective for early lymphedema. Prophylactic LVA simultaneously with lymph adenectomy could prevent occurrence of edema. For severe cases, combined surgical treatment with LVA and lymph channel transfer is indicated with added tissue reduction. The purpose of surgical treatments is improvement of quality of life, free from physio-compression therapy, complete recovery from edema. prevention of septicemia secondary to low immunity, complete recovery from sarcoma, and Salvage of Life. We report findings on surgical treatment and future prospects based on the past 26 years including immune-stimulation against cancer with LVA.