Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy
Introduction
Lymphedema is a chronic disease that lasts a lifetime in most cases [1], [2], [3], and many patients face physical and psychological pain, as well as economic burdens, as a result of the disease. Sentinel lymph node navigation surgery is a promising treatment for lowering the frequency of postoperative leg edema in patients with cervical carcinoma of the uterus [4]. However, it is unknown at present whether sentinel lymph node navigation surgery can be applied in endometrial cancer [4]. It has been suggested that the total number of resected lymph nodes has relevance to the incidence of lower-extremity lymphedema [5], [6]. A wide range of incidences (1.2–27.3%) of postoperative lower-extremity lymphedema in patients with uterine corpus cancer has been reported [6], [7], the difference considered to be due to the difference in total number of resected lymph nodes. On the other hand, it has recently been reported that not selective but systematic lymphadenectomy including para-aortic lymphadenectomy has therapeutic significance for patients with intermediate-/high-risk endometrial cancer [8]. Several studies have also suggested that the total number of resected lymph nodes, especially removal of 11 or more nodes, has relevance to better survival in patients with endometrial cancer [9], [10]. Therefore, careful consideration should be given to reducing the number of resected lymph nodes. Gynecologic oncologists are facing a dilemma of whether to remove more regional lymph nodes for improving prognosis or to remove less of them for reducing the incidence of lower-extremity lymphedema. Although unsubstantiated by data, Abu-Rustum et al. [11] suggested that removal of circumflex iliac nodes to the distal external iliac nodes (CINDEIN) is likely a factor contributing to the risk of postoperative lower-extremity lymphedema. The authors are, therefore, paying attention to these nodes to overcome this dilemma. The aim of this study was to determine the incidence rate of lower-extremity lymphedema after systematic lymphadenectomy in patients with endometrial cancer and to elucidate risk factors for this type of lymphedema.
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Patients and clinicopathologic findings
A total of 530 patients with malignant tumor of the uterine corpus were treated in the National Hospital Organization, Hokkaido Cancer Center during the period from January 1986 to December 2007. Twenty patients did not undergo surgery and 130 patients underwent surgery without lymphadenectomy. Sixty-four patients died of cancer or intercurrent disease. Medical records concerning postoperative lower-extremity lymphedema in thirty patients were missing. Finally, 286 living patients who underwent
Results
With a median follow-up period of 71 months (interquartile range, 45-108 months), POLEL was noted in medical records of 108 patients (37.8%). Table 2 shows the occurrence of POLEL according to the range of number of resected lymph nodes. Regarding correlation of the number of resected lymph nodes and POLEL, a significant relationship was found between the cut-off number of 21 or 31 and POLEL (chi-square test; p = 0.0230 and p = 0.0055, respectively). On the other hand, no significant relationship was
Discussion
Lower-extremity lymphedema is a serious complication following lymphadenectomy and a chronic disease that lasts a lifetime in most cases [1], [2], [3]. The incidence rate of lower-extremity lymphedema that originates in lymphadenectomy has been reported to be 1.2–27.3% in patients with uterine corpus cancer [6], [7].
The overall rate of lymphedema of 37.8% in our study is higher than rates reported in the literature. This may be due to the number of lymph nodes dissected. It has been reported
Conflict of interest statement
There is no conflict of interest with others about the research content, conclusions, and significance of this study.
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