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ObjectiveLower extremity lymphedema adversely affects quality of life by causing discomfort, impaired mobility and increased risk of infection. The goal of this study is to investigate factors that influence the likelihood of lymphedema in patients with endometrial cancer who undergo adjuvant radiation with or without chemotherapy.MethodsA retrospective chart review identified all stage I–III endometrial cancer patients who had a hysterectomy with or without complete staging lymphadenectomy and adjuvant radiation therapy between January 2006 and February 2013. Patients with new-onset lymphedema after treatment were identified. Logistic regression was used to find factors that influenced lymphedema risk.ResultsOf 212 patients who met inclusion criteria, 15 patients (7.1%) developed new-onset lymphedema. Lymphedema was associated with lymph-node dissection (odds ratio [OR], 5.6; 95% CI, 1.01 to 105.5; p=0.048) and with the presence of pathologically positive lymph nodes (OR, 4.1; 95% CI, 1.4 to 12.3; p=0.01). Multivariate logistic regression confirmed the association with lymph-node positivity (OR, 3.2; 95% CI, 1.0007 to 10.7; p=0.0499) when controlled for lymph-node dissection. Median time to lymphedema onset was 8 months (range, 1 to 58 months) with resolution or improvement in eight patients (53.3%) after a median of 10 months.ConclusionLymph-node positivity was associated with an increased risk of lymphedema in endometrial cancer patients who received adjuvant radiation. Future studies are needed to explore whether node-positive patients may benefit from early lymphedema-controlling interventions.

Background: Retirement of surgeons has important workforce implications given the shortage of surgeons throughout the country. Our study was designed to evaluate factors that influence surgeon retirement decisions. Material and methods:A paper-based survey regarding retirement decisions was mailed nationwide from April to June of 2018 to retired General, Colorectal, Vascular, and Cardiothoracic surgeons that are members of the American College of Surgeons.Results: A total of 2295 of 5282 surveys were completed (43.4% response rate). The mean age of respondents was 79.0 ± 0.8 years, their mean age of retirement was 63.9 ± 0.1 years, and their mean interval since retirement was 15.2 ± 0.9 years. The five most common reasons for retirement were advancing age, personal health, increased outside interference, burnout, and worsening malpractice environment. The most common reported health problems leading to retirement were musculoskeletal disorders. The percentage of reported burnout was significantly lower in academic surgeons (5.8%) vs. surgeons in private practice (10.5%); academic/private practice combination (10.0%); those employed by community hospital or health system (11.4%); and Veteran Affairs institution, military hospital, and Indian Health Service (13.8%). Burnout was the only factor associated with an earlier retirement age (61.2 ± 0.4 years vs. 65.8 ± 0.2 years in the absence of burnout). Results were comparable when stratified by surgical specialty. Conclusion:Our survey brings awareness to potentially-modifiable factors influencing surgeon retirement, such as