A 5-year prospective assessment of risk factors for lower limb lymphedema after gynecologic cancer surgery

Abstract

Lower limb lymphedema is a distressing complication after lymphadenectomy. Currently, no definite intervention for reducing the incidence of lower limb lymphedema has been established. This study identified risk factors for lower limb lymphedema following a gynecologic surgery with a 5-year follow-up. A total of 190 patients who underwent surgery, including pelvic lymphadenectomy, between 2011 and 2012 were enrolled and followed up for 5 years. Lymphedema was defined as International Society of Lymphology stage I or higher. The patients' physical characteristics, surgical methods, and adjuvant therapies were investigated and hazard ratios and 95% confidence intervals were calculated. Kaplan-Meier analysis was performed to assess the 5-year cumulative risk of lower limb lymphedema. Multivariate analysis revealed that adjuvant chemotherapy with docetaxel or paclitaxel and the number of lymph nodes removed ≥ 60 were the risk factors. The 5-year cumulative incidence of total lower limb lymphedema was 39.6%, 51.6% with adjuvant chemotherapy using taxanes, 49.1% with the removal of ≥ 60 lymph nodes. The incidence of lower limb lymphedema was highest in the first year. Since taxane administration and lymphadenectomy remain essential for optimizing patient prognosis, close monitoring of lower limbs is crucial in the first year after lymphadenectomy for patients with these risk factors.

Keywords: Adjuvant chemotherapy; Docetaxel; Gynecologic cancer; Lower limb lymphedema; Lymphadenectomy; Risk factors.

Fig. 1

Flowchart of data collection process. During the study period, 224 patients were candidates of pelvic lymphadenectomy. In accordance with exclusion criteria, 190 patients were included. We could follow 164 patients after 5 years.

Fig. 2

The 5-year cumulative incidence of total lower limb lymphedema is 39.6%. The range of occurrence of LLE in the first year was significantly higher than that in the following years. LLE: Lower Limb Lymphedema.

Fig. 3

a. The 5-year cumulative incidence of lower limb lymphedema with adjuvant chemotherapy with taxane was 51.6% that with adjuvant chemotherapy other than taxane was 44.4%, and that without adjuvant therapy was 27.9%. LLE: Lower Limb Lymphedema LN: lymph node b. The 5-year cumulative incidence of lower limb lymphedema with ≥60 LNs removed was 49.1%, and that with <60 LNs removed was 31.4%. LN: lymph node.