Saturday, May 4, 2013

Pelvic lymphedema in rectal cancer: a magnetic resonance feasibility study: a preliminary report.

Pelvic lymphedema in rectal cancer: a magnetic resonance feasibility study: a preliminary report.

Apr 2013

Vannelli A, Basilico V, Zanardo M, Caizzone A, Rossi F, Battaglia L, Scaramuzza


Division of Gastrointestinal and Surgical Oncology, Ospedale Valduce, Como,



Functional pelvic disorders in patients undergoing conservative surgical approach for rectal cancer are considered a major public health issue and
represent one third of cost of colorectal cancer. We investigated the hypothesis that lymphadenectomy, involves the pelvic floor results in a localized hides or
silent pelvic lymphedema characterized by symptoms without signs.

We examined 13 colo-rectal cancer patients: five intra-peritoneal adenocarcinoma: 1 sigmoid and 4 upper third rectal cancer (1 male and 3 female)and 9 extra-peritoneal adenocarcinoma: 3 middle and 5 lower third rectal
cancer (4 male and 5 female) using 1.5-T magnetic resonance, one week before and twelve months after discharged from hospital.

Lymphedema was discovered on post-operative magnetic resonance imaging of all 9 patients with extra-pertitoneal cancer, whereas preoperative magnetic resonance
imaging as well as a post-operative examination of 4 intra-peritoneal adenocarcinoma, revealed no evidence of lymphedema. Unlike the common clinical skin signs that typify all other sites of lymphedema, pelvic lymphedema is hides or silent, with no skin changes or any single symptom manifested. Magnetic resonance imaging showed that pelvic illness alone is accompanied by lymphedema related exclusively to venous congestion, and accumulation of liquid in adipose
tissue or lipedema.

Alteration of the pelvic lymphatic network during pelvic surgery can lead to lymphedema and, pelvic floor disease. Patients should be routinely examined for
the possibility of developing this post-surgical syndrome and further studies are needed to establish diagnosis and to evaluate treatment preferences.