Lymphology. 2023;56(4):133-151.
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 Malmo, Sweden, the 2012 Executive Committee Meetings (9); [F] 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 (10); informal discussions at the XXVI ICL in Barcelona, Spain; [G] discussions at a dedicated, focused Post-Congress session at the XXVII ICL in Iguazu, Argentina (2019) followed by additional written comments from the Executive Committee and others (11); and [H] discussions and written comments from the XXVIII ICL in Athens, Greece (2021), and the XXIX ICL in Genoa, Italy (2023). 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 impede clinical treatment or research progress. It is not meant to be a legal formulation from which variations could be used to describe or 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, technical expertise, and supplies is limited; therefore, the suggested assessments and treatments might be impractical. Adaptability and inclusiveness do 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 (few randomized control trials). Most members are frustrated by the reality that NO treatment method has really undergone a satisfactory meta-analysis (let alone rigorous, randomized, controlled study). With this understanding, the absence of optimally conducted clinical trials and definitive answers, 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, breadth, and details. With these considerations in mind, we believe that this 2023 version presents a Consensus that embraces the entire ISL membership, acknowledges national standards but rises above them, identifies, and stimulates promising areas for future research, and represents the best judgment of the ISL member-ship 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.
本国际淋巴学会（ISL）共识文件是1995年《外周性淋巴水肿评估与管理文件》的最新修订版（1）。它基于以下修改：[A] 1997年在西班牙马德里举行的第十六届国际淋巴学大会（ICL）后提出并发表的建议（2），在1999年于印度金奈举行的第十七届ICL上进行了讨论（3），并在2000年德国欣特察滕举行的（ISL）执行委员会会议上被视为确认（4）；[B] 源自对2001年于意大利热那亚举行的第十八届ICL期间及之后获得的讨论和书面评论进行整合，并在2003年阿根廷科尔多瓦举行的ISL执行委员会会议上进行了修改（5）；[C] 来自2004年12月《淋巴学》杂志上发表的评论、批评和反驳意见（6）；[D] 在2005年于巴西萨尔瓦多举行的第二十届ICL和2007年于中国上海举行的第二十一届ICL上进行了讨论，并在2008年意大利那不勒斯举行的执行委员会会议上进行了修改（7,8）；[E] 根据2009年于澳大利亚悉尼举行的第二十二届ICL、2011年于瑞典马尔默举行的第二十三届ICL以及2012年执行委员会会议的讨论和书面评论进行了修改（9）；[F] 在2013年于意大利罗马举行的第二十四届ICL和2015年于美国旧金山举行的第二十五届ICL上进行了讨论，以及在2016年起草期间执行委员会和其他ISL成员的多次书面评论和反馈（1）；在西班牙巴塞罗那举行的第二十六届ICL上进行的非正式讨论；[G] 在2019年于阿根廷伊瓜苏举行的第二十七届ICL专门的、聚焦的会后会议上进行了讨论，随后执行委员会和其他方面又提供了更多书面评论（11）；以及[H] 来自2021年于希腊雅典举行的第二十八届ICL和2023年于意大利热那亚举行的第二十九届ICL的讨论和书面评论。该文件试图将全球范围内倡导的外周性淋巴水肿诊断和治疗的广泛方案与实践整合为一份协调声明，代表基于不同证据水平的国际社会“共识”。该文件并非旨在取代针对复杂患者的个体临床考量，也无意阻碍临床治疗或研究进展。它并非旨在成为一种法律规定，据此差异可被用于描述或界定医疗过失。学会明白，在一些诊所，治疗方法源自国家标准，而在另一些诊所，获取医疗设备、技术专长和物资的机会有限；因此，所建议的评估和治疗可能不切实际。适应性和包容性确实存在代价，成员们可能会合理地批评他们认为定义中的模糊性或不精确性、用词中的限定词（例如使用“可能……或许……不明确”等）以及（尽管未予认可）对仅有有限确凿数据支持的治疗选择（很少有随机对照试验）的提及。由于没有一种治疗方法真正经过令人满意的荟萃分析（更不用说严格的随机对照研究）这一现实，大多数成员感到沮丧。基于这种理解，缺乏最优进行的临床试验和明确答案，以及新技术、新方法和新发现即将出现，一定程度的不确定性、模糊性和灵活性以及对当前淋巴水肿评估和管理的不满是适当的且可以预期的。我们继续努力在保持文件简洁的同时，平衡深度、广度和细节的需求。考虑到这些因素，我们认为2023年版呈现了一份涵盖整个ISL成员的共识，承认国家标准但又超越它们，识别并激发未来研究的有前景领域，并代表ISL成员根据现有证据对如何处理外周性淋巴水肿患者的最佳判断。因此，该文件过去一直并应继续在《淋巴学》杂志的页面上受到挑战和辩论（例如作为给编辑的信），理想情况下将继续成为淋巴学及相关学科的地方、国家和国际会议上热烈讨论的焦点。我们进一步预期，随着经验的积累以及新思想和新技术的出现，这份“动态文件”将随着医学尤其是淋巴学的实践和概念基础的变化与进步而经历进一步定期修订和完善。
