{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:24:57Z","timestamp":1785237897105,"version":"3.55.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T00:00:00Z","timestamp":1704153600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002701","name":"Ministry of Education","doi-asserted-by":"publisher","award":["NRF-2022R1I1A1A01068463"],"award-info":[{"award-number":["NRF-2022R1I1A1A01068463"]}],"id":[{"id":"10.13039\/501100002701","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["NRF-2021R1A2C1093636"],"award-info":[{"award-number":["NRF-2021R1A2C1093636"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["NRF-2021R1F1A1060946"],"award-info":[{"award-number":["NRF-2021R1F1A1060946"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Lymphaticovenous anastomosis (LVA) is a promising microsurgical treatment for lower extremity lymphedema (LEL). Lymphoscintigraphy effectively assesses lower limb lymphatic systems before LVA, but its role in predicting the therapeutic outcomes of LVA is indeterminate. In this study we investigate the efficacy of preoperative lymphoscintigraphy using clinical findings to predict outcomes in gynecological cancer-related LEL patients who underwent LVA.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective review was conducted on consecutive gynecological cancer patients with LEL who had undergone LVA between June 2018 and June 2021. The therapeutic efficacy was assessed by measuring the change rate of the lower extremity lymphedema index (LELi) six months after surgery. Clinical data and lymphoscintigraphic findings were analyzed to assess therapeutic efficacy of LVA.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Out of the 60 evaluated legs, 83.3% of the legs showed improved results after LVA. Univariable linear regression analysis revealed that higher preoperative LELi, and ovarian cancer were associated with superior LELi change rate (LC rate). Absence of dermal backflow (DBF) on lymphoscintigraphy was associated with inferior LC rate. Multivariable linear regression analysis identified ovarian cancer and higher preoperative LELi were independently correlated with favorable outcomes, while the absence of DBF was independently correlated with inferior outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The results of this study emphasizes the effectiveness of preoperative lymphoscintigraphy, preoperative LELi, and primary malignancy as predictors of LVA outcomes in gynecological cancer-related LEL patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0296466","type":"journal-article","created":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T19:18:34Z","timestamp":1704223114000},"page":"e0296466","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Efficacy of preoperative lymphoscintigraphy in predicting surgical outcomes of lymphaticovenous anastomosis in lower extremity lymphedema: Clinical correlations in gynecological cancer-related lymphedema"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6360-1108","authenticated-orcid":true,"given":"Min Young","family":"Yoo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyong-Je","family":"Woo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seo Young","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung Seok","family":"Moon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2520-7182","authenticated-orcid":true,"given":"Bom Sahn","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8752-6280","authenticated-orcid":true,"given":"Hai-Jeon","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,1,2]]},"reference":[{"issue":"4","key":"pone.0296466.ref001","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.cps.2012.08.001","article-title":"Surgical treatment of congenital lymphedema","volume":"39","author":"C Becker","year":"2012","journal-title":"Clin Plast Surg"},{"issue":"1","key":"pone.0296466.ref002","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ygyno.2014.11.006","article-title":"Incidence, risk factors and estimates of a woman\u2019s risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer","volume":"136","author":"VL Beesley","year":"2015","journal-title":"Gynecol Oncol"},{"issue":"8","key":"pone.0296466.ref003","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1002\/micr.30246","article-title":"Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema","volume":"37","author":"MF Scaglioni","year":"2017","journal-title":"Microsurgery"},{"issue":"22","key":"pone.0296466.ref004","doi-asserted-by":"crossref","first-page":"5138","DOI":"10.1002\/cncr.25458","article-title":"Lymphedema beyond breast cancer: A systematic review and meta-analysis of cancer-related secondary lymphedema","volume":"116","author":"JN Cormier","year":"2010","journal-title":"Cancer"},{"issue":"3","key":"pone.0296466.ref005","doi-asserted-by":"crossref","first-page":"H1103","DOI":"10.1152\/ajpheart.00167.2009","article-title":"Impact of acute exposure to increased hydrostatic pressure and reduced shear rate on conduit artery endothelial function: a limb-specific response","volume":"297","author":"J Padilla","year":"2009","journal-title":"Am J Physiol Heart Circ Physiol"},{"issue":"5","key":"pone.0296466.ref006","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1089\/lrb.2019.0084","article-title":"Prognostic factors of quantitative lymphoscintigraphic findings in patients with breast cancer-related lymphedema","volume":"18","author":"J Kim","year":"2020","journal-title":"Lymphat Res Biol"},{"issue":"4","key":"pone.0296466.ref007","doi-asserted-by":"crossref","first-page":"379","DOI":"10.21037\/gs.2017.11.04","article-title":"Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments","volume":"7","author":"TC Gillespie","year":"2018","journal-title":"Gland Surg"},{"issue":"4","key":"pone.0296466.ref008","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.4143\/crt.2015.463","article-title":"Identification of prognostic risk factors for transient and persistent lymphedema after multimodal treatment for breast cancer","volume":"48","author":"M Kim","year":"2016","journal-title":"Cancer Res Treat"},{"issue":"1","key":"pone.0296466.ref009","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21708","article-title":"Cancer statistics, 2022","volume":"72","author":"RL Siegel","year":"2022","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"pone.0296466.ref010","doi-asserted-by":"crossref","first-page":"330","DOI":"10.4143\/crt.2022.128","article-title":"Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2019","volume":"54","author":"MJ Kang","year":"2022","journal-title":"Cancer Res Treat"},{"issue":"1","key":"pone.0296466.ref011","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.soc.2017.08.001","article-title":"Surgical intervention for lymphedema","volume":"27","author":"K Gallagher","year":"2018","journal-title":"Surg Oncol Clin N Am"},{"issue":"1","key":"pone.0296466.ref012","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/SAP.0000000000000362","article-title":"Practicality of the lower extremity lymphedema index: lymphedema index versus volumetry-based evaluations for body-type\u2013corrected lower extremity volume evaluation","volume":"77","author":"T Yamamoto","year":"2016","journal-title":"Ann Plast Surg"},{"issue":"1","key":"pone.0296466.ref013","first-page":"26","article-title":"Reliability and limits of agreement of circumferential, water displacement, and optoelectronic volumetry in the measurement of upper limb lymphedema","volume":"40","author":"T Deltombe","year":"2007","journal-title":"Lymphology"},{"issue":"6","key":"pone.0296466.ref014","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1097\/SAP.0b013e318208fd75","article-title":"Lower extremity lymphedema index: A simple method for severity evaluation of lower extremity lymphedema","volume":"67","author":"T Yamamoto","year":"2011","journal-title":"Ann Plast Surg"},{"issue":"7","key":"pone.0296466.ref015","first-page":"1125","article-title":"Lymphoscintigraphy in lymphedema: an aid to microsurgery","volume":"27","author":"M Vaqueiro","year":"1986","journal-title":"J Nucl Med"},{"issue":"1","key":"pone.0296466.ref016","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1186\/s12880-021-00713-1","article-title":"Predictive role of lymphoscintigraphy undergoing lymphovenous anastomosis in patients with lower extremity lymphedema: a preliminary study","volume":"21","author":"HR Kwon","year":"2021","journal-title":"BMC Med Imaging"},{"issue":"7","key":"pone.0296466.ref017","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1097\/RLU.0000000000003630","article-title":"Lymphoscintigraphic findings as indicators of lymphaticovenous anastomosis outcome in patients with extremity lymphedema: a retrospective cohort study","volume":"46","author":"HO Kim","year":"2021","journal-title":"Clin Nucl Med"},{"key":"pone.0296466.ref018","article-title":"Lymphatic flow velocity is a predictor for functional lymphatic vessels for lymphaticovenous anastomosis","author":"J-W Park","year":"2023","journal-title":"JPRAS Open"},{"issue":"7","key":"pone.0296466.ref019","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1016\/j.bjps.2022.02.049","article-title":"Classification of superficial lymphatic pathways in the upper extremity and incidence of lymphatic obstruction according to the lymphatic pathways in patients with unilateral upper extremity lymphedema","volume":"75","author":"KJ Woo","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"6","key":"pone.0296466.ref020","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1016\/j.acra.2013.01.018","article-title":"Reliability of a radiological grading system for dermal backflow in lymphoscintigraphy imaging","volume":"20","author":"ES Dylke","year":"2013","journal-title":"Acad Radiol"},{"issue":"2","key":"pone.0296466.ref021","first-page":"214","article-title":"Predicting the effect of stellate ganglion block on the lymphoscintigraphic findings for lymphedema in post-mastectomy patients","volume":"35","author":"HR Kim","year":"2011","journal-title":"J Korean Acad Rehabil Med"},{"issue":"6","key":"pone.0296466.ref022","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1002\/jso.24974","article-title":"Lymphatic vessel diameter in female pelvic cancer-related lower extremity lymphedematous limbs","volume":"117","author":"T Yamamoto","year":"2018","journal-title":"J Surg Oncol"},{"issue":"7","key":"pone.0296466.ref023","doi-asserted-by":"crossref","first-page":"e41126","DOI":"10.1371\/journal.pone.0041126","article-title":"Pathological steps of cancer-related lymphedema: histological changes in the collecting lymphatic vessels after lymphadenectomy","volume":"7","author":"M Mihara","year":"2012","journal-title":"PLoS One"},{"issue":"6","key":"pone.0296466.ref024","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/j.bjps.2013.02.023","article-title":"Comparison of lymphoscintigraphy and indocyanine green lymphography for the diagnosis of extremity lymphoedema","volume":"66","author":"S Akita","year":"2013","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"5","key":"pone.0296466.ref025","doi-asserted-by":"crossref","first-page":"e404","DOI":"10.1097\/GOX.0000000000000375","article-title":"Estimating lymphodynamic conditions and lymphovenous anastomosis efficacy using 99mTc-phytate lymphoscintigraphy with SPECT-CT in patients with lower-limb lymphedema","volume":"3","author":"T Iimura","year":"2015","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"6","key":"pone.0296466.ref026","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1002\/micr.20772","article-title":"Types of lymphoscintigraphy and indications for lymphaticovenous anastomosis","volume":"30","author":"J Maegawa","year":"2010","journal-title":"Microsurgery"},{"issue":"5","key":"pone.0296466.ref027","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/j.jvsv.2022.04.011","article-title":"Lymphoscintigraphy for prediction of effect of lymphaticovenular anastomosis for treatment of secondary lower limb lymphedema","volume":"10","author":"T Nuri","year":"2022","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"issue":"3","key":"pone.0296466.ref028","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/SLA.0000000000002917","article-title":"Validity of the novel Taiwan lymphoscintigraphy staging and correlation of Cheng lymphedema grading for unilateral extremity lymphedema","volume":"268","author":"MH Cheng","year":"2018","journal-title":"Ann Surg"},{"issue":"12","key":"pone.0296466.ref029","doi-asserted-by":"crossref","first-page":"2607","DOI":"10.1002\/cncr.22684","article-title":"Lymphedema after gynecological cancer treatment: prevalence, correlates, and supportive care needs","volume":"109","author":"V Beesley","year":"2007","journal-title":"Cancer"},{"issue":"3","key":"pone.0296466.ref030","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.3802\/jgo.2023.34.e28","article-title":"Risk factors for lower extremity lymphedema after surgery in cervical and endometrial cancer","volume":"34","author":"J Lee","year":"2023","journal-title":"J Gynecol Oncol"},{"issue":"7","key":"pone.0296466.ref031","doi-asserted-by":"crossref","first-page":"e0253143","DOI":"10.1371\/journal.pone.0253143","article-title":"Comparison of the complications between minimally invasive surgery and open surgical treatments for early-stage cervical cancer: A systematic review and meta-analysis","volume":"16","author":"Y Li","year":"2021","journal-title":"PLoS One"},{"issue":"3","key":"pone.0296466.ref032","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.ygyno.2017.06.004","article-title":"Lymphedema following gynecological cancer: results from a prospective, longitudinal cohort study on prevalence, incidence and risk factors","volume":"146","author":"SC Hayes","year":"2017","journal-title":"Gynecol Oncol"},{"issue":"6","key":"pone.0296466.ref033","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3892\/etm.2020.9311","article-title":"Associated risk factors of lower limb lymphedema after treatment of cervical and endometrial cancer","volume":"20","author":"LF Rebegea","year":"2020","journal-title":"Exp Ther Med"},{"issue":"2","key":"pone.0296466.ref034","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.ygyno.2020.04.702","article-title":"Incidence and risk factors for lower limb lymphedema associated with endometrial cancer: results from a prospective, longitudinal cohort study","volume":"158","author":"A Pigott","year":"2020","journal-title":"Gynecol Oncol"},{"issue":"1","key":"pone.0296466.ref035","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.asjsur.2020.08.010","article-title":"Current operative management and therapeutic algorithm of lymphedema in the lower extremities","volume":"44","author":"S Ramachandran","year":"2021","journal-title":"Asian J Surg"},{"issue":"3","key":"pone.0296466.ref036","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1245\/s10434-009-0778-9","article-title":"Predictive factors of response to decongestive therapy in patients with breast-cancer-related lymphedema","volume":"17","author":"I Forner-Cordero","year":"2010","journal-title":"Ann Surg Oncol"},{"issue":"4","key":"pone.0296466.ref037","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/S0002-9610(99)00185-3","article-title":"Edema volume, not timing, is the key to success in lymphedema treatment","volume":"178","author":"SM Ramos","year":"1999","journal-title":"Am J Surg"},{"issue":"3","key":"pone.0296466.ref038","doi-asserted-by":"crossref","first-page":"e59523","DOI":"10.1371\/journal.pone.0059523","article-title":"Side-to-end lymphaticovenular anastomosis through temporary lymphatic expansion","volume":"8","author":"T Yamamoto","year":"2013","journal-title":"PLOS ONE"},{"issue":"5","key":"pone.0296466.ref039","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1097\/SAP.0000000000000513","article-title":"Comparison of vascularized supraclavicular lymph node transfer and lymphaticovenular anastomosis for advanced stage lower extremity lymphedema","volume":"74","author":"S Akita","year":"2015","journal-title":"Ann Plast Surg"},{"issue":"2","key":"pone.0296466.ref040","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1002\/jso.24812","article-title":"Effective and efficient lymphaticovenular anastomosis using preoperative ultrasound detection technique of lymphatic vessels in lower extremity lymphedema","volume":"117","author":"A Hayashi","year":"2018","journal-title":"J Surg Oncol"},{"issue":"7","key":"pone.0296466.ref041","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.3390\/cancers13071540","article-title":"Prospective validation of indocyanine green lymphangiography staging of breast cancer-related lymphedema","volume":"13","author":"MG J\u00f8rgensen","year":"2021","journal-title":"Cancers"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296466","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T19:18:58Z","timestamp":1704223138000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296466"}},"subtitle":[],"editor":[{"given":"Andrea","family":"Giannini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,1,2]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0296466","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,2]]}}}