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Kaneyasu Y, Fujiwara H, Nishimura T, Sakurai H, Kazumoto T, Ikushima H, Uno T, Tokumaru S, Harima Y, Gomi H, Toita T, Kita M, Noda SE, Takahashi T, Kato S, Ohkawa A, Tozawa-Ono A, Ushijima H, Hasumi Y, Hirashima Y, Niibe Y, Nakagawa T, Akita T, Tanaka J, Ohno T. A multi-institutional survey of the quality of life after treatment for uterine cervical cancer: a comparison between radical radiotherapy and surgery in Japan. JOURNAL OF RADIATION RESEARCH 2021; 62:269-284. [PMID: 33415337 PMCID: PMC7973450 DOI: 10.1093/jrr/rraa107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/04/2020] [Indexed: 05/14/2023]
Abstract
This study aimed to research the post-treatment quality of life (QOL) between radiotherapy (RT)- and operation (OP)-treated early cervical cancer survivors, using separate questionnaires for physicians and patients. We administered an observational questionnaire to patients aged 20-70 years old with Stages IB1-IIB cervical cancer who had undergone RT or OP and without recurrence as outpatients for ≥6 months after treatment. We divided 100 registered patients equally into two treatment groups (n = 50 each). The average age was 53 and 44 years in the RT and OP groups, respectively. The RT group included 34 and 66% Stage I and II patients, respectively, whereas the OP group included 66 and 34% Stage I and II patients, respectively. The OP group included 58% of patients with postoperative RT. Combination chemotherapy was performed in 84 and 48% of patients in the RT and OP groups, respectively. On the physicians' questionnaire, we observed significant differences in bone marrow suppression (RT) and leg edema (OP). On the patients' questionnaire, significantly more patients had dysuria and leg edema in the OP group than in the RT group, and severe (Score 4-5) leg edema was significantly higher in the post-operative RT group than in the OP only group. The frequency of sexual intercourse decreased after treatment in both groups. On the patients' questionnaire, there were no significant differences between the two groups regarding sexual activity. These findings are useful to patients and physicians for shared decision-making in treatment choices. The guidance of everyday life and health information including sexual life after treatment is important.
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Affiliation(s)
- Yuko Kaneyasu
- Corresponding author. Department of Radiation Oncology, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama, Hiroshima, 720-8520 Japan. Tel: +81-84-922-0001; Fax: +81-84-931-3969;
| | - Hisaya Fujiwara
- Department of Obstetrics and Gynecology, Chugoku Rosai Hospital, Hiroshima, Japan
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsuo Nishimura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan
| | - Tomoko Kazumoto
- Department of Radiation Oncology, Fukaya Red Cross Hospital, Saitama, Japan
- Department of Radiation Oncology, Saitama Cancer Center, Saitama, Japan
| | - Hitoshi Ikushima
- Department of Therapeutic Radiology, Tokushima University Graduate School, Tokushima, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sunao Tokumaru
- Hyogo Ion Beam Medical Center, Hyogo, Japan
- Department of Radiology, Saga University, Saga, Japan
| | - Yoko Harima
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | - Hiromichi Gomi
- Radiation Oncology Center, St. Marianna University School of Medicine Hospital, Kanagawa, Japan
| | - Takafumi Toita
- Radiation Therapy Center, Okinawa Chubu Hospital, Okinawa, Japan
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Midori Kita
- Department of Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Shin-ei Noda
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical University Saitama Medical Center, Saitama, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ayako Ohkawa
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan
- Department of Radiation Oncology, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Akiko Tozawa-Ono
- Department of Gynecology, St. Marianna University School of Medicine, Toyoko Hospital, Tokyo, Japan
| | - Hiroki Ushijima
- Department of Radiation Oncology, Saitama Cancer Center, Saitama, Japan
| | - Yoko Hasumi
- Department of Obstetrics and Gynecology, Mitsui Memorial Hospital, Tokyo, Japan
- Department of Gynecology, Saitama Cancer Center, Saitama, Japan
| | | | - Yuzuru Niibe
- Department of Public Health, Kurume University School of Medtioicine, Fukuoka, Japan
| | - Tomio Nakagawa
- Department of Radiation Oncology, National Hospital Organization Fukuyama Medical Center, Hiroshima, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate school of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate school of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
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Zeng W, Wang R, Ying W, Xu W, Zhao X. Impact on lower limb lymphedema of pelvic lymphadenectomy with external iliac lymph nodes left-opened distal lymphatics technique. INT ANGIOL 2020; 40:143-149. [PMID: 33300763 DOI: 10.23736/s0392-9590.20.04486-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effect of maintaining opened distal lymphatic vessels of external iliac lymph nodes on lymphedema and lymphocyst formation of lower limbs after pelvic lymphadenectomy. METHODS Prospective single center observational study was carried out in 83 patients with gynecological malignancies who underwent pelvic lymphadenectomy. During the operation, the distal lymphatic vessels of the external iliac lymph nodes were cut off by an ultrasound scalpel or scissors, and the proximal end was closed by bipolar coagulation. The patients were re-examined by a physical examination, ultrasound examination and inquiry of the symptoms within 2 years after the operation to check whether they had lower limb lymphedema and to analyze the presence of lymphedema and lymphocyst of lower limbs and the risk. RESULTS The incidence of lower limb lymphedema (LLL) was 21.6% (18/83). Among the patients with LLL, 5.5% (1/18) was diagnosed with stage 0 according to the criteria of International Society of Lymphology, 83.3% (15/18) with stage 1, and 11.1% (2/18) with stage 2. Presently, there was no lymphedema diagnosed at stage 3. The incidence of lymphocyst was 7.2% (6/83). Among the patients with lymphocyst, 3.6% (3/83) occurred 1 month after operation, 2.4% (2/83) occurred 3 months after operation and 1.2% (1/83) occurred 6 months after operation. Patients with radiotherapy and abdominal infection were more likely to suffer from LLL (P<0.05). CONCLUSIONS Maintaining opened distal lymphatic vessels of external iliac lymph nodes during pelvic lymphadenectomy is feasible, safe and with a 21.6% and 7.2% of potential lymphedema and lymphocists, respectively.
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Affiliation(s)
- Wenjie Zeng
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, People's Hospital, Hangzhou, China
| | - Rui Wang
- Bengbu Medical College, Bengbu, China
| | - Weijia Ying
- Zhejiang Chinese University Hospital, Hangzhou, China
| | - Wanwan Xu
- The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Xiaofeng Zhao
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, China -
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Arié A, Yamamoto T. Lymphedema secondary to melanoma treatments: diagnosis, evaluation, and treatments. Glob Health Med 2020; 2:227-234. [PMID: 33330812 PMCID: PMC7731060 DOI: 10.35772/ghm.2020.01022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 01/20/2023]
Abstract
Approximately 300,000 new cases of melanoma are annually diagnosed in the world. Advanced stage melanomas require sentinel lymph node biopsy (SLNB), sometimes lymph node dissections (LND). The development rate of lower extremity lymphedema ranges from 7.6% to 35.1% after inguinal SLNB, and from 48.8% to 82.5% after inguinal LND. Development rate of upper extremity lymphedema ranges from 4.4% to 14.6% after axillary LND. Lymphedema management has constantly improved but effective evaluation and surgical management such as supermicrosurgical lymphaticovenular anastomosis (LVA) are becoming common as minimally invasive lymphatic surgery. Diagnosis and new classification using indocyanine green lymphography allowing pre-clinical secondary lymphedema stage management are improving effectiveness of supermicrosurgical LVA and vascularized lymph node transfer. Lymphatic transfer with lymph-interpositional-flap can restore lymph flow after large oncologic excision even without performing lymphatic anastomosis. Since lymphatic reconstructive surgery may affect local to systemic dissemination of remnant tumor cells, careful consideration is required to evaluate indication of surgical treatments.
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Affiliation(s)
- Azuelos Arié
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, Creteil, France
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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Wedin M, Stålberg K, Marcickiewicz J, Ahlner E, Åkesson Å, Lindahl G, Kjølhede P. Incidence of lymphedema in the lower limbs and lymphocyst formation within one year of surgery for endometrial cancer: A prospective longitudinal multicenter study. Gynecol Oncol 2020; 159:201-208. [PMID: 32763108 DOI: 10.1016/j.ygyno.2020.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study aimed to determine the incidence of lower limb lymphedema (LLL) after surgery for endometrial cancer (EC) by means of three methods, and to determine the incidence of lymphocysts after one year. METHODS A prospective longitudinal multicenter study was conducted in 14 hospitals in Sweden. Two-hundred-and-thirty-five women with EC were included; 116 underwent surgery that included lymphadenectomy (+LA) and 119 were without lymphadenectomy (-LA). Lymphedema was assessed objectively on four occasions; preoperatively, at 4-6 weeks, six months and one year postoperatively using systematic measurement of leg circumferences, enabling calculation of leg volumes, and a clinical grading of LLL, and subjectively by the patient's perception of lymphedema measured by a lymphedema-specific quality-of-life instrument. Lymphocyst was evaluated by vaginal ultrasonography. RESULTS After one year the incidence of LLL after increase in leg volume adjusted for body mass index was 15.8% in +LA women and 3.4% in -LA women. The corresponding figures for clinical grading were 24.1% and 11.8%, and for patient-reported perceived LLL 10.7% and 5.1%. The agreement between the modalities revealed fair to moderate correlation between patient-reported LLL and clinical grading, but poor agreement between volume increase and patient-reported LLL or clinical grading. Lymphocysts were found in 4.3% after one year. CONCLUSIONS Although the incidence of LLL and lymphocysts after surgery for EC including LA seemed to be relatively high the study demonstrated significant variations in incidence depending on the measurement modality. This emphasizes the need for a 'gold standard' of measurement of LLL in clinical practice and research.
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Affiliation(s)
- Madelene Wedin
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Science, Linköping University, Sweden.
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Eva Ahlner
- Department of Oncology, and Department of Biomedical and Clinical Science, Linköping University, Sweden
| | - Åsa Åkesson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, and Institute of clinical sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Gabriel Lindahl
- Department of Oncology, and Department of Biomedical and Clinical Science, Linköping University, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Science, Linköping University, Sweden
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Pigott A, Obermair A, Janda M, Vagenas D, Ward LC, Reul-Hirche H, Hayes SC. Incidence and risk factors for lower limb lymphedema associated with endometrial cancer: Results from a prospective, longitudinal cohort study. Gynecol Oncol 2020; 158:375-381. [PMID: 32499070 DOI: 10.1016/j.ygyno.2020.04.702] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Evidence on the incidence and risk factors for lower limb lymphedema (LLL) associated with endometrial cancer is limited. Our objective was to use data from a prospective, longitudinal gynecological cancer cohort study to determine LLL incidence up to 24 months post-diagnosis of endometrial cancer and to explore the relationship between personal and treatment-related factors and risk of developing LLL. METHODS Women recently diagnosed with endometrial cancer (n = 235) were evaluated at regular intervals post-diagnosis (up to 3-monthly) using bioimpedance spectroscopy (BIS) and self-reported leg swelling (SRLS). RESULTS Incidence of LLL at 24 months post-diagnosis was 33% and 45% according to BIS and SRLS, respectively. When analyses were restricted to obese women, incidence at 24 months post-diagnosis increased to 67% (BIS) and 54% (SRLS). Following adjusted analyses, higher body mass index was associated with higher odds of baseline lymphedema (BIS: OR 1.91, 95% CI 1.47-2.49, p < .01; SRLS: OR 1.06, 95% CI 1.00-1.12, p < .01) and LLL incidence by 24 months post-diagnosis (BIS: OR 1.29, 95% CI: 0.99-1.68, p = .055; SRLS: OR 1.06, 95% CI 1.02-1.11, p = .008). According to SRLS, presence of comorbidities was also associated with baseline lymphedema (OR: 1.43, 95% CI: 1.15-1.78, p = .001), and more extensive lymph node dissection (OR 1.06, 95% CI: 1.01-1.12, p = .026) and receipt of chemotherapy (OR: 2.65, 95% CI: 1.12-6.29, p = .027) were identified as risk factors for lymphedema incidence. CONCLUSIONS These findings suggest that LLL following endometrial cancer is common, particularly in women with high body mass index, or comorbidities, and those requiring more extensive lymph node dissection or chemotherapy. Future studies should examine the potential of weight loss intervention as a strategy to reduce LLL incidence.
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Affiliation(s)
- Amanda Pigott
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Occupational Therapy Department, Brisbane, Queensland, Australia.
| | - Andreas Obermair
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Queensland Centre of Gynaecological Research, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Hildegard Reul-Hirche
- Royal Brisbane and Women's Hospital, Physiotherapy Department, Brisbane, Queensland, Australia
| | - Sandra C Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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Chen J, He B, Dong D, Liu P, Duan H, Li W, Li P, Wang L, Fan H, Wang S, Zhang L, Tian J, Huang Z, Chen C. Noninvasive CT radiomic model for preoperative prediction of lymph node metastasis in early cervical carcinoma. Br J Radiol 2020; 93:20190558. [PMID: 31957473 DOI: 10.1259/bjr.20190558] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To build and validate a CT radiomic model for pre-operatively predicting lymph node metastasis in early cervical carcinoma. METHODS AND MATERIALS A data set of 150 patients with Stage IB1 to IIA2 cervical carcinoma was retrospectively collected from the Nanfang hospital and separated into a training cohort (n = 104) and test cohort (n = 46). A total of 348 radiomic features were extracted from the delay phase of CT images. Mann-Whitney U test, recursive feature elimination, and backward elimination were used to select key radiomic features. Ridge logistics regression was used to build a radiomic model for prediction of lymph node metastasis (LNM) status by combining radiomic and clinical features. The area under the receiver operating characteristic curve (AUC) and κ test were applied to verify the model. RESULTS Two radiomic features from delay phase CT images and one clinical feature were associated with LNM status: log-sigma-2-0 mm-3D_glcm_Idn (p = 0.01937), wavelet-HL_firstorder_Median (p = 0.03592), and Stage IB (p = 0.03608). Radiomic model was built consisting of the three features, and the AUCs were 0.80 (95% confidence interval: 0.70 ~ 0.90) and 0.75 (95% confidence intervalI: 0.53 ~ 0.93) in training and test cohorts, respectively. The κ coefficient was 0.84, showing excellent consistency. CONCLUSION A non-invasive radiomic model, combining two radiomic features and a International Federation of Gynecology and Obstetrics stage, was built for prediction of LNM status in early cervical carcinoma. This model could serve as a pre-operative tool. ADVANCES IN KNOWLEDGE A noninvasive CT radiomic model, combining two radiomic features and the International Federation of Gynecology and Obstetrics stage, was built for prediction of LNM status in early cervical carcinoma.
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Affiliation(s)
- Jiaming Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bingxi He
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Duan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pengfei Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lu Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huijian Fan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siwen Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Liwen Zhang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Zhipei Huang
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Ezawa M, Sasaki H, Yamada K, Takano H, Iwasaka T, Nakao Y, Yokochi T, Okamoto A. Long term outcomes from lymphatic venous anastomosis after total hysterectomy to prevent postoperative lymphedema in lower limb. BMC Surg 2019; 19:177. [PMID: 31771562 PMCID: PMC6878618 DOI: 10.1186/s12893-019-0628-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphedema in lower limb is one of major postoperative complications followed by a total hysterectomy with lymph node dissection. The objective of this report is to examine a long-term result of lymphaticovenous anastomosis procedure as a preventive surgery. METHODS Sixteen patients with endometrial cancer underwent an abdominal hysterectomy with a bilateral salpingo-oophorectomy. Just after pelvic lymph node dissection, either end-to-end or sleeve anastomosis utilizing venules and suprainguinal lymph vessels was performed. During the observation period from 4 to 13 years, the symptom of lymphedema in lower extremities has been assessed. RESULTS Among 16 patients, 1 presented postoperative lymphedema grade 3 (CTCAE (Common Terminology Criteria for Adverse Events) Ver. 4.0, 10025233) in lower limb, and a second surgery at 7 years after the first one was required. Other 6 patients showed non-severe symptoms of lymphedema, diagnosed as grade 1. The rest 9 patients did not show any symptoms of postoperative lymphedema in a long term (up to 13 years). CONCLUSION From the long term outcomes of our 16 cases, we propose that a direct lymphaticovenous microsurgery immediately after a hysterectomy with lymphadenectomy of external inguinal lymph node is one of the appropriate therapeutic choices to prevent severe lymphedema in lower limb.
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Affiliation(s)
- Masahiro Ezawa
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Sasaki
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan. .,Department of Gynecology, Chiba Tokushukai Hospital, Chiba, Japan.
| | - Kyosuke Yamada
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirokuni Takano
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Iwasaka
- Department of Obstetrics and Gynecology, Saga University School of Medicine, Saga, Japan
| | | | - Tomoki Yokochi
- Department of Clinical Research, Chiba Tokushukai Hospital, Chiba, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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McGee P, Munnoch DA. Treatment of gynaecological cancer related lower limb lymphoedema with liposuction. Gynecol Oncol 2018; 151:460-465. [PMID: 30293713 DOI: 10.1016/j.ygyno.2018.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/22/2018] [Accepted: 09/25/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate outcomes in patients with gynaecological cancer related lymphoedema treated with liposuction. METHODS A prospective analysis of 21 patients who underwent liposuction followed by compression therapy for chronic unilateral lower limb lymphoedema with up to 8 years follow up was performed. RESULTS Duration of lymphoedema prior to liposuction ranged from 4 to 28 years (mean 15.2 years). The mean age at time of liposuction was 52 years (range 37-67). Estimated volume excess in the affected limb ranged from 1.6 to 12 l (mean 4.7 l). The mean percentage reduction was 92.6% at 6 months (range 59.4-159.9) and 88.9% (range 60.9-127.5) at 1 year. Longer term follow-up of 6 patients at 5 years post-liposuction revealed a mean percentage reduction of 113.6% (range 83.5-155.5). CONCLUSION Our experience of liposuction combined with compression garments has demonstrated significant and sustainable reduction in limb volume in patients with lower limb lymphoedema secondary to gynaecological malignancy.
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Affiliation(s)
- Pauline McGee
- Department of Plastic Surgery, Ninewells Hospital, James Arrott Drive, Dundee DD1 9SY, United Kingdom.
| | - David Alex Munnoch
- Consultant Plastic Surgeon, Department of Plastic Surgery, Ninewells Hospital, James Arrott Drive, Dundee DD2 9SY, United Kingdom.
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The Combination of Preoperative Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Sentinel Lymph Node Mapping in the Surgical Management of Endometrioid Endometrial Cancer. Int J Gynecol Cancer 2018; 26:1228-38. [PMID: 27643647 DOI: 10.1097/igc.0000000000000773] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The goal of this study was to evaluate the combination of sentinel lymph node (SLN) mapping and F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) scan in detection of lymph node involvement in patients with endometrioid endometrial cancer (EEC). METHODS/MATERIALS Ninety-five patients with EEC who had preoperative PET/CT imaging and underwent SLN mapping were retrospectively analyzed. Methylene blue dye was used and injected to the cervix at 3- and 9-o'clock positions (a total of 4 mL). Pelvic lymphadenectomy was performed on all of the patients after SLN mapping. If the SLN was negative in the initial hematoxylin and eosin staining, an ultrastaging study was performed for the SLNs. RESULTS Sentinel lymph nodes were detected in 77 (81.1%) of 95 patients, with a mean of 2.95 SLNs. There was only 1 case (1.4%) with a positive SLN in the intraoperative frozen section examination in those patients with negative PET/CT findings and in whom SLNs were detected (n = 70). Among the remaining 69 patients with negative preoperative PET/CT findings and negative frozen section results for the SLNs, there were 2 patients with SLN involvement in the final ultrastaging pathology. In the patient-based analyses, the sensitivity, specificity, and positive and negative predictive values of the PET/CT and SLN frozen section were 33%, 100%, 100%, and 97.1%, respectively. CONCLUSIONS As no metastases in the nonsentinel pelvic lymph nodes were found in patients with EEC who had both negative PET/CT findings and frozen section results of the SLNs in both hemipelvises, we suggest using both methods to reduce the incidence of unnecessary systematic lymphadenectomy.
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Yamamoto T, Narushima M, Koshima I. Lymphatic vessel diameter in female pelvic cancer-related lower extremity lymphedematous limbs. J Surg Oncol 2018; 117:1157-1163. [DOI: 10.1002/jso.24974] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/08/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery; National Center for Global Health and Medicine; Tokyo Japan
- Department of Plastic and Reconstructive Surgery; The University of Tokyo Hospital; Tokyo Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery; The University of Tokyo Hospital; Tokyo Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery; The University of Tokyo Hospital; Tokyo Japan
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The Influence of Adverse Effects on Quality of Life of Survivors of Gynecologic Cancer. Int J Gynecol Cancer 2017; 27:2014-2019. [DOI: 10.1097/igc.0000000000001125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe objective of this observational study was to investigate correlations between adverse effects (lower-extremity lymphedema [LEL], dysuria, and severe gastrointestinal symptoms) and quality of life (QOL) (physical well-being [PWB], social well-being, emotional well-being [EWB], and functional well-being) before treatment, at least 6 weeks after treatment (posttreatment1), and 3 or 6 months after treatment (posttreatment2) of patients with gynecologic cancer (GC).MethodsFrom August 2012 to October 2016, questionnaire responses and clinical data of 75 patients with GC were collected and assessed by treatment received. The χ2 test was used to determine the significance of correlations.ResultsParticipants with LEL had significantly poorer QOL than did those without it in the domains of PWB at posttreatment1 (P = 0.026) and EWB at posttreatment2 (P = 0.020). Moreover, patients with 2 adverse effects (LEL plus dysuria or severe gastrointestinal symptoms) had significantly poorer QOL than did those with no or single adverse effect in the domains of PWB at posttreatment1 and posttreatment2 (posttreatment1: P = 0.049, P = 0.001; posttreatment2: P = 0.002, P = 0.028) and poorer QOL compared with those with no adverse effect in the domain of EWB at posttreatment1 (P = 0.017).ConclusionsPoorer QOL in emotional and physical domains is associated with adverse effects of treatment in patients with GC. It is important to consider the effects of radical therapy not only on survival but also on the QOL of survivors.
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Abstract
BACKGROUND Lymphaticovenular anastomosis is a useful treatment option for compression-refractory lower extremity lymphedema, but its efficacy depends largely on the severity of lymphosclerosis. To maximize lymphaticovenular anastomosis efficacy, it is important to elucidate factors associated with severe lymphosclerosis. METHODS Medical charts of 134 lower extremity lymphedema patients who underwent preoperative indocyanine green lymphography and lymphaticovenular anastomosis were reviewed to obtain data of clinical demographics, indocyanine green lymphography findings, and intraoperative findings. Based on intraoperative findings of lymphatic vessels, severity of lymphosclerosis was classified into s0, s1, s2, and s3. Severe lymphosclerosis was defined as lymphatic vessels with s3 sclerosis. Logistic regression analysis was used to identify independent factors associated with severe lymphosclerosis. RESULTS In total, 962 lymphatic vessels were analyzed, among which severe lymphosclerosis was observed in 97 (10.1 percent). Multivariate analysis revealed that independent factors associated with severe lymphosclerosis were higher body mass index (OR, 1.803; 95 percent CI, 1.041 to 3.123; p = 0.035), incision site in the thigh/foot compared with in the groin (OR, 2.355/4.471; 95 percent CI, 1.201 to 4.617/2.135 to 9.362; p = 0.013/p < 0.001), and S-region/D-region on indocyanine green lymphography compared with L-region (OR, 83.134/1441.126; 95 percent CI, 11.296 to 611.843/146.782 to 14149.195; p < 0.001/p < 0.001). Inverse associations were observed in positive history of radiation therapy (OR, 0.461; 95 percent CI, 0.269 to 0.788; p = 0.005). CONCLUSIONS Independent factors associated with severe lymphosclerosis were clarified. Indocyanine green lymphography pattern had the strongest association with severe lymphosclerosis. D-region on indocyanine green lymphography should be avoided for lymphaticovenular anastomosis. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Lindqvist E, Wedin M, Fredrikson M, Kjølhede P. Lymphedema after treatment for endometrial cancer − A review of prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol 2017; 211:112-121. [DOI: 10.1016/j.ejogrb.2017.02.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/19/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
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Lower-extremity lymphedema following management for endometrial and cervical cancer. Surg Oncol 2016; 25:200-4. [DOI: 10.1016/j.suronc.2016.05.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/17/2015] [Accepted: 05/19/2016] [Indexed: 11/23/2022]
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Nakamura K, Kitahara Y, Satoh T, Takei Y, Takano M, Nagao S, Sekiguchi I, Suzuki M. Analysis of the effect of adjuvant radiotherapy on outcomes and complications after radical hysterectomy in FIGO stage IB1 cervical cancer patients with intermediate risk factors (GOTIC Study). World J Surg Oncol 2016; 14:173. [PMID: 27356862 PMCID: PMC4928324 DOI: 10.1186/s12957-016-0931-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background There are no definitive criteria for identifying which patients with The International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical cancer will benefit from adjuvant therapy after radical hysterectomy. The aims of this study were to clarify the efficacy of adjuvant therapy and assess complications after radical hysterectomy in patients with FIGO stage IB1 cervical cancer with intermediate risk factors. Methods Between January 2005 and December 2009, the medical records of 75 stage IB1 patients’ intermediate risk factors (i.e., tumor size 2–4 cm, lymphovascular involvement, and/or deep stromal invasion >1/2) who underwent radical hysterectomy at six institutions were collected, and these patients were enrolled in this nonrandomized retrospective study. We simplified the criteria of intermediate risk factors as much as possible, as the criteria adopted in some clinical studies are complicated in practice. Results The patients were grouped according to the receipt of adjuvant therapy as follows: 46 patients, no further treatment; 19 patients, external beam radiation treatment, including 9 patients who received brachytherapy; 5 patients, concurrent chemoradiotherapy (CCRT); and 5 patients, chemotherapy (CT). The clinical outcomes and complications in each group were analyzed. After an average follow-up of 82.6 months (range, 24–135 months), only one patient with all three risk factors who received radiotherapy (RT) experienced recurrence. Excluding this patient, the remaining patients who received RT, CCRT, or CT had two or three risk factors. Lymphedema was significantly more common among patients who received RT or CCRT, whereas the incidence of ileus and ureteral obstruction was not different among the treatment groups. However, an unsutured peritoneum increased the risk of ileus. Conclusions The findings of this study suggest that RT and CCRT after radical hysterectomy are not beneficial in patients with intermediate risk factors. In particular, RT and CCRT appeared to increase the incidence of lymphedema. A prospective randomized study is needed to verify the findings of this study.
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Affiliation(s)
- Kazuto Nakamura
- Department of Obstetrics and Gynecology, Gunma University Hospital, Maebashi, Gunma, 371-8511, Japan. .,Current address: Department of Gynecology, Gunma Cancer Center, Ota, Gunma, 373-8550, Japan.
| | - Yoshikazu Kitahara
- Department of Obstetrics and Gynecology, Gunma University Hospital, Maebashi, Gunma, 371-8511, Japan
| | - Toyomi Satoh
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8577, Japan
| | - Yuji Takei
- Department of Obstetrics and Gynecology, Jichi Medical University Hospital, Shimotsuke, Tochigi, 329-0498, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan
| | - Shoji Nagao
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, 350-1298, Japan.,Current address: Department of Gynecology, Hyogo Cancer Center, Akashi, Hyogo, 673-8558, Japan
| | - Isao Sekiguchi
- Department of Gynecology, Tochigi Cancer Center, Utusnomiya, Tochigi, 320-0834, Japan
| | - Mitsuaki Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University Hospital, Shimotsuke, Tochigi, 329-0498, Japan
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Yamazaki H, Todo Y, Takeshita S, Ohba Y, Sudo S, Minobe S, Okamoto K, Yamashiro K, Kato H. Relationship between removal of circumflex iliac nodes distal to the external iliac nodes and postoperative lower-extremity lymphedema in uterine cervical cancer. Gynecol Oncol 2015; 139:295-9. [DOI: 10.1016/j.ygyno.2015.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/01/2015] [Accepted: 09/06/2015] [Indexed: 11/25/2022]
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Bae HS, Lim MC, Lee JS, Lee Y, Nam BH, Seo SS, Kang S, Chung SH, Kim JY, Park SY. Postoperative Lower Extremity Edema in Patients with Primary Endometrial Cancer. Ann Surg Oncol 2015; 23:186-95. [DOI: 10.1245/s10434-015-4613-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Indexed: 11/18/2022]
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Prevalence, Classification, and Risk Factors for Postoperative Lower Extremity Lymphedema in Women With Gynecologic Malignancies: A Retrospective Study. Int J Gynecol Cancer 2015; 25:751-7. [DOI: 10.1097/igc.0000000000000405] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveLower 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 MethodsWe 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.ResultsOverall 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.ConclusionsPostoperative 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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Shaitelman SF, Cromwell KD, Rasmussen JC, Stout NL, Armer JM, Lasinski BB, Cormier JN. Recent progress in the treatment and prevention of cancer-related lymphedema. CA Cancer J Clin 2015; 65:55-81. [PMID: 25410402 PMCID: PMC4808814 DOI: 10.3322/caac.21253] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overview of important trends in the diagnosis, treatment, and management of cancer-related lymphedema.
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Incidence and risk factors for lower limb lymphedema after gynecologic cancer surgery with initiation of periodic complex decongestive physiotherapy. Int J Clin Oncol 2014; 20:556-60. [DOI: 10.1007/s10147-014-0724-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/13/2014] [Indexed: 12/31/2022]
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Distribution Pattern of Circumflex Iliac Node Distal to the External Iliac Node Metastasis in Stage IA to IIA Cervical Carcinoma. Int J Gynecol Cancer 2014; 24:935-40. [DOI: 10.1097/igc.0000000000000138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesThis study aimed to investigate the metastatic rate of circumflex iliac node distal to the external iliac node (CINDEIN) and its associations with clinicopathological factors in patients with stage IA to IIA cervical cancer to determine whether dissection of CINDEIN had a role in surgery of these patients.MethodsSix hundred thirty-three patients with the International Federation of Gynecology and Obstetrics stage IA to IIA cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively reviewed. The metastatic rate and distribution of the pelvic lymph nodes (PLNs) and CINDEINs were analyzed.ResultsThe PLN metastatic rate was 25.6% (162 of 633 patients). Sixteen of 162 node-positive patients had CINDEIN metastases. Only 1 patient without PLN metastases had positive CINDEIN nodes. Univariate analysis revealed that other PLNs (including lymph nodes collected from obturator, external iliac, and internal iliac regions) and lymph vascular space involvement were the risk factors of CINDEIN metastases (P < 0.05). Other PLN metastasis (odds ratio, 50.6; 95% confidence interval, 6.6–386.7) was an independent risk factor for metastasis to CINDEIN by binary logistic regression analysis.ConclusionsCircumflex iliac node distal to the external iliac node metastases seemed to occur secondarily to widespread PLN metastases. In early stage cervical cancer, removal of the CINDEIN as a routine surgical procedure might be omitted to reduce operation time and minimize surgical morbidity.
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Akita S, Mitsukawa N, Kuriyama M, Hasegawa M, Kubota Y, Tokumoto H, Ishigaki T, Hanaoka H, Satoh K. Suitable therapy options for sub-clinical and early-stage lymphoedema patients. J Plast Reconstr Aesthet Surg 2014; 67:520-5. [DOI: 10.1016/j.bjps.2013.12.056] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
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Lim MC, Lee JS, Nam BH, Seo SS, Kang S, Park SY. Lower extremity edema in patients with early ovarian cancer. J Ovarian Res 2014; 7:28. [PMID: 24602386 PMCID: PMC3975336 DOI: 10.1186/1757-2215-7-28] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/03/2014] [Indexed: 11/13/2022] Open
Abstract
Background The objective of this study was to investigate clinical manifestations of lower extremity edema (LEE) in early ovarian cancer. Methods Patients with early ovarian cancer who underwent staging surgery between January 2001 and December 2010. Medical records for LEE and/or responses to the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) were evaluated. Results Patients had a median age of 46 years. Twenty-nine patients (40.8%) had past (13 patients, 44.8%) and/or current patient-reported LEE (16 patients, 55.2%). Symptoms reported on the GCLQ in over 20% of respondents were numbness, firmness/tightness, swelling, heaviness, limited movement of knee, and aching. GCLQ total symptoms score was significantly higher in patients with current LEE. Most of the LEE (25/29, 86.2%) developed within 12 months after surgery and LEE lasted more than 6 months in approximately two-thirds of the patients (18/29, 62.1%). Only half of the patients (52.1%) indicated knowledge of lymphedema: 86.2% of LEE patients and 28.6% of patients with no LEE. Conclusions Although a significant proportion of patients with ovarian cancer have LEE after surgery, most are not aware of lymphedema until they develop. Education and analyses for LEE and lymphedema are needed in patients with ovarian cancer.
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Affiliation(s)
- Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si 410-769, Gyeonggi-do, Republic of Korea.
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Singh L, Stevens EE. Leg Pain and Gynecologic Malignancy. Am J Hosp Palliat Care 2013; 30:594-600. [DOI: 10.1177/1049909112460422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Gynecologic malignancies affect more than 83 000 women in the United States, each year. Because the disease involves the pelvis, many patients have side effects distal to this area in their lower extremities. The differential diagnosis of leg pain can be divided into vascular, neurologic, and musculoskeletal causes. In this review article, we address numerous etiologies of leg pain, reviewing the prevalence of disease, physical examination findings, diagnostic as well as treatment modalities.
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Affiliation(s)
- Lilly Singh
- Department of Obstetrics & Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Erin E. Stevens
- Department of Obstetrics & Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Early diagnosis and risk factors for lymphedema following lymph node dissection for gynecologic cancer. Plast Reconstr Surg 2013; 131:283-290. [PMID: 23357989 DOI: 10.1097/prs.0b013e318277870f] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although early diagnosis is important for selecting an effective surgical treatment for secondary lymphedema, an efficient screening test for detecting early-stage lymphedema has not yet been established. Serial changes of lymphatic function before and after lymph node dissection and risk factors for secondary lymphedema are important indicators. METHODS A prospective cohort observational study was conducted with 100 consecutive gynecologic cancer patients who underwent pelvic lymph node dissection. Lymphatic function was assessed by noninvasive lymphography using indocyanine green fluorescence imaging on a routine schedule. Earliest findings after lymphadenectomy and risk factors for lower leg lymphedema were investigated. RESULTS Atypical transient dermal backflow patterns were observed in an early postoperative period in 50 cases, all of which disappeared within 3 months. Of these patterns, the splash pattern was observed in 31 patients, of which five improved to normal following a natural course. In contrast, the stardust pattern was observed in 27 patients, and none had improved with conservative therapy. Postoperative radiotherapy was a significant risk factor for the stardust pattern. CONCLUSIONS All patients who undergo lymphadenectomy for gynecologic malignancies should be examined for secondary lower extremity lymphedema by qualitative evaluation methods on a routine schedule to determine the earliest possible diagnosis. Because the splash pattern on indocyanine green lymphography is a reversible lymphatic disorder following a natural course, surgical treatments are not recommended. The decision regarding surgical treatment can be made after observing the stardust pattern. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, IV.
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Ohba Y, Todo Y, Akashi D, Kawaguchi S, Minobe S, Okamoto K, Kato H. Incidence of metastasis in the circumflex iliac nodes distal to the external iliac nodes in ovarian cancer. Gynecol Oncol 2012; 126:387-90. [DOI: 10.1016/j.ygyno.2012.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 05/23/2012] [Accepted: 05/25/2012] [Indexed: 11/25/2022]
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Hareyama H, Ito K, Hada K, Uchida A, Hayakashi Y, Hirayama E, Oikawa M, Okuyama K. Reduction/prevention of lower extremity lymphedema after pelvic and para-aortic lymphadenectomy for patients with gynecologic malignancies. Ann Surg Oncol 2011; 19:268-73. [PMID: 21717243 DOI: 10.1245/s10434-011-1863-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lower extremity lymphedema (LEL) is a serious complication caused by lymphadenectomy in patients with gynecologic malignancies. In this study, we evaluated the effect of preserving the circumflex iliac lymph nodes (CILNs), i.e., the most caudal external iliac lymph nodes, for the prevention and reduction of LEL by comparing two groups of patients, one in which CILN were removed and the other in which CILNs were preserved. METHODS We retrospectively reviewed 329 patients with gynecologic malignancies who had undergone abdominal complete systematic pelvic and para-aortic lymphadenectomy. The patients were divided into nonpreserved (n = 189) and preserved (n = 140) groups, depending on whether CILNs were removed. Primary outcome measures included the incidence and severity of LEL. RESULTS The incidence of LEL was significantly lower in the preserved group than in the nonpreserved group (P < 0.0001). The frequency of LEL was also significantly lower in the preserved group than in the nonpreserved group regardless of the range of pelvic and para-aortic lymphadenectomy (P < 0.0001). LEL in the overwhelming majority of cases in the preserved group was mild, and no patients experienced severe LEL. Further, the incidence of cellulitis was 0% in the preserved group, while it was 12.7% in the nonpreserved group (P < 0.0001). Lymphoscintigraphy revealed collateral pathways from the preserved CILN along the iliac and large abdominal vessels. CONCLUSIONS This method of lymph node preservation is a simple and extremely effective approach for preventing/reducing LEL after pelvic and para-aortic lymphadenectomy for patients with gynecologic malignancies.
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Affiliation(s)
- Hitoshi Hareyama
- Department of Obstetrics and Gynecology, Sapporo City General Hospital, Sapporo, Japan.
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Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer 2011; 116:5138-49. [PMID: 20665892 DOI: 10.1002/cncr.25458] [Citation(s) in RCA: 305] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Secondary lymphedema is a debilitating, chronic, progressive condition that commonly occurs after the treatment of breast cancer. The purpose of the current study was to perform a systematic review and meta-analysis of the oncology-related literature excluding breast cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various malignancies. METHODS The authors systematically reviewed 3 major medical indices (MEDLINE, Cochrane Library databases, and Scopus) to identify studies (1972-2008) that included a prospective assessment of lymphedema after cancer treatment. Studies were categorized according to malignancy, and data included treatment, complications, lymphedema measurement criteria, lymphedema incidence, and follow-up interval. A quality assessment of individual studies was performed using established criteria for systematic reviews. Bayesian meta-analytic techniques were applied to derive summary estimates when sufficient data were available. RESULTS A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n = 15), gynecologic malignancies (n = 22), genitourinary cancers (n = 8), head/neck cancers (n = 1), and sarcomas (n = 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary, 10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods and longer follow-up were both associated with increased lymphedema incidence. CONCLUSIONS Lymphedema is a common condition affecting cancer survivors with various malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic location, heterogeneity of assessment methods, and length of follow-up.
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Affiliation(s)
- Janice N Cormier
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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Risk factors for lower-limb lymphedema after surgery for cervical cancer. Int J Clin Oncol 2011; 16:238-43. [DOI: 10.1007/s10147-010-0171-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 11/26/2010] [Indexed: 11/27/2022]
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Park NY, Seong WJ, Chong GO, Hong DG, Cho YL, Park IS, Lee YS. The effect of nonperitonization and laparoscopic lymphadenectomy for minimizing the incidence of lymphocyst formation after radical hysterectomy for cervical cancer. Int J Gynecol Cancer 2010; 20:443-8. [PMID: 20375812 DOI: 10.1111/igc.0b013e3181d1895f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To determine the clinical effect of nonperitonization and laparoscopic lymphadenectomy using bipolar electrocautery after radical hysterectomy for cervical cancer compared with peritonization and open lymphadenectomy using monopolar electrocautery. MATERIALS AND METHODS This was a retrospective study of 180 patients who underwent a radical hysterectomy and pelvic lymph node dissection (PLND) for cervical cancer from August 1998 to August 2007. The patients were composed of the Peritonization + Laparotomy group (group A; n = 98, 196 PLND) and the Nonperitonization + Laparoscopy group (group B; n = 82, 164 PLND). Group B left the peritoneum in front of the PLND open. Two closed-suction drains were placed at each side of the PLND. RESULTS Group B statistically showed a lesser total amount of lymphatic drainage (P = 0.001), shorter duration of inserted drains (P < 0.001), and shorter length of hospital stay (P < 0.001), compared with group A. The formation of lymphocysts occurred in 30 patients (41 lymphocysts) of group A and 5 patients (5 lymphocysts) of group B. Lymphocyst formation of group B had a statistically lower incidence than that of group A (P < 0.001). Lymphocyst formation was associated with an increase in the total amount of lymphatic drainage in group A (P = 0.090) and group B (P = 0.041) and a pathologic type of adenocarcinoma in group B (P = 0.016). Surgical experiences were not correlated with lymphocyst formation. CONCLUSIONS The omission of peritonization and laparoscopic lymphadenectomy using bipolar electrocautery in early-stage cervical cancer were more effective than peritonization and open lymphadenectomy using monopolar electrocautery in minimizing the incidence of lymphocyst formation.
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Affiliation(s)
- Nae Yoon Park
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Hospital, Daegu, Korea
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Place du ganglion sentinelle dans le cancer du col de l’utérus en 2009. ONCOLOGIE 2010. [DOI: 10.1007/s10269-009-1831-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Montejo M, Werner TL, Gaffney D. Current challenges in clinical management of endometrial cancer. Adv Drug Deliv Rev 2009; 61:883-9. [PMID: 19422864 DOI: 10.1016/j.addr.2009.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 04/28/2009] [Indexed: 12/25/2022]
Abstract
Endometrial cancer remains a management challenge. Improved understanding of the mechanisms of carcinogenesis may enable better understanding of biologic behavior and guide therapy. Improvements in diagnostic imaging, radiation delivery systems, and systemic therapies potentially can improve outcomes while minimizing morbidity. Novel strategies for screening and prevention also hold promise for reducing incidence and mortality of this disease.
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