|  Gaps in the Field of Lymphatic Research  |  2026–27 Update  |  3
Standardized Definitions of Disease:
• Need objective documentation of appropriate 
standards for the diagnosis of lymphedema, 
lipedema, and other chronic edematous conditions.
• Need the study of lymphatic medicine included as  
a discipline taught in medical school and included  
as an integral part of the cardiovascular system. 
• Need to better characterize the sex-specific  
patterns of obesity and regional adipose definition  
in order to understand when the pathology of 
lipedema is present.
• Develop and measure core outcome measures  
for lymphedema/lymphatic disease therapists  
to optimize clinical care and bring consistency  
to lymphedema/lymphatic disease research  
outcome goals.
• Awareness campaign to help providers better 
understand their patients with lymphatic disease.
2. Lymph Collection and Analysis
• Development of clinically relevant approaches/
methods/technologies for lymph sampling and 
comprehensive multi-omics analysis of lymph  
fluid in vitro.
• Integrate diagnosis and targeting of lymphatic  
cell populations.
• Surveillance of cancer cells in lymph flow to  
provide earlier insights into metastases and  
improve cancer.
3. Lymphatic Specific Pharmacotherapies  
and Targeted Therapies
• We lack medications that improve lymphatic function 
without causing significant off-target toxic effects. 
• We lack drug mechanism studies.
• How do we evaluate drug resistance (pathway 
investigation)?
• Inhibition of lymphatic signaling in tumor metastasis.
• Novel methods of drug delivery (viral vectors,  
CAR T-cell therapy). 
• Is there a role for pharmacology in lymphedema 
prevention?
• Is there a role for pharmacology in lipedema 
prevention or treatment?
• Does leukotriene biology offer opportunities for 
related lymphatic diseases like vascular malformation, 
lymphagiectasia, lipedema, and others?
• Causes and interventions for complications of 
lymphatic disease and lymphedema (e.g., lymphatic 
pain, disfiguration, fibrosis, and coagulopathy).
4. Therapeutic Devices, Surgical or 
Interventional Radiology Treatments of 
Lymphedema or other Lymphatic Diseases
• Improve lymphatic microsurgery by using robotics, 
virtual reality, augmented reality, and/or artificial 
intelligence to enhance training and increase the 
number of lymphatic micro-surgeons.
• How can the strategy of surgical prevention of 
lymphedema in cancer operations or treatment of  
other lymphatic diseases be further refined with  
regard to technique?
• Longer-term outcomes need to be evaluated  
for lymph node transfer and lymphaticovenous 
anastomosis for lymphedema. 
• Further research to determine which patients 
vascularized lymph node transfer and/or 
lymphaticovenous anastomosis is effective to  
aid in patient selection.
• Large-scale prospective clinical trials are needed to 
determine optimal treatment algorithms. (Some do 
well, but those with an inflammatory component to 
lymphedema do not do as well.)
• Mechanisms of immunomodulation following 
vascularized lymph node transplant need to be 
elucidated to aid development of pharmacological 
therapies.
• Need for large scale prospective trials analyzing 
outcomes of lymphedema surgery with a goal of 
defining optimal surgical algorithms and analyzing  
these outcomes long-term. Studies like this are 
needed for insurance coverage.
• Understanding post-surgical lymphedema prevention 
and long-term surveillance for current breast cancer 
surgical reconstruction procedures.
• How to improve and tailor Phase 2 Complete 
Decongestive Therapy self-management activities  
for the person living with lymphedema.
• Examine the role of complete decongestive therapy 
in rehabilitation pre- and post-surgical treatment. 
• Examine the adherence and outcomes of people 
living with lymphedema to use of pneumatic 
compression devices across the lifespan.
• Novel compression device development and 
comparison studies with current approved devices.
• Interventions to manage lymphedema in advanced 
cancer and innovation in palliative care.
• Need for further development of novel techniques in 
magnetic resonance lymphangiography. 
• Need for novel interventional radiology preventative 
and therapeutic approaches to lymphatic disease. 
• Need for interventional radiology drug delivery 
options. 

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