Nationwide Medical Survey on Regional Disparities in Secondary Lymphedema Surgical Treatment Covered by Health Insurance

Background: Lymphedema is a lifelong complication for cancer survivors, highlighting the need to address the regional disparities in its treatment. To assess the current regional disparities in surgical treatment for lymphedema, we conducted a comprehensive nationwide survey of medical institutions through questionnaires. Methods: Japanese surgical treatment facilities were categorized into 9 regions, distinguishing between designated cancer hospitals and other medical institutions, as well as high-volume and low-volume hospitals. We examined variations in the number of surgical procedures per capita across regions and analyzed differences in surgical indications between high-volume and low-volume hospitals based on the clinical classification of the International Society of Lymphology. Results: There was a 17.4-fold difference in the number of lymphedema surgical treatments per population between the region with the highest and lowest numbers. A strong correlation was found between the number of procedures in a region and the percentage of procedures performed at high-volume hospitals (ρ = 0.73, P = 0.03). High-volume hospitals had a significantly higher proportion of cases deemed suitable for surgery at an early stage of lymphedema than low-volume hospitals ( P < 0.001 and P = 0.0032 in stages 0 and I in the upper extremity, and P < 0.001 in stages 0 and I in the lower extremity). Conclusions: Significant regional variations exist in both the frequency of lymphedema surgery and surgical indication patterns across healthcare facilities, even in an environment where surgical treatment is covered by insurance. Standardized studies evaluating treatment outcomes are needed to assess the appropriateness of treatment indications.