Incidence and Risk Factors of Lower-Extremity Lymphedema After Radical Surgery With or Without Adjuvant Radiotherapy in Patients With FIGO Stage I to Stage IIA Cervical Cancer

ArticleinInternational Journal of Gynecological Cancer 22(4):686-91 · March 2012with11 Reads
DOI: 10.1097/IGC.0b013e3182466950 · Source: PubMed
This study aimed to determine the incidence and risk factors of lower-extremity lymphedema (LEL) in women who had radical surgery with or without adjuvant radiotherapy for International Federation of Gynecology and Obstetrics (FIGO) stage I to stage IIA cervical cancer. The medical records were reviewed retrospectively on patients with histologically confirmed FIGO stage I to IIA cervical cancer. Lower-extremity lymphedema-related medical problems such as peripheral vascular disease, congestive heart failure, or chronic renal disease were excluded. A logistic regression analysis was used to examine the relationship between variable clinical characteristics and development of LEL. We evaluated 707 patients. Of the 707 patients evaluated, we excluded 92 patients who had received radiotherapy as the initial therapy and 19 patients with LEL related to medical problems. Seventy-five patients (12.6%) developed LEL. The incidence was high in patients with adjuvant radiotherapy (odds ratio, 3.47; 95% confidence interval, 2.086-5.788; P = 0.000), with 78.7% of the patients with LEL having developed the condition within 3 years after initial treatment. Adjuvant radiotherapy was significantly associated with development of LEL in women who had undergone radical surgery with lymphadenectomy for FIGO stage I to stage IIA cervical cancer. The possibility for the occurrence of LEL must be fully explained before treatment and patients should be provided with the appropriate preventive education. Further prospective studies are needed to confirm the incidence and risk factors for LEL.
    • "Evidence linking obesity with lymphedema is more scant beyond breast cancer. Several studies report no association of BMI and incident lower extremity lymphedema among cervical cancer survivors [38][39][40], while one other prospective cohort study among cervical cancer survivors found that low BMI (<18.5 kg/m 2 ) was associated with increased frequency of lymphedema [41] . Finally, in a crosssectional survey study of 243 Australian women, lymphedema risk was 2.7-fold higher among overweight compared to normal weight endometrial cancer survivors (95 % CI: 1.0–7.5) "
    [Show abstract] [Hide abstract] ABSTRACT: It is estimated that between 1971 and 2002, the population of cancer survivors grew from approximately three million to ten million. Currently, it is estimated that there are over 13.7 million cancer survivors in the USA and this number is expected to increase to 18 million by 2022. The seminal Institute of Medicine’s report on cancer survivorship that outlines the need to develop strategies to address the unique issues faced by this growing clinical population was published 8 years ago. However, long-term cancer survivors are still a relatively new clinical population in the field of oncology, borne of successes in improved cancer screening and treatment approaches. There continues to be a need to define and clarify the factors that contribute significantly to outcomes in cancer survivors in order to develop effective and efficient intervention strategies. Within this chapter we address the independent and interactive contributions of two issues thought to substantively influence the length and quality of cancer survivorship: obesity and race/ethnicity.
    Full-text · Chapter · Jan 2014 · World Journal of Surgical Oncology
    • "Adjuvant radiotherapy was significantly associated with the development of lymphedema in women who had undergone radical surgery with lymphadenectomy for FIGO stage I to stage IIA cervical cancer (odds ratio, 3.47; 95% confidence interval, 2.086-5.788; P = 0.000) [43] Moreover, there are also risks of infection by pneumonia, with pyelonephritis and/or fever of unknown origin, a risk of ureter stenosis and of uncorrected positioning, with arm/shoulder/leg pain. In the Piver study, there were 2 deaths (one from pneumonia and one from pelvic abscess), 2 pulmonary emboli, one ureterovaginal fistula and one ureteral stricture and a total of 15 complications in 55 patients who underwent type III open radical hysterectomy (27%). "
    [Show abstract] [Hide abstract] ABSTRACT: Cervical cancer remains the leading cause of death by gynecologic cancer worldwide, comprising 15% of all cancers in women younger than 40 years. Standard treatments of invasive cancer in early stages are radical hysterectomy and pelvic radiotherapy, both of which are almost reliable by minimal invasive surgery, so as traditional laparoscopy and robotic-assisted surgery. Moreover, 45% of reproductive-age women are diagnosed with stage IB1 disease, making the fertility-sparing procedure, radical trachelectomy, a viable option for most patients for treatment of early-stage cervical cancer and maintenance of future fertility. This chapter focuses on emerging surgical techniques, including the laparoscopic and robotic approach, are improving perioperative outcomes for these patients.A manual and computer-aided search was carried out for all reviews related to this topic, randomized controlled trials, prospective observational studies, retrospective studies and case reports published between 1980 and 2012, assessing robotic surgery, Search strings were: laparoscopic surgery; robot or robot-assisted surgery; radical hysterectomy; cervical cancer, minimally invasive surgery. Robotic-assisted gynecologic surgery has increased worldwide, considering the number of scientific articles dedicated to it though few retrospective and prospective studies have demonstrated the feasibility of robotic-assisted surgery inradical hysterectomy. In general, robot-assisted gynecologic surgery is often associated with longer operating room time but generally similar clinical outcomes, decreased blood loss, and shorter hospital stay. Robotic-assisted procedures are not, however, without their limitations: the equipment is still very large, bulky, and expensive, the staff must be trained, specifically on draping and docking the apparatus to maintain efficient operative times. Functional limitations include lack of haptic feedback, limited vaginal access, limited instrumentation, and larger port incisions. Exchanging instruments becomes more cumbersome and requires a surgical assistant to change the instruments. Additionally, the current robotic instruments do not include endoscopic staplers or vessel sealing devices. Finally, laparoscopic radical hysterectomy is a feasible and safe procedure that is associated with fewer intraoperative and postoperative complications than abdominal radical hysterectomy. The role of robotic-assisted surgery is continuing to expand, but well-designed, prospective studies with well-defined clinical, long-term outcomes, including complications, cost, pain, return to normal activity, and quality of life, are needed to fully assess the value of this new technology in radical hysterectomy. Scientific literature has shown the feasibility of a radical resection by minimally invasive oncological surgery and documented an equivalent number of pelvic nodes harvested by laparoscopy and open surgery. Women with a tumor size 2 cm or smaller and stage IA1 with lymphovascular space involvement (LVSI), IA2, or IB1 disease may be offered fertility-sparing treatment after thorough evaluation by an oncologist trained in this management. Keywords: Cervical cancer, endoscopy, minimally invasive surgery, robotic assisted surgery, complication, gynecological cancer, oncology.
    Full-text · Chapter · Oct 2013 · World Journal of Surgical Oncology
    • "Most studies report a diagnosis of LEL within the first year (median four to six months) after treatment, with 5% diagnosed within the first month [71,72,91,111]. However, long-term assessment should be performed as up to 20% of LEL cases are diagnosed after the first year [70,100]. "
    [Show abstract] [Hide abstract] ABSTRACT: Lymphedema remains a poorly understood entity that can occur after lymphadenectomy. Herein, we will review the pathogenesis of lymphedema, diagnostic modalities and the natural history of extremity involvement. We will review the incidence of upper extremity lymphedema in patients treated for breast malignancies and lower extremity lymphedema in those treated for gynecologic malignancy. Finally, we will review traditional treatment modalities for lymphedema, as well as introduce new surgical treatment modalities that are under active investigation.
    Full-text · Article · Sep 2013
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