Introduction/Background Evaluate the association between the clipping of distal external iliac lymph nodes and risk of postoperative lower extremity lymphedema in women who underwent radical hysterectomy and PLND with or without PALND for cervical cancer.

Methodology Data from 128 patients with cervical cancer who underwent radical hysterectomy with pelvic lymphadenectomy between January 2004 and December 2012 were reviewed. Patients were divided into two groups depending on whether they underwent clipping of the distal external iliac node clusters during pelvic lymphadenectomy. The incidence of lower extremity lymphedema and post-operative complications were compared between groups.

Results The incidence rates of lower extremity lymphedema were significantly higher in Group A (15.8% vs. 7.0%, p = 0.034). On comparing the severity of lower extremity lymphedema, patients in group A exhibited more severe lower extremity lymphedema than those in Group B, which was significantly different (p = 0.041). The incidence rates of lymphangitis, seroma, and phlebitis were similar in both groups.

Conclusion Clipping of distal external iliac lymph nodes during lymphadenectomy play a critical role in the development of lower extremity lymphedema.