Incidence, prevalence, and factors associated with lymphedema after treatment for cervical cancer: a systematic review

Abstract

BackgroundLower limb lymphedema is a frequent and debilitating complication after cervical cancer treatment.ObjectiveTo evaluate the incidence and prevalence of lymphedema after treatment for cervical cancer and evaluate the factors associated with this outcome.MethodsThe study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Eligible studies were identified through the databases Medline (via PubMed), LILACS, Scopus, and Web of Science. For the search, descriptors, keywords, and synonyms were used for cervical cancer, lymphedema, and outcomes of interest (incidence, prevalence, frequency, occurrence, morbidity, risk factors, and prognosis). Observational studies were included that were published in English, Portuguese, or Spanish, between January 1, 2013 and December 31, 2019, with frequency data and associated factors for lymphedema after cervical cancer treatment. Studies that evaluated the presence of lymphedema less than 6 months after surgery or radiotherapy and those in which frequency data were not stratified by tumor topography, were excluded.ResultsTwenty-three studies were included. The incidence of lymphedema varied between 0% and 69%. Different designs and methods were employed for lymphedema assessment. The main factors associated with lymphedema included extension of lymphadenectomy, number of lymph nodes removed, removal of circumflex iliac lymph nodes, and adjuvant radiotherapy. Other factors associated with lymphedema included cellulitis, lymphocyst formation, increased age, invasive lymph node staging, higher body mass index, and insufficient physical activity.ConclusionsThe frequency of lymphedema after treatment for cervical cancer is variable. The different designs and methodology to measure this complication make it difficult to draw definitive conclusions about its prevalence. The method used for lymphedema assessment is not standardized.

Primary or adjuvant chemoradiotherapy for cervical cancer with intraoperative lymph node metastasis – A review

“…We found lower extremity lymphoedema to be associated with RHRT in multiple quality of life studies [21,24,25]. This is in line with a recent review, that reported adjuvant radiotherapy and (the extent of) lymphadenectomy as main risk factors for developing lower extremity lymphoedema after cervical cancer treatment [39]. The authors also showed that the incidence of lower extremity lymphoedema seems to increase with follow-up.…”

“…Correspondingly, in the present review, distress from lower extremity lymphoedema was reported in studies with varying follow-up periods. Ferreira Bona et al [39] confirmed our finding that lower extremity lymphoedema occurs less often after PRT than after RHRT. As the benefit of lymphadenectomy in patients treated with PRT for intraoperatively diagnosed lymph node positive cervical cancer has shown to be debatable [19], clinicians should take into account that chances of developing lymphoedema increase with the extent of lymph node dissection.…”

Number of lymph node in early-stage cervical cancer after radical surgery, does it matter?

“…Lower lymphadenoma is one of the most common complication effecting the quality of life of many patients. A systematic review including 23 articles, revealed the factors associated with lymphedema after treatment of cervical cancer [20]. The extension of lymphadenectomy and number of RLN increase the risk of lymphedema [20].…”

“…A systematic review including 23 articles, revealed the factors associated with lymphedema after treatment of cervical cancer [20]. The extension of lymphadenectomy and number of RLN increase the risk of lymphedema [20]. Sentinel lymph node (SNL) mapping might be a promising option to minimize the risk of lower limb lymphedema.…”

Long-term oncological outcomes and recurrence patterns in early-stage cervical cancer treated with minimally invasive versus abdominal radical hysterectomy: The Norwegian Radium Hospital experience

“…For instance, 58.7% of the ARH patients and 47.1% of the MIRH patients received postoperative adjuvant therapy in the SUCCOR study [29]. The combination of surgery and radiotherapy increases morbidity, especially from lymphoedema [30], and should therefore be avoided when possible.…”