Elsevier

Gynecologic Oncology

Volume 103, Issue 2, November 2006, Pages 714-718
Gynecologic Oncology

The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: A 12-year experience at Memorial Sloan-Kettering Cancer Center

https://doi.org/10.1016/j.ygyno.2006.03.055Get rights and content

Abstract

Objectives.

To describe the incidence of symptomatic postoperative lower-extremity lymphedema in women treated for uterine corpus cancer, and to evaluate its relationship to regional lymph node removal and postoperative therapy.

Methods.

A retrospective chart review of all patients with uterine corpus cancer managed over a 12-year period (1/93–12/04). All patients had a hysterectomy as part of their therapy. We identified patients with leg lymphedema – as described by the physician or reported by the patient – through medical records. We excluded cases of leg edema that developed secondary to medical conditions such as cardiovascular and renal disease, venous thrombosis, and end-stage recurrent malignancy. Lymphedema dermal changes and related fibrosis were graded using the common terminology criteria for adverse events.

Results.

In all, 1289 patients with uterine corpus malignancy were evaluated. We excluded other chronic lower-extremity edema that was related to a variety of medical conditions in 74 patients (5.7%). With a median follow-up of 3 years (interquartile range, 1.1–5.4 years), new symptomatic post-treatment lower-extremity lymphedema was noted in 16 patients. Patients who had lymph nodes removed at initial surgery had a higher rate of developing lymphedema (16/670, 2.4%) than those who did not (0/619, 0%) (P = 0.0001). Furthermore, symptomatic lymphedema was limited to patients who had 10 or more regional lymph nodes removed 16/469 (3.4%). Lymphedema was noted at a median of 5.3 months after surgery (range, 1–32 months). Lymphedema was unilateral in 11 patients (69%) and bilateral in 5 (31%); moreover, it was considered grade 1 in 12 patients (75%) and grade 2 in 4 (25%). Age, weight, stage, type of hysterectomy, and type of postoperative adjuvant therapy were not associated with lymphedema.

Conclusions.

To date, this is the largest series evaluating symptomatic lower-extremity lymphedema in women with uterine corpus cancer. Patients who had 10 or more regional lymph nodes removed at initial surgery appeared to be at higher risk for developing new symptomatic leg lymphedema. Patients undergoing surgery with lymphadenectomy for uterine corpus malignancy should be informed about the possibility of postoperative new symptomatic leg lymphedema. A prospective evaluation of leg lymphedema is needed to accurately determine the incidence, severity, and risk factors of this complication.

Introduction

Surgical staging is the standard of care for operable uterine corpus cancer. In addition, adjuvant radiation therapy and/or chemotherapy may be needed in the postoperative setting. The general postoperative complications of hysterectomy for uterine corpus cancer are known; however, there is very limited information on the incidence of new symptomatic leg lymphedema following therapy for uterine corpus cancer. In recent years, complete surgical staging for operable endometrial cancer with pelvic and paraaortic lymph node sampling or dissection has become more commonly used in the gynecologic oncology community, and the possible therapeutic benefit of selective lymphadenectomy in patients with apparent early-stage endometrial cancer has been documented [1]. The effects of regional lymph node removal on the incidence of new leg edema in women treated for endometrial cancer are unknown. Moreover, the baseline prevalence of leg edema from other etiologies in this patient population is also not well described. Over the last several years, some aspects of the management of endometrial and uterine corpus malignancy have changed at our institution. Since 2001, it has been our group preference to perform bilateral pelvic lymphadenectomy with limited paraaortic lymph node sampling on all patients with endometrial cancer when technically and medically possible. This is a change from previous years when lymph node sampling or dissection was frequently based on an intraoperative frozen-section evaluation. The objective of this review is to describe the incidence of symptomatic postoperative lower-extremity lymphedema in women treated for uterine corpus cancer, and to evaluate the relationship to lymph node removal and postoperative therapy.

Section snippets

Materials and methods

We conducted a retrospective chart review of all patients with uterine corpus cancer managed over a 12-year period (1/93–12/04). All patients had a hysterectomy as part of their initial therapy. We excluded patients who were managed by radiation therapy or medical therapy only and those who had supportive care as their only treatment. We included all histologic subtypes and stages. We identified patients with leg lymphedema – as described by the physician or reported by the patient – through

Results

The records of 1289 patients with uterine corpus malignancies were reviewed. All patients had hysterectomy as part of their initial therapy. The median age at diagnosis for all patients was 62 years (mean, 61.9; range, 21–93 years). With a median follow-up of 3.0 years (interquartile range, 1.1–5.4 years), any leg edema was noted in the medical records of 90 (7.0%) patients. These cases were thoroughly reviewed, and we excluded cases of chronic lower-extremity edema that was related to a

Discussion

It is assumed that for women with uterine corpus malignancy, the lower-extremity lymphatic pathways may be affected by surgery or postoperative external radiation therapy, which may result in lower-extremity edema or lymphedema. The true incidence (based on prospective long-term limb circumference or volume measurements) and severity of post-therapy leg lymphedema in this patient population are unknown, and postoperative lymphedema after uterine corpus cancer therapy is likely underreported in

Conclusions

To date, this is the largest series evaluating the incidence of symptomatic lower-extremity lymphedema in women with uterine corpus cancer. New symptomatic leg lymphedema was noted in 3.4% of patients who had 10 or more regional lymph nodes removed and was usually mild. Keeping in mind the importance of pathologic evaluation of regional lymph nodes in endometrial cancer and its effect on type of postoperative adjuvant therapy and possible therapeutic role, postoperative leg lymphedema should

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