Abstract
ObjectiveTo evaluate patient-reported incidence and severity of early lymphedema and its impact on quality of life (QoL) after sentinel lymph node (SLN) mapping only and after SLN and pelvic lymphadenectomy (PL) in women undergoing surgery for early-stage cervical cancer. MethodsIn a national prospective multicenter study, we included women with early-stage cervical cancer from March 2017–January 2021 to undergo radical surgery including SLN mapping. Women with tumors >20 mm underwent completion PL. The incidence and severity of early lymphedema and its influence on QoL were evaluated using validated patient-reported outcome measures before surgery and three months postoperative. We investigated changes over time using linear regression. ResultsTwo hundred of 245 (81.6%) included women completed questionnaires at baseline and three months postoperatively. The incidence of early lymphedema was 5.6% (95% CI 2.1–11.8%) and 32.3% (95% CI 22.9–42.7%) in women who underwent SLN mapping only and SLN + PL, respectively. Lymphedema symptoms in the legs, genitals, and groins increased in both groups postoperatively but three times more in women who underwent PL. Lymphedema symptoms after SLN + PL significantly impaired physical performance (p = 0.001) and appearance (p = 0.007). Reporting lymphedema was significantly associated with impaired body image, physical-, role-, and social functioning, and a high level of fatigue. ConclusionsSLN mapping alone carries a low risk of lymphedema in women undergoing surgery for early-stage cervical cancer. In contrast, completion PL is associated with a high incidence of early lymphedema. Reporting lymphedema is associated with significant impairment of several physical, psychological, and social aspects of QoL.
Highlights
Sentinel lymph node (SLN) mapping represents a less invasive staging procedure than radical pelvic lymphadenectomy (PL) and may reduce or prevent late effects as lymphedema [1–10]
The current paper reports the incidence and severity of early lymphedema and its impact on quality of life (QoL) assessed by validated PROMs
Participants and non-participants differed in age, Charlson Comorbidity Index (CCI), smoking, adjuvant therapy, and site of hospital inclusion (Table 1)
Summary
Sentinel lymph node (SLN) mapping represents a less invasive staging procedure than radical pelvic lymphadenectomy (PL) and may reduce or prevent late effects as lymphedema [1–10]. Despite the increased implementation of SLN mapping, evidence on the potential reduction of lymphedema remains scarce [3,11,12]. In the transition to SLN mapping, it is crucial to ascertain the accuracy of the technique and to learn how the procedure affects women in terms of lymphedema. We seek to contribute with this knowledge to improve future shared decisionmaking in nodal staging of women with early-stage cervical cancer. The SLN mapping technique is gradually adopted in women with cervical cancer and low-risk disease (tumors ≤20 mm) due to the high sensitivity and negative predictive value (NPV) along with a welldocumented low rate of nodal metastases [1,7,15–18]. Though recent studies have shown similar high sensitivity and NPV in women with large tumors (>20 mm), there is still an ongoing debate on the oncological safety in these women [7,19–21]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
