Associated risk factors of lower limb lymphedema after treatment of cervical and endometrial cancer

Abstract

The scope of the study was to identify the associated risk factors of lower limb lymphedema development in cervical and endometrial cancer patients. We retrospectively analysed 326 patients: 186 cases (57.06%) with cervical cancer and 140 cases (42.94%) with endometrial cancer were treated in Surgery, Radiotherapy, Oncology and Gynaecology Clinics of 'St. Apostle Andrew' Emergency Clinical Hospital Galati over 9 years. Adjuvant radiotherapy was performed in 83.57% of endometrial cancer cases. Adjuvant chemotherapy was performed in 45.16% of cervical cancer cases. Over 10 lymph nodes were removed in 74.73% of cervical cancer patients. Incidence of lymphedema was 15.05% in cervical cancer patients and 10% in endometrial cancer patients, P=0.06. Analysed risk factors for lower limb lymphedema occurrence were: Age, disease stage, radiotherapy, number of invaded lymph nodes (for cervical cancer patients), number of removed lymph nodes (for cervical cancer patients) and obesity. Multivariate analysis for associated risk factors of lower limb lymphedema development in cervical cancer showed that number of removed lymph nodes, OR=2.109 (0.907-4.903), P<0.0001, number of lymph nodes with metastasis, OR=1.903 (0.253-4.332), P=0.004 and obesity, OR=1.713 (0.226-2.967), P= 0.006 were found as statistically significant risk factors for lower limb lymphedema onset. For endometrial cancer patients, obesity, OR=1.518 (0.721-2.75), P=0.0003, was the only associated risk factor with statistical significance for the lower limb lymphedema development. Lower limb lymphedema represents one of the adverse reactions of multimodal treatment in gynaecological cancers which affects patient's quality of life. Lower limb lymphedema occurrence is related with number of risk factors, the most important being removed lymph nodes, obesity and radiotherapy.

Calcium channel blocker and risk of postoperation lymphatic-related complications among gynecologic malignances

“…Biglia et al found that neither chemotherapy alone nor the association of consecutive chemotherapy and radiotherapy was associated with an increased incidence of lower limb lymphedema ( 13 ). In addition, there have been a few studies investigating the risk factors including BMI, nutritional status, number of removed lymph nodes, lymphedema, and adjuvant radiotherapy in patients having systematic lymphadenectomy ( 14 , 15 ).…”

Invisible cervical cancers on MRI: Can the type of histology (SCC versus non-SCC) influence surgical planning?

“…This surgical technique consists of parametrectomy and LN dissection. Accordingly, patients have a higher risk of postoperative complications, such as voiding difficulty ( 7 – 9 ), anorectal dysfunction ( 10 , 11 ), sexual dissatisfaction ( 10 , 11 ), and lymphedema ( 12 – 14 ), if parametrectomy or LN dissection becomes aggressive. Therefore, greater attention is being paid to minimally invasive surgery to minimize these postoperative complications.…”

Multi-segment bioimpedance in the evaluation of treatment for secondary lower limb lymphedema: Gynecological cancer

“…The main factors associated with secondary lower limb lymphedema are gynecological cancer, age, disease stage, radiotherapy, number of lymph nodes invaded (for patients with cervical cancer), number of lymph nodes removed (for patients with cervical cancer) and obesity, the most important of which are obesity and the number of lymph nodes removed [6].…”