Close relationship between removal of circumflex iliac nodes to distal external iliac nodes and postoperative lower-extremity lymphedema in uterine corpus malignant tumors

Cost‐effectiveness of sentinel node biopsy and pathological ultrastaging in patients with early‐stage cervical cancer

“…Although early studies had suggested unacceptably high false‐negative rates, recent studies have shown that with careful patient selection and adherence to strict lymph node mapping algorithms, SLNB combined with pathological ultrastaging can be safely applied to the management of early‐stage cervical cancer with acceptably low false‐negative rates . An accruing body of evidence suggests that in comparison with systematic PLND, this treatment modality can provide similar if not better diagnostic information, albeit at reduced morbidity levels . No study to date has, however, assessed the effectiveness of the 2 procedures in conjunction with the economic impact of the associated morbidities.…”

Lymphedema after treatment for endometrial cancer − A review of prevalence and risk factors

“…In other studies the median number of removed lymph nodes is significantly higher, up to over 80 [20,27,28,31]. The number of removed lymph nodes seems to be of importance for developing LLL with an increasing risk for LLL when a larger number of lymph nodes are removed [10,21,22,24,[37][38][39][40][41][42]. Interestingly, and with no obvious reasonable pathophysiological explanation, Hareyama et al found a significantly lower risk of LLL in women when the number of removed lymph nodes exceeded 70 [28].…”

“…In many of the studies the assessment of LLL was based on information retrieved from the medical records or from patient reported symptoms in the survey studies. The ISL 4-grade staging of lymphedema [26] has been used by some authors [21,24,[27][28][29], whereas others have used the National Cancer Institute Common Toxicity Criteria (NCI-CTC v2 [30]) [20,22,31,32] or the National Lymphedema Network [16] to grade the severity of lymphedema.…”

“…Besides being retrospective the common denominators for all these studies were that they might be characterized by either having no baseline data concerning leg swelling, lacked objective measures or were based on incompletely described or not validated subjective measurements. In some studies only cases with moderate to severe lymphedema or cases that complained of leg swelling and received treatment were classified as having LLL [20][21][22]. Consequently the true prevalence of LLL was not obtained in these studies.…”

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.…”