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abstract
Objective: Lower extremity lymphedema (LEL) is a major
long-term complication of radical surgery. We aimed to estimate the
incidence and grading of LEL in women who underwent lymphadenectomy and
to evaluate risk factors associated with LEL.
Materials and Methods: We retrospectively reviewed 358
patients with cervical, endometrial, and ovarian cancer who underwent
transabdominal complete systematic pelvic and para-aortic
lymphadenectomy between 1997 and 2011. Lower extremity lymphedema was
graded according to criteria of the International Society of Lymphology.
Incidence of LEL and its correlation with various clinical
characteristics were investigated using Kaplan-Meier survival and Cox
proportional hazards methods.
Results: Overall incidence of LEL was 21.8% (stage 1,
60%; stage 2, 32%; and stage 3, 8%). Cumulative incidence increased with
observation period: 12.9% at 1 year, 20.3% at 5 years, and 25.4% at 10
years. Age, cancer type, stage (International Federation of Gynecology
and Obstetrics), body mass index, hysterectomy type, lymphocyst
formation, lymph node metastasis, and chemotherapy were not associated
with LEL. Multivariate analysis confirmed that removal of circumflex
iliac lymph nodes (hazard ratio [HR], 4.28; 95% confidence interval
[CI], 2.09–8.77; P < 0.0001), cellulitis (HR, 3.48; 95% CI, 2.03–5.98; P < 0.0001), and number of removed lymph nodes (HR, 0.99; 95% CI, 0.98–0.99; P = 0.038) were independent risk factors for LEL.
Conclusions: Postoperative LEL incidence increased
over time. The results of the present study showed a significant
correlation with removal of circumflex iliac lymph nodes and cellulitis
with the incidence of LEL. Multicenter or prospective studies are
required to clarify treatment efficacies.
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