Catherine H Watson1, Micael Lopez-Acevedo2, Gloria Broadwater3, Amy H Kim3, Jessie Ehrisman4, Brittany A Davidson5, Paula S Lee5, Fidel Valea6, Andrew Berchuck5, Laura J Havrilesky5. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States of America. Electronic address: catherine.h.watson@duke.edu. 2. Department of Obstetrics and Gynecology, George Washington University Hospital, Washington, DC, United States of America. 3. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United States of America. 4. Duke Cancer Institute, Durham, NC, United States of America. 5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States of America; Duke Cancer Institute, Durham, NC, United States of America. 6. Department of Obstetrics and Gynecology Virginia Tech Carilion School of Medicine Roanoke, VA, United States of America.
Abstract
OBJECTIVE: The primary aim of this study was to pilot the use of an objective measurement technique to prospectively evaluate the incidence of lower extremity lymphedema (LEL) after minimally invasive staging surgery for endometrial cancer. Secondary objectives included observation of changes in lower extremity function and quality of life in this patient population. METHODS: A prospective evaluation of LEL was performed in 97 women who underwent minimally invasive staging surgery for endometrial cancer using comparative circumferential volume measurements. Postoperative changes in lower extremity function and global quality of life were also assessed using patient-reported outcome measures. RESULTS: Ninety-seven patients were included for lymphedema analysis. The rate of LEL was 25% at 4-6 weeks, 19% at 6-9 months, and 27% at 12-18 months postoperatively. The presence of LEL was associated with a significant worsening from baseline Lower Extremity Functional Scale (LEFS) scores at 4-6 weeks (-27.0% vs -3.7%, p = 0.02) and 6-9 months (-13.0% vs 0%, p = 0.01). LEL was not associated with a change in patient-reported global quality of life. CONCLUSIONS: Up to one in four women experience lymphedema following surgical staging for endometrial cancer, and its presence is associated with diminished lower extremity function. Larger, prospective trials using the objective methodology piloted in this study should better clarify risk factors and long-term outcomes of this morbidity.
OBJECTIVE: The primary aim of this study was to pilot the use of an objective measurement technique to prospectively evaluate the incidence of lower extremity lymphedema (LEL) after minimally invasive staging surgery for endometrial cancer. Secondary objectives included observation of changes in lower extremity function and quality of life in this patient population. METHODS: A prospective evaluation of LEL was performed in 97 women who underwent minimally invasive staging surgery for endometrial cancer using comparative circumferential volume measurements. Postoperative changes in lower extremity function and global quality of life were also assessed using patient-reported outcome measures. RESULTS: Ninety-seven patients were included for lymphedema analysis. The rate of LEL was 25% at 4-6 weeks, 19% at 6-9 months, and 27% at 12-18 months postoperatively. The presence of LEL was associated with a significant worsening from baseline Lower Extremity Functional Scale (LEFS) scores at 4-6 weeks (-27.0% vs -3.7%, p = 0.02) and 6-9 months (-13.0% vs 0%, p = 0.01). LEL was not associated with a change in patient-reported global quality of life. CONCLUSIONS: Up to one in four women experience lymphedema following surgical staging for endometrial cancer, and its presence is associated with diminished lower extremity function. Larger, prospective trials using the objective methodology piloted in this study should better clarify risk factors and long-term outcomes of this morbidity.
Authors: Sandra Russo; Joan L Walker; Jay W Carlson; Jeanne Carter; Leigh C Ward; Allan Covens; Edward J Tanner; Jane M Armer; Sheila Ridner; Sandi Hayes; Alphonse G Taghian; Cheryl Brunelle; Micael Lopez-Acevedo; Brittany A Davidson; Mark V Schaverien; Sharad A Ghamande; Michael Bernas; Andrea L Cheville; Kathleen J Yost; Kathryn Schmitz; Barbara Coyle; Jeannette Zucker; Danielle Enserro; Stephanie Pugh; Electra D Paskett; Leslie Ford; Worta McCaskill-Stevens Journal: Gynecol Oncol Date: 2020-11-04 Impact factor: 5.482