Incidence Of Lower Extremity Lymphedema Research Articles

Risk factors for lower extremity lymphedema after cervical cancer treatment: a systematic review and meta-analysis.

BackgroundThe main risk factors for the development of lower extremity lymphedema after cervical cancer treatment are controversial. Our aim was to evaluate the main risk factors of lower extremity lymphedema after cervical cancer treatment.MethodsWe searched the English database PubMed, Embase, Medline, Central and the Chinese database CNKI to obtain relevant studies. Inclusion criteria: (I) the subjects were cervical cancer patients receiving treatment; (II) cohort studies or case-control studies; (III) exposure factors were not limited; (IV) the outcome was lower extremity lymphedema after treatment; (V) the odds ratio (OR) value and 95% confidence interval of exposure factors can be obtained. The chi-square test was used to test for heterogeneity. The Egger test was used to test for publication bias. OR (95% CI) was calculated using inverse variance.ResultsA total of 12 retrospective studies with a total of 3,401 patients were included in this literature review. The incidence of lower extremity lymphedema after cervical cancer treatment was between 12.6% and 43.1%. Meta-analysis results demonstrated that the main risk factors were: body mass index (BMI) (OR =1.37, 95% CI: 1.10–1.71, P=0.005), age (OR =1.68, 95% CI: 1.07–2.64, P=0.02), International Federation of Gynecology and Obstetrics (FIGO) stage (OR =1.50, 95% CI: 1.24–1.82, P<0.001), radiotherapy (OR =2.87, 95% CI: 1.71–4.82, P<0.001), lymph node (LN) dissection (OR =3.24, 95% CI: 1.44–7.31, P=0.005), and the number of LNs dissected (OR =2.34, 95% CI: 1.80–3.05, P<0.001). Egger’s test showed that there was no publication bias among the literatures (P>0.05).ConclusionsBMI, age, FIGO stage, radiotherapy, LN dissection and the number of LNs removed are the main risk factors for lower extremity lymphedema after cervical cancer treatment. When treating patients with cervical cancer, effective interventions should be sought to reduce the risk of lower extremity edema.

Risk factors for lower extremity lymphedema after inguinal lymphadenectomy in melanoma patients: A retrospective cohort study

BackgroundThe aim of lymph node dissection for melanoma patients is to prevent metastasis. However, this procedure is accompanied by a long-term and impaired life-quality complication called extremity lymphedema. This condition involves long-term lower limb swelling, which causes discomfort and impaired function, and affects patients both physically and psychologically. Herein, we conducted a retrospective cohort study at a single center to investigate the risk factors associated with lower extremity lymphedema after inguinal lymphadenectomy. Materials and MethodsWe identified 136 inguinal lymphadenectomy melanoma patients treated between January 2010 and January 2021. The patients' demographic, clinical, and pathological data and postoperative outcomes were collected by electronic medical record review and patient follow-up. The patients' postoperative outcomes were defined as lower extremity swelling and lower extremity lymphedema. Univariate and multivariate analyses were used to determine the independent predictors of lower extremity lymphedema. ResultsThe follow-up results from 85 melanoma patients who underwent inguinal lymphadenectomy were analyzed. Multivariate logistic regression analysis showed that number of lymph nodes removed≥10 was the significant risk factor for postoperative lower extremity lymphedema (odds ratio = 6.468, P = .042, 95% confidence interval: 1.069 to 39.147). Moreover, 8 (100%) patients in the lower extremity lymphedema group and 32 (53.3%) patients in the normal group were female, which indicated that female patients might be more susceptible to postoperative lower extremity lymphedema (P = .012). ConclusionOur study found that number of inguinal lymph nodes removed ≥10 was associated with a significantly higher incidence of lower extremity lymphedema with a 6.5-fold increased risk in melanoma patients. Also, female patients were more likely to develop lower extremity lymphedema after inguinal lymphadenectomy.

Early prevention of complex decongestive therapy and rehabilitation exercise for prevention of lower extremity lymphedema after operation of gynecologic cancer

ObjectiveTo investigate efficacy of early prevention of complex decongestive therapy and rehabilitation exercise for prevention of postoperative lower limb extremity lymphedema for patients with gynecologic cancer. Methods109 female patients were randomly divided into two groups, the control group who only received routine treatment and the CDT group who received both CDT and rehabilitation exercise. For rehabilitation exercise, patients received additional rehabilitation exercise strategy including professional education and full range exercise of hip joint. The incidence of lower extremity lymphedema was recorded. A simple scale for patients’ lower extremity lymphedema was designed. The diameter of low limbs (both thighs and calves) was also measured The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Brief Fatigue Inventory (BFI) was used for measurement of quality of life. ResultsThe incidence of lower extremity lymphedema was 15.09% cases of CDT group and 32.14% in the control group. K-M curve showed the lymphedema free time in CDT group was significantly longer. The subjective scores for heaviness of lower limbs, pain, numbness and dysfunction, as well as the diameters of both thighs and calves were lower in the CDT group. In both groups, the values of EORTC QLQ-C30-GHS and EORTC QLQ-C30-FS were significantly higher, and EORTC QLQ-C30-SS scores and BFI scores were remarkably lower. ConclusionEarly prevention of CDT combined with rehabilitation exercise reduced incidence of lower limb extremity lymphedema and improved patients’ quality of life, as well as reduced the cancer-related fatigue.

A pilot study of lower extremity lymphedema, lower extremity function, and quality of life in women after minimally invasive endometrial cancer staging surgery

ObjectiveThe primary aim of this study was to pilot the use of an objective measurement technique to prospectively evaluate the incidence of lower extremity lymphedema (LEL) after minimally invasive staging surgery for endometrial cancer. Secondary objectives included observation of changes in lower extremity function and quality of life in this patient population. MethodsA prospective evaluation of LEL was performed in 97 women who underwent minimally invasive staging surgery for endometrial cancer using comparative circumferential volume measurements. Postoperative changes in lower extremity function and global quality of life were also assessed using patient-reported outcome measures. ResultsNinety-seven patients were included for lymphedema analysis. The rate of LEL was 25% at 4–6 weeks, 19% at 6–9 months, and 27% at 12–18 months postoperatively. The presence of LEL was associated with a significant worsening from baseline Lower Extremity Functional Scale (LEFS) scores at 4–6 weeks (−27.0% vs −3.7%, p = 0.02) and 6–9 months (−13.0% vs 0%, p = 0.01). LEL was not associated with a change in patient-reported global quality of life. ConclusionsUp to one in four women experience lymphedema following surgical staging for endometrial cancer, and its presence is associated with diminished lower extremity function. Larger, prospective trials using the objective methodology piloted in this study should better clarify risk factors and long-term outcomes of this morbidity.

Lower-extremity lymphedema following management for endometrial and cervical cancer

BackgroundDespite the alleged benefits conferred by a lymphadenectomy in the management of gynecologic malignancies, there are concerns regarding the development of postoperative lower-extremity lymphedema. The purpose of this study was to identify the incidence of lymphedema and associated risk factors in accordance with surgical staging during the management of endometrial and cervical cancer. MethodWe conducted a 5-year review of all endometrial and cervical cancer patients who underwent a lymphadenectomy. The subjects’ demographics, medical co-morbidities, diagnosis, surgical treatment, inclusion of adjuvant radiotherapy and incidence of lower-extremity lymphedema were noted. ResultsWe identified 165 (135 endometrial cancer and 30 cervical cancer) subjects. Positive pelvic and para-aortic lymph nodes were present in 21 (12.7%) and 10 patients (6.1%), respectively. In the entire population, 6 (3.6% incidence) subjects developed post-operative lymphedema. Supplementary analyses revealed that a BMI >35 kg/m2 and possessing numerous (≥3) co-morbidities significantly correlated with the manifestation of lower-extremity lymphedema. ConclusionIn the current investigation, we observed a reasonably low, overall incidence of postoperative lower-extremity lymphedema. Nevertheless, when evaluating the potential for lymphedema in patients for whom a lymphadenectomy is indicated, specific risk factors should be considered in an effort to attenuate the development of this morbid condition.

Comparison of lower extremity lymphedema incidence between two pelvic lymphadenectomy techniques in uterine cancer patients undergoing robotic-assisted staging procedures

Objectives: To compare the difference in incidence of lower extremity lymphedema after robotic surgical staging for uterine cancer employing standard pelvic lymphadenectomy and selective pelvic lymphadenectomy with sparing of the lateral external iliac chain as well as to evaluate the adequacy of selective approach in detecting lymph node metastases.

Comparison of Lymphedema Incidence Between 2 Lymphadenectomy Techniques in Patients With Uterine Cancer Undergoing Robotic Staging

This study aimed to compare the incidence of lower extremity lymphedema in patients with uterine cancer after robotic staging using the following 2 methods: standard and selective pelvic lymphadenectomy. Three hundred forty-four consecutive patients who presented with endometrial cancer from March 2007 to October 2012 underwent robotic staging. Surgeon A performed standard pelvic lymphadenectomy and surgeon B performed selective lymphadenectomy. Selective pelvic lymphadenectomy spared the lateral chain of the external iliac lymph nodes (LNs). The incidence of lymphedema and staging adequacy between the 2 groups were analyzed. Standard pelvic lymphadenectomy was performed in 238/344 (69.2%) patients and selective pelvic lymphadenectomy was performed in 106/344 (30.8%) patients. Conversion to laparotomy occurred in 2/344 cases (0.6%). Mean age for 344 patients was 63.6 (10) years and body mass index was 34.8 (10.1) kg/m(2). The mean operative time was 162.3 (54.6) minutes. Postoperative hospitalization was 1.62 (1.93) days. Histology included 80.8% endometrioid adenocarcinomas and 19.2% clear cell, serous, and carcinosarcomas. Mean pelvic LN counts for the standard and selective pelvic lymphadenectomy groups were 16 (8.6) and 15.5 (7.1), respectively (P = 0.31). Mean numbers of para-aortic LNs retrieved for the standard and selective lymphadenectomy groups were 3.1 (4.1) and 4.9 (4.5), respectively (P < 0.01).Median follow-up was 29.3 months (interquartile range, 15.6-43.1 months). The difference in the incidence of lower extremity lymphedema was statistically significant: 4.6% (11/238 patients) in the standard lymphadenectomy group versus 0.9% (1/106 patients) in the selective lymphadenectomy group (P = 0.03). When compared to the standard technique, selective pelvic lymphadenectomy with sparing of the lateral chain of the external iliac LNs is adequate and results in a lower incidence of lower extremity lymphedema.

Occurrence of Lymphedema Following Sentinel Node Biopsy (SNB) for Lower Extremity Melanoma

Background : The benefits of sentinel node biopsy for melanoma are well established, while the risks have received less attention. This study was undertaken to establish the incidence of lower extremity lymphedema following inguinal SNB and to identify risk factors predictive for the development of lymphedema. Methods: We conducted a retrospective chart review of all patients undergoing SNB at our institution between January 2000 and December 2007. Sixty-five patients were identified who had a lower extremity melanoma and underwent inguinal SNB in the absence of a completion lymph node dissection. After a minimum one year of follow-up, all patients were surveyed regarding their qualitative assessment of lymphedema. Results: Forty patients returned surveys and are the subject of this study. Fourteen of 40 patients (35%) reported experiencing post-operative lymphedema, with 9 patients (23%) having lymphedema that persisted for more than 1 year. The onset occurred within 1 month of surgery in 8 patients (25%). Lymphedema was described as minimal or mild by 13 patients and severe by 1 patient. Lymphedema requiring support stocking use was reported by 10 patients (25%). An increased incidence of post-operative lymphedema was found to be associated with primary tumors located on the lower leg or foot. Conclusions: Fourteen patients (35%) undergoing inguinal SNB experienced post-operative lymphedema, with 9 patients (23%) having persistent lymphedema for more than 1 year. These numbers are higher than in previously reported series. Location of the melanoma on the lower leg or foot appeared to be a significant risk factor. doi:10.4021/jcs33w

Reduction/Prevention of Lower Extremity Lymphedema after Pelvic and Para-aortic Lymphadenectomy for Patients with Gynecologic Malignancies

Lower extremity lymphedema (LEL) is a serious complication caused by lymphadenectomy in patients with gynecologic malignancies. In this study, we evaluated the effect of preserving the circumflex iliac lymph nodes (CILNs), i.e., the most caudal external iliac lymph nodes, for the prevention and reduction of LEL by comparing two groups of patients, one in which CILN were removed and the other in which CILNs were preserved. We retrospectively reviewed 329 patients with gynecologic malignancies who had undergone abdominal complete systematic pelvic and para-aortic lymphadenectomy. The patients were divided into nonpreserved (n=189) and preserved (n=140) groups, depending on whether CILNs were removed. Primary outcome measures included the incidence and severity of LEL. The incidence of LEL was significantly lower in the preserved group than in the nonpreserved group (P<0.0001). The frequency of LEL was also significantly lower in the preserved group than in the nonpreserved group regardless of the range of pelvic and para-aortic lymphadenectomy (P<0.0001). LEL in the overwhelming majority of cases in the preserved group was mild, and no patients experienced severe LEL. Further, the incidence of cellulitis was 0% in the preserved group, while it was 12.7% in the nonpreserved group (P<0.0001). Lymphoscintigraphy revealed collateral pathways from the preserved CILN along the iliac and large abdominal vessels. This method of lymph node preservation is a simple and extremely effective approach for preventing/reducing LEL after pelvic and para-aortic lymphadenectomy for patients with gynecologic malignancies.

Lymphedema is common among post-operative cancer survivors

18524 Background: Lymphedema (LE) is associated with the surgical treatment of a number of tumors and is a serious long-term condition with significant medical, economic, and quality of life consequences. Early detection and management are critical to preventing LE progression and complications. We examined the literature to ascertain the incidence and identify factors associated with an increased postoperative risk for LE. Methods: We systematically reviewed the oncology literature (1972–2005) to identify studies that examined postoperative LE. Data pertaining to the type of malignancy, the surgical procedure performed, the criteria used to define LE, and the median follow-up time were extracted. The incidence of LE was summarized using weighted averages. Results: We identified a total of 122 reports of postoperative LE (N = 24,095 patients), which were broken down by cancer type as follows: breast cancer (n = 45), melanoma (n = 31), gynecologic (GYN) malignancies (n = 30), genitourinary (GU) malignancies (prostate n = 6, penile n = 6, bladder n = 2), and sarcoma (n = 2). When only prospective studies (n = 74, 61%) were considered, the incidence of LE following axillary node dissection (AND) in patients with breast cancer was 19% compared with 8% following AND for melanoma. The incidence of lower extremity LE following inguinofemoral and/or pelvic lymph node dissection for melanoma was 30% compared with 24%, 14%, and 20% for GYN malignancies, GU malignancies and sarcomas. The relative risk of postoperative lower extremity LE increased two-fold in patients who received radiation therapy. Methods of measuring LE included extremity circumference (n = 17 studies) with various defined thresholds (&gt;1 cm [n = 8], &gt;2 cm [n = 7], and &gt;3 cm [n = 2]). Fourteen studies used volume measurements, while the remainder used an ad hoc clinical grading method. The lowest incidence of LE was seen in studies with the shortest follow-up. Conclusions: LE is a common condition resulting from the surgical treatment of a number of different malignancies. To enhance the quality of postoperative care in cancer survivors, objective LE measurement and symptom assessment should be part of standard practice during both early and long-term follow-up. No significant financial relationships to disclose.