Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma

Abstract

BackgroundLymph node dissection has proven prognostic benefits for patients with ovarian or uterine carcinoma; however, one of the complications associated with this procedure is lymphedema. We aimed to identify the factors that are associated with the occurrence of lymphedema after lymph node dissection for the treatment of ovarian or uterine carcinoma.MethodsA total of 694 patients with histologically confirmed ovarian (135 patients) or uterine cancer (258 with cervical cancer, 301 with endometrial cancer) who underwent lymph node dissection were studied retrospectively. Logistic regression analyses were used to identify the risk factors associated with occurrence of lymphedema.ResultsAmong ovarian and uterine cancer patients who underwent pelvic lymph node dissection, post-operative radiotherapy (odds ratio: 1.79; 95% confidence interval: 1.20–2.67; p = 0.006) was statistically significantly associated with occurrence of lymphedema.ConclusionThere was no relationship between any surgical procedure and occurrence of lymphedema among patients undergoing pelvic lymphadenectomy. Our findings are supported by a sound biological rationale because they suggest that limb lymphedema is caused by pelvic lymph node dissection.

Lower Body Lymphedema in Patients with Gynecologic Cancer

“…Some studies have suggested that radiation increases the risk of lymphedema, but most patients in these studies had more than 20 nodes removed, which might increase the risk of lymphedema per se (39,40). In a recent study, the risk of LLL after post-operative radiation (mainly external beam radiation), evaluated through both objective and subjective evaluations, was associated with lymph node positivity (OR=3,2; 95%CI=1.0007-10·7; p=0.0499) when controlled for lymph-node dissection (41).…”

The incidence and risk factors for development of lower limb lymphedema after treatment for gynaecological cancers

“…Postoperative radiotherapy was found to be an independent risk factor for lower limb lymphedema. 9 For the site of lymph nodes, removal of groin lymph nodes in vulvar cancer was associated with a higher incidence of lymphedema compared to removal of para aortic lymph nodes in ovarian cancer. [10][11][12] Another study by Ki EY et al revealed that pelvic node dissection increased the risk of LLL after surgery compared to no pelvic node dissection, but para-aortic node dissection did not increase the risk of LLL compared to pelvic node dissection alone.…”

“…Post-operative radiation was found to be a risk factor for occurrence of LLL among cervical and uterine cancer patients who underwent pelvic lymph node dissection. 7,9 Present study involved a small number of patients who underwent any form of adjuvant therapy. Only 6 patients received radiation therapy and we did not find any significant association in development of lymphedema in these patients.…”

“…The diagnosis of lymphedema in many of these studies was done with the help of questionnaires or with patient-reported or physicianreported swelling of lower limbs. 7,9,14 Present study was a prospective observational study with all the study subjects undergoing serial limb measurements and this has helped in the early detection of lymphedema. The incidence of lymphedema is quite high according to our study and this undermines the importance of proper preoperative counseling and education regarding this disabling side effect of gynecology cancer treatment.…”

Short commentary on Lymphedema after Treatment for Endometrial Cancer

“…Risk factors remains to be evaluated in correctly designed and sufficiently powered studies. However, lymphadenectomy per se [4][5][6][7], number of lymph nodes removed [6,[8][9][10][11][12][13][14][15][16] and radiotherapy [3, [7][8][9][10][11]14,[17][18][19][20] seem to be established risk factor. Lymphedema onset may begin immediately after surgery or may be delayed for many years.…”