Executive Committee.
Lymphology. Date of publication 2016 Dec 1;volume 49(4):170-84.
1. Lymphology. 2016 Dec;49(4):170-84.
The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of
the International Society of Lymphology.
Executive Committee.
This International Society of Lymphology (ISL) Consensus Document is the latest
revision of the 1995 Document for the evaluation and management of peripheral
lymphedema (1). It is based upon modifications: [A] suggested and published
following the 1997 XVI International Congress of Lymphology (ICL) in Madrid,
Spain (2), discussed at the 1999 XVII ICL in Chennai, India (3), and considered/
confirmed at the 2000 (ISL) Executive Committee meeting in Hinterzarten, Germany
(4); [B] derived from integration of discussions and written comments obtained
during and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003
ISL Executive Committee meeting in Cordoba, Argentina (5); [C] suggested from
comments, criticisms, and rebuttals as published in the December 2004 issue of
Lymphology (6); [D] discussed in both the 2005 XX ICL in Salvador, Brazil and the
2007 XXI ICL in Shanghai, China and modified at the 2008 Executive Committee
meeting in Naples, Italy (7,8);[E] modified from discussions and written comments
from the 2009 XXII ICL in Sydney, Australia, the 2011 XXIII ICL in Malmö, Sweden,
the 2012 Executive Committee Meetings (9),and [F] from discussions at the 2013
XXIV ICL in Rome, Italy, and the 2015 XXV ICL in San Francisco, USA, as well as
multiple written comments and feedback from Executive Committee and other ISL
members during the 2016 drafting. The document attempts to amalgamate the broad
spectrum of protocols and practices advocated worldwide for the diagnosis and
treatment of peripheral lymphedema into a coordinated proclamation representing a
“Consensus” of the international community based on various levels of evidence.
The document is not meant to override individual clinical considerations for
complex patients nor to stifle progress. It is also not meant to be a legal
formulation from which variations define medical malpractice. The Society
understands that in some clinics the method of treatment derives from national
standards while in others access to medical equipment and supplies is limited;
therefore the suggested treatments might be impractical. Adaptability and
inclusiveness does come at the price that members can rightly be critical of what
they see as vagueness or imprecision in definitions, qualifiers in the choice of
words (e.g., the use of “may... perhaps... unclear”, etc.) and mentions (albeit
without endorsement) of treatment options supported by limited hard data. Most
members are frustrated by the reality that NO treatment method has really
undergone a satisfactory meta-analysis (let alone rigorous, randomized,
stratified, long-term, controlled study). With this understanding, the absence of
definitive answers and optimally conducted clinical trials, and with emerging
technologies and new approaches and discoveries on the horizon, some degree of
uncertainty, ambiguity, and flexibility along with dissatisfaction with current
lymphedema evaluation and management is appropriate and to be expected. We
continue to struggle to keep the document concise while balancing the need for
depth and details. With these considerations in mind, we believe that this 2016
version presents a Consensus that embraces the entire ISL membership, rises above
national standards, identifies and stimulates promising areas for future
research, and represents the best judgment of the ISL membership on how to
approach patients with peripheral lymphedema in the light of currently available
evidence. 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 practice and conceptual foundations of medicine and specifically
lymphology change and advance.
PMID: 29908550 [Indexed for MEDLINE]
