GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients

Abstract

Objectives: To evaluate the incidence and risk factors for lymphedema associated with surgery for gynecologic malignancies on GOG study 244.Methods: Women undergoing a lymph node dissection for endometrial, cervical, or vulvar cancer were eligible for enrollment. Leg volume was calculated from measurements at 10-cm intervals starting 10 cm above the bottom of the heel to the inguinal crease. Measurements were obtained preoperatively and postoperatively at 4-6 weeks, and at 3-, 6-, 9-, 12-, 18-, and 24months. Lymphedema was defined as a limb volume change (LVC) ≥10% from baseline and categorized as mild: 10-19% LVC; moderate: 20-40% LVC; or severe: >40% LVC. Risk factors associated with lymphedema were also analyzed. Results:Of 1054 women enrolled on study, 140 were inevaluable due to inadequate measurements or eligibility criteria. This left 734 endometrial, 138 cervical, and 42 vulvar patients evaluable for LVC assessment. Median age was 61 years (range, 28-91) in the endometrial, 44 years (range, 25-83) in the cervical, and 58 years (range, 35-88) in the vulvar group. The incidence of LVC ≥10% was 34% (n=247), 35% (n=48), and 43% (n=18), respectively. The peak incidence of lymphedema was at the 4-6 week assessment. Logistic regression analysis showed a Carlson et al.

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

“…Risk factors can include radiation, large radiation field, conventional fractionation radiation, obesity, age, chemotherapy infusion to the affected limb, taxane-based chemotherapy, advanced stage disease, number of lymph nodes removed, and number of positive lymph nodes. [2,[4][5][6][7][8][9][10][11] Secondary lymphedema can also result from traumatic injury or infections involving the lymphatic tree. Less frequently, secondary lymphedema can develop in patients due to extreme obesity.…”

Robotic sentinel node mapping in clinical stage 1 endometrial cancer using methylene blue dyes using the robotic platform

“…5,6 Comprehensive lymphadenectomy can result in significant chronic long-term leg edema impairing patients' quality of life. [7][8][9] Efforts has been made to limit the extent of nodal dissection to minimize longterm lymphedema side effects by the application of sentinel lymph node (SLN) mapping algorithm with success. 10 SLN mapping had been validated as an alternative to full lymphadenectomy without compromising diagnostic accuracy especially in low grade clinical stage 1 endometrial cancer where the chance of nodal metastasis is commonly reported to be less than 11,12 10%.…”

Lower-Limb Lymphedema after Sentinel Lymph Node Biopsy in Cervical Cancer Patients

“…The incidence of LLL after standard surgical treatment, including PLND, of cervical cancer varies broadly in the literature, in the range of 3–62% [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 25 , 26 , 31 ]. Such great variation is likely attributed to the flaws in LLL assessment, such as the absence of objective assessment methods, the simple postoperative assessment instead of longitudinal repeated follow-up, as well as a short period between the surgery and endpoint assessment.…”

“…Out of ten identified prospective studies, the description of LLL assessment methodology is only vaguely portrayed in two [ 43 , 44 ]; three studies were based on subjective reports [ 45 , 46 , 47 ]; and only two were based on objective diagnostic methods (bioimpedance spectroscopy, CT, or MRI) [ 25 , 48 ]. The last three prospective studies utilized objective assessment using circumferential measurements [ 7 , 10 , 19 ]. In the first study, 34.8% (48/138) of patients developed LLL during the two years of follow-up [ 10 ].…”

“…The true incidence of LLL after surgical treatment of cervical cancer is unclear, previously reported in the range of 0–62% [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The incidence varies mainly according to the extent of the surgery and administration of adjuvant treatment [ 16 , 17 , 18 , 19 ].…”