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Prevalence, Classification, and Risk Factors for Postoperative Lower Extremity Lymphedema in Women With Gynecologic Malignancies: A Retrospective Study
  1. Hitoshi Hareyama, MD, PhD,
  2. Kenichi Hada, MD,
  3. Kumiko Goto, MD,
  4. Sawako Watanabe, MD,
  5. Minako Hakoyama, MD,
  6. Kikuo Oku, MD,
  7. Yukitoki Hayakashi, MD,
  8. Emi Hirayama, MD, PhD and
  9. Kazuhiko Okuyama, MD, PhD
  1. Department of Obstetrics and Gynecology, Sapporo City General Hospital, Sapporo, Japan.
  1. Address correspondence and reprint requests to Hitoshi Hareyama, MD, PhD, Department of Obstetrics and Gynecology, Sapporo City General Hospital, North 11, West 13, Tyuuou-ku, Sapporo 060-8604, Japan. E-mail: hitoshi.hareyama{at}


Objective Lower 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 Methods We 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.

Results Overall 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.

Conclusions Postoperative 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.

  • Lymphedema
  • Cellulitis
  • Pelvic node
  • Para-aortic node

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  • The authors declare no conflicts of interest.