What is the risk of lower limb oedema after excision of a single inguinal lymph node on each side?

Risk of Lower Limb Oedema After Bilateral Single Inguinal Lymph Node Excision

The risk of lower limb oedema after excision of a single inguinal lymph node on each side is approximately 5%, which is significantly lower than the 30-70% risk associated with complete inguinal lymphadenectomy. 1

Lymphoedema Risk Factors and Incidence

• Lymphoedema risk is directly related to the extent of lymph node dissection rather than the surgical approach (open vs. minimally invasive) 1
• Complete inguinal lymphadenectomy carries a high risk of lymphoedema, affecting 30-70% of patients 1
• Sentinel lymph node biopsy (SLNB) has a significantly lower risk of lymphoedema (approximately 5%) compared to complete lymphadenectomy 1
• Removal of a single lymph node on each side would have a risk profile similar to SLNB rather than complete lymphadenectomy 1

Mechanism of Lymphoedema Development

• Lymphoedema occurs when lymphatic drainage is impaired due to disruption of lymphatic channels 2
• Bilateral excision increases risk compared to unilateral procedures, but the risk remains relatively low with limited node removal 1
• The number of lymph nodes removed is the primary determinant of lymphoedema risk rather than the surgical approach 1
• Lymphoedema typically develops early in the postoperative period and is often worst in the first 6 months 3

Risk Reduction Strategies

• Careful surgical technique to minimize disruption of lymphatic channels 1
• Occluding lymphatic channels with surgical clips or ligation during the procedure 1
• Placement of suction drains to manage postoperative lymphatic fluid accumulation 1
• Minimally invasive approaches may reduce wound complications but do not significantly affect lymphoedema rates 1

Complications Beyond Lymphoedema

• Wound complications occur in 20-40% of patients undergoing inguinal lymphadenectomy 1
• Wound complications are associated with a higher risk of subsequent lymphoedema development 3
• In one study, 80% of patients who had healing complications developed postoperative oedema, compared to 42% of those without healing complications 3
• Limited node dissection (such as removing a single node on each side) significantly reduces these risks 1

Management of Lymphoedema if it Occurs

• Elastic compression garments are the mainstay of conservative management 3
• However, class II compression stockings have not shown benefit in preventing lymphoedema in a randomized controlled trial 4
• Lymphoedema, if it develops, tends to persist despite time and treatment 3
• Vascularized lymph node transfer techniques have shown promising results for established lymphoedema 2

Special Considerations

• The risk of lymphoedema increases with additional risk factors such as radiation therapy, obesity, or infection 5
• Patients with pre-existing vascular disease may have higher risk 6
• Bilateral procedures carry higher risk than unilateral procedures, but limited dissection (single node on each side) minimizes this risk 1

In summary, while complete inguinal lymphadenectomy carries a substantial risk of lymphoedema (30-70%), the excision of a single lymph node from each groin has a much lower risk profile, similar to sentinel lymph node biopsy (approximately 5%). This risk is significantly influenced by surgical technique, postoperative complications, and patient-specific factors.