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Lymphedema, serious adverse events, and imaging 1 year after comprehensive staging for endometrial cancer: results from the RASHEC trial
  1. Sahar Salehi1,
  2. Elisabeth Åvall-Lundqvist2,
  3. Yvonne Brandberg3,
  4. Hemming Johansson3,
  5. Chikako Suzuki4,5 and
  6. Henrik Falconer1
  1. 1 Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
  2. 2 Department of Oncology and Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden
  3. 3 Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
  4. 4 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  5. 5 Department of Diagnostic Radiology, Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Sahar Salehi, Department of Women’s and Children’s health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University, Stockholm 17176, Sweden; sahar.salehi{at}


Background and Objectives In the Robot Assisted Surgery for High Risk Endometrial Cancer (RASHEC) trial, patients with high-risk endometrial cancer were randomly assigned to robot-assisted laparoscopic surgery (RALS) or laparotomy for pelvic and infrarenal para-aortic lymph node dissection. We here report on self-reported lower limb lymphedema (LLL), lymphocyst formation, ascites, and long-term serious adverse events 12 months after surgery.

Patients and methods Patients were enrolled between 2013 and 2016, and 96 patients were included in the per protocol analysis, evenly distributed between RALS and laparotomy. Self-reported LLL was recorded using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for endometrial cancer—EN24, assessed before and 12 months after surgery. Computed tomography was assessed at baseline, 3, and 12 months. Medical charts were reviewed for serious adverse events and hospital admissions 31 to 365 days after surgery.

Results At 12 months after laparotomy and RALS, 61% and 50% patients, respectively, reported LLL (p = 0.31). In univariate analysis, the mean score of LLL at 12 months was significantly higher for laparotomy than for RALS (p < 0.05) and for those without abdominal drainage (p = 0.02), but was not independently associated with LLL in the multivariate analysis. Imaging showed no significant difference in lymphocyst formation or ascites between surgical modalities. No difference was found in serious adverse events and admissions to hospital for any reason. There was no agreement between lymphocyst formation or ascites and self-reported LLL.

Conclusion Follow-up 1 year after comprehensive surgical staging for high-risk endometrial cancer showed no differences in self-reported LLL, findings on imaging, or SAE between laparotomy and robot-assisted surgery.

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SS, EÅ-L, YB, CS, HJ declare no conflict of interest in regard to this paper. HF is a proctor for Intuitive Surgical.

  • Provenance and peer review Not commissioned, externally peer reviewed.