The incidence and risk factors for development of lower limb lymphedema after treatment for gynaecological cancers

Noori Khalid; Adarsh Dharmarajan; Satheeshan B.; Biji M. S.; Abina S. S.; Remya Binesh

doi:10.18203/2320-1770.ijrcog20180912

Authors

Noori Khalid Department of Surgical Oncology, Malabar Cancer Center, Thalassery, Kerala, India
Adarsh Dharmarajan Department of Surgical Oncology, Malabar Cancer Center, Thalassery, Kerala, India
Satheeshan B. Department of Surgical Oncology, Malabar Cancer Center, Thalassery, Kerala, India
Biji M. S. Department of Cancer Palliative Medicine, Malabar Cancer Center, Thalassery, Kerala, India
Abina S. S. Department of Cancer Palliative Medicine, Malabar Cancer Center, Thalassery, Kerala, India
Remya Binesh Department of Surgical Oncology, Malabar Cancer Center, Thalassery, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20180912

Keywords:

Lower limb, Lymphedema, Gynecological cancer

Abstract

Background: The development of postoperative lower limb lymphedema (LLL) is a disabling, yet usually overlooked sequele of most gynecological cancer treatment. It can lead to significant functional problems that negatively affect gynecological cancer survivors’ daily living, work, emotional state, and overall quality of life. The objective of this study is to calculate the incidence of lower limb lymphedema in patients undergoing surgery for gynecological cancer and to evaluate the risk factors for its development.

Methods: Women with newly diagnosed carcinoma ovary, carcinoma endometrium and carcinoma cervix, who underwent surgery at a tertiary cancer centre from September 2016 were included in the study. The circumference of both lower limbs was measured at prefixed sites. The limb volume was calculated using the formula C2/pi. A baseline value was taken prior to surgery. The patients were followed up every 3 months and the limb volume were calculated at each visit. An increase in limb volume by >10% was defined as lymphedema.

Results: The incidence of lymphedema after 1 year follow up was 43.5%. There was no significant association between known risk factors such as extent of lymphadenectomy (p value 0.633) number of pelvic or para aortic lymph nodes removed (p value 0.69 and 0.44 respectively) and type of adjuvant therapy (p value 0.455).

Conclusions: The incidence of LLL according to the present study was 43.5%. There was no statistically significant association between development of LLL and risk factors like site and number of lymph nodes removed and type of adjuvant therapy.

Metrics

Metrics Loading ...

References

Soisson AP, Soper JT, Clarke-Pearson DL, Berchuck A, Montana G, Creasman WT. Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer. Gynecol Oncol. 1990;37:390-5.

Mihara, M, Hara H, Hayashi Y. Pathological steps of cancer-related lymph- edema: histological changes in the collecting lymphatic vessels after lymphadenectomy. PLoS One. 2012;7(7):e41126.

Newman ML, Brennan M, Passik S. Lymphedema complicated by pain and psychological distress: a case with complex treatment needs. J Pain Symptom Manage. 1996;12:376-9.

Rockson SG. Lymphedema. Am J Med. 2001;110:288-95.

Carter BJ. Women's experiences of lymphedema. Oncol Nurs Forum. 1997;24:875-82.

Morgan PA, Moffat CJ. International consensus on managing lymphoedema. Nurs Times. 2006;102:42-4.

Beesley V, Janda M, Eakin E, Obermair A, Battistutta D. Lymphedema after gynecological cancer treatment: prevalence, correlates, and supportive care needs. Cancer. 2007;109(12):2607-14.

Hopp EE, Osborne JL, Schneider DK, Bojar CJ, Uyar DS. A prospective pilot study on the incidence of post-operative lymphedema in women with endometrial cancer. Gynecol Oncol Rep. 2016;15:25-8.

Tada H, Teramukai S, Fukushima M, Sasaki H. Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma. BMC Cancer. 2009; 9:47

Ryan M, Slaytor EK, Jaconelli C. Aetiology and prevalence of lower limb lymphoedema following treatment for gynaecological cancer. Aust N Z J Obstet Gynaecol. 2003;43:148-51.

Achouri A, Huchon C, Bats AS. Postoperative lymphocytes after lymphadenectomy for gynaecological malignancies: preventive techniques and prospects. Eur J Obstet Gynecol Reprod Biol. 2012;161:125Y129.

Tiwari P, Salani R, Povoski SP. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options. World J Surg Oncol. 2013;11:237-49.

Ki EY, Park JS, Lee KH, Hur SY. Incidence and risk factors of lower extremity lymphedema after gynecologic surgery in ovarian cancer. Int J Gynecol Cancer. 2016;26:1327-32.

Abu-Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C, et al. The incidence of lower-extremity lymph-edema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center. Gynecol Oncol. 2006;103:714-8.

Fuller J, Guderian D, Kohler C. Lymphedema of the lower extremities after lymphadenectomy and radiotherapy for cervical cancer. Strahlenther Onkol. 2008;184:206Y211.