The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: A 12-year experience at Memorial Sloan-Kettering Cancer Center Journal Article


Authors: Abu-Rustum, N. R.; Alektiar, K.; Iasonos, A.; Lev, G.; Sonoda, Y.; Aghajanian, C.; Chi, D. S.; Barakat, R. R.
Article Title: The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: A 12-year experience at Memorial Sloan-Kettering Cancer Center
Abstract: Objectives.: To describe the incidence of symptomatic postoperative lower-extremity lymphedema in women treated for uterine corpus cancer, and to evaluate its relationship to regional lymph node removal and postoperative therapy. Methods.: A retrospective chart review of all patients with uterine corpus cancer managed over a 12-year period (1/93-12/04). All patients had a hysterectomy as part of their therapy. We identified patients with leg lymphedema - as described by the physician or reported by the patient - through medical records. We excluded cases of leg edema that developed secondary to medical conditions such as cardiovascular and renal disease, venous thrombosis, and end-stage recurrent malignancy. Lymphedema dermal changes and related fibrosis were graded using the common terminology criteria for adverse events. Results.: In all, 1289 patients with uterine corpus malignancy were evaluated. We excluded other chronic lower-extremity edema that was related to a variety of medical conditions in 74 patients (5.7%). With a median follow-up of 3 years (interquartile range, 1.1-5.4 years), new symptomatic post-treatment lower-extremity lymphedema was noted in 16 patients. Patients who had lymph nodes removed at initial surgery had a higher rate of developing lymphedema (16/670, 2.4%) than those who did not (0/619, 0%) (P = 0.0001). Furthermore, symptomatic lymphedema was limited to patients who had 10 or more regional lymph nodes removed 16/469 (3.4%). Lymphedema was noted at a median of 5.3 months after surgery (range, 1-32 months). Lymphedema was unilateral in 11 patients (69%) and bilateral in 5 (31%); moreover, it was considered grade 1 in 12 patients (75%) and grade 2 in 4 (25%). Age, weight, stage, type of hysterectomy, and type of postoperative adjuvant therapy were not associated with lymphedema. Conclusions.: To date, this is the largest series evaluating symptomatic lower-extremity lymphedema in women with uterine corpus cancer. Patients who had 10 or more regional lymph nodes removed at initial surgery appeared to be at higher risk for developing new symptomatic leg lymphedema. Patients undergoing surgery with lymphadenectomy for uterine corpus malignancy should be informed about the possibility of postoperative new symptomatic leg lymphedema. A prospective evaluation of leg lymphedema is needed to accurately determine the incidence, severity, and risk factors of this complication. © 2006 Elsevier Inc. All rights reserved.
Keywords: adult; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; cancer recurrence; follow up; endometrial cancer; hysterectomy; lymph nodes; lymph node excision; lymphadenectomy; accuracy; kidney disease; incidence; risk factor; risk assessment; postoperative complication; lymphedema; fibrosis; cancer center; disease severity; cardiovascular disease; vein thrombosis; medical record; physician; uterus cancer; uterine neoplasms; leg edema; leg
Journal Title: Gynecologic Oncology
Volume: 103
Issue: 2
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2006-11-01
Start Page: 714
End Page: 718
Language: English
DOI: 10.1016/j.ygyno.2006.03.055
PUBMED: 16740298
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 59" - "Export Date: 4 June 2012" - "CODEN: GYNOA" - "Source: Scopus"
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MSK Authors
  1. Gali Lev
    4 Lev
  2. Richard R Barakat
    629 Barakat
  3. Dennis S Chi
    541 Chi
  4. Kaled M Alektiar
    271 Alektiar
  5. Yukio Sonoda
    323 Sonoda
  6. Alexia Elia Iasonos
    217 Iasonos