THE DIAGNOSIS AND TREATMENT OF PERIPHERAL LYMPHEDEMA: 2013 CONSENSUS DOCUMENT OF THE INTERNATIONAL SOCIETY OF LYMPHOLOGY

Abstract

This International Society of Lymphology(ISL) Consensus Document is the currentrevision of the 1995 Document for theevaluation and management of peripherallymphedema (1) for discussion at the XXIVInternational Congress of Lymphology. It isbased upon modifications: [A] suggested andpublished following the 1997 XVI InternationalCongress of Lymphology (ICL) inMadrid, Spain (2) discussed at the 1999 XVIIICL in Chennai, India (3) and considered/confirmed at the 2000 (ISL) ExecutiveCommittee meeting in Hinterzarten, Germany(4); [B] derived from integration ofdiscussions and written comments obtainedduring and following the 2001 XVIII ICL inGenoa, Italy as modified at the 2003 ISLExecutive Committee meeting in Cordoba,Argentina (5); [C] suggested from comments,criticisms, and rebuttals as published in theDecember 2004 issue of Lymphology (6);[D] discussed in both the 2005 XX ICL inSalvador, Brazil and the 2007 XXI ICL inShanghai, China and modified at the 2008Executive Committee Meeting in Naples, Italy(7,8); and [E] modified from discussions andwritten comments from the 2009 XXII ICLin Sydney, Australia, the 2011 XXIII ICL inMalmo, Sweden and 2012 ExecutiveCommittee Meetings.The document attempts to amalgamatethe broad spectrum of protocols advocatedworldwide for the diagnosis and treatment ofperipheral lymphedema into a coordinatedproclamation representing a “Consensus” ofthe international community. The document is not meant to override individual clinicalconsiderations for problematic patients nor tostifle progress. It is also not meant to be alegal formulation from which variations definemedical malpractice. The Society understandsthat in some clinics the method of treatmentderives from national standards while inothers access to medical equipment andsupplies is limited, and therefore the suggestedtreatments are impractical. Adaptability andinclusiveness does come at the price thatmembers can rightly be critical of what theysee as vagueness or imprecision in definitions,qualifiers in the choice of words (e.g., the useof “may... perhaps... unclear”, etc.) andmention (albeit without endorsement) oftreatment options supported by limited harddata. Most members are frustrated by thereality that NO treatment method has reallyundergone a satisfactory meta-analysis(let alone rigorous, randomized, stratified,long-term, controlled study). With this understanding,the absence of definitive answersand optimally conducted clinical trials, andwith emerging technologies and newapproaches and discoveries on the horizon,some degree of uncertainty, ambiguity, andflexibility along with dissatisfaction withcurrent lymphedema evaluation and managementis appropriate and to be expected.We continue to struggle to keep the documentconcise while balancing the need for depthand details. With these considerations inmind, we believe that this latest versionpresents a Consensus that embraces the entireISL membership, rises above national standards, identifies and stimulates promisingareas for future research and represents the best judgment of the ISL membership on  how to approach patients with peripheral lymphedema as of 2013. Therefore the document has been, and should continue to be, challenged and debated in the pages of Lymphology (e.g., as Letters to the Editor), and ideally will remain a continued focal point for robust discussion at local, national and international conferences in lymphology and related disciplines. We further anticipate as experience evolves and new ideas and technologies emerge that this “living document” will undergo further periodic revision and refinement as the practiceand theories of medicine and specificallylymphology change and advance.