OBJECTIVE: The aim of this study was to determine the incidence rate of lower-extremity lymphedema after systematic lymphadenectomy in patients with uterine corpus malignancies and to elucidate risk factors for this type of lymphedema. METHODS: A retrospective chart review was carried out for all patients with uterine corpus malignant tumor managed at Hokkaido Cancer Center between 1991 and 2007. Patients who did not undergo lymphadenectomy as a treatment or died of cancer/intercurrent disease were excluded from this study. All living patients included in this study had hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy and their medical records were reviewed. We identified patients with postoperative lower-extremity lymphedema (POLEL). Logistic regression analysis was used to select the risk factors for POLEL. RESULTS: Of 286 patients evaluated, 103 (37.8%) had POLEL. Multivariate analysis confirmed that adjuvant radiation therapy (OR=5.2, 95% CI=2.1-12.7), resection of more than 31 lymph nodes (OR=2.6, 95% CI=1.4-4.9), and removal of circumflex iliac nodes to the distal external iliac nodes (CINDEIN) (OR=6.1, 95% CI=1.3-28.2) were independent risk factors for POLEL. CONCLUSION: Adjuvant radiation therapy should be avoided in patients who undergo systematic lymphadenectomy if an alternative postoperative strategy is possible. Although reducing the number of resected lymph nodes is not appropriate from a therapeutical point of view, elimination of CINDEIN dissection may be helpful in reducing the incidence of POLEL. The clinical significance of CINDEIN dissection needs to be investigated by a randomized controlled trial.
OBJECTIVE: The aim of this study was to determine the incidence rate of lower-extremity lymphedema after systematic lymphadenectomy in patients with uterine corpus malignancies and to elucidate risk factors for this type of lymphedema. METHODS: A retrospective chart review was carried out for all patients with uterine corpus malignant tumor managed at Hokkaido Cancer Center between 1991 and 2007. Patients who did not undergo lymphadenectomy as a treatment or died of cancer/intercurrent disease were excluded from this study. All living patients included in this study had hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy and their medical records were reviewed. We identified patients with postoperative lower-extremity lymphedema (POLEL). Logistic regression analysis was used to select the risk factors for POLEL. RESULTS: Of 286 patients evaluated, 103 (37.8%) had POLEL. Multivariate analysis confirmed that adjuvant radiation therapy (OR=5.2, 95% CI=2.1-12.7), resection of more than 31 lymph nodes (OR=2.6, 95% CI=1.4-4.9), and removal of circumflex iliac nodes to the distal external iliac nodes (CINDEIN) (OR=6.1, 95% CI=1.3-28.2) were independent risk factors for POLEL. CONCLUSION: Adjuvant radiation therapy should be avoided in patients who undergo systematic lymphadenectomy if an alternative postoperative strategy is possible. Although reducing the number of resected lymph nodes is not appropriate from a therapeutical point of view, elimination of CINDEIN dissection may be helpful in reducing the incidence of POLEL. The clinical significance of CINDEIN dissection needs to be investigated by a randomized controlled trial.
Authors: Kathryn H Schmitz; Marian L Neuhouser; Tanya Agurs-Collins; Krista A Zanetti; Lisa Cadmus-Bertram; Lorraine T Dean; Bettina F Drake Journal: J Natl Cancer Inst Date: 2013-08-29 Impact factor: 13.506
Authors: Rudy S Suidan; Charlotte C Sun; Scott B Cantor; Andrea Mariani; Pamela T Soliman; Shannon N Westin; Karen H Lu; Sharon H Giordano; Larissa A Meyer Journal: Obstet Gynecol Date: 2018-07 Impact factor: 7.661
Authors: Justin C Brown; Gabriella M John; Saya Segal; Christina S Chu; Kathryn H Schmitz Journal: Med Sci Sports Exerc Date: 2013-11 Impact factor: 5.411
Authors: Rebecca A Brooks; David S Tritchler; Kathleen M Darcy; Heather A Lankes; Ritu Salani; Paul Sperduto; Saketh Guntupalli; Paul DiSilvestro; Joshua Kesterson; Alexander B Olawaiye; Katherine Moxley; Steven Waggoner; Alessandro Santin; Janet S Rader; Nora T Kizer; Premal H Thaker; Matthew A Powell; David G Mutch; Michael J Birrer; Paul J Goodfellow Journal: Gynecol Oncol Date: 2019-02-28 Impact factor: 5.482