Epidemiology of lymphedema

Analysis of the international literature has demonstrated a lack of significant data on the epidemiology of lymphedema, in that the research is limited to the clinical observations of each working group and its corresponding geographical area. We have attempted to group together and analyze a larger number of patients from the various regions of Italy, and also the rest of Europe and other parts of the world. Lymphedema cases were studied and subdivided on the basis of etiopathogenetic aspects (congenital, primary - early and late onset - and secondary lymphedemas), pathophysiological aspects (association of more complex pathology of a panangiodysplastic nature) and clinical aspects (classification, staging, limbs affected: upper or lower, mono- or bilateral). Of 945 patients observed, primary lymphedema was noted in 57% of cases overall, corresponding to 11% with upper-limb and 72% with lower-limb involvement. Lymphedema of secondary origin was diagnosed in 43% of patients. In upper-limb cases, the secondary form almost always (98%) concerned axillary lymphadenectomy and/or radiotherapy for the treatment of breast cancer. In lower-limb cases, the most common secondary lymphedema followed treatment of uterine cancer (46%), the next was following urological surgery (39%) of an oncological nature (prostate, penile cancer, seminoma of the testis), then treatment for melanoma (6%), Hodgkin's lymphoma (3%), etc. These epidemiological evaluations furnished interesting data which we propose to extend further in the interest of ever-improving awareness of the etiopathogenetic and pathophysiological aspects of lymphedema and greater understanding of the modern possibilities for diagnosis, treatment, and prevention.