You are here

  • Home
  • Archive
  • Volume 29, Issue 2
  • Long term complications following pelvic and para-aortic lymphadenectomy for endometrial cancer, incidence and potential risk factors: a single institution experience

Article Text

Article menu
Download PDFPDF
Original Article
Long term complications following pelvic and para-aortic lymphadenectomy for endometrial cancer, incidence and potential risk factors: a single institution experience
  1. Lavinia Volpi1,
  2. Giulio Sozzi2,
  3. Vito Andrea Capozzi1,
  4. Matteo Ricco’3,
  5. Carla Merisio1,
  6. Maurizio Di Serio1,
  7. Vito Chiantera4 and
  8. Roberto Berretta1
  1. 1 Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
  2. 2 Department of Gynecologic Oncology, ARNAS Civico Hospital of Palermo, Palermo, Italy
  3. 3 Local Health Unit of Reggio Emilia, Department of Public Health, Reggio Emilia, Reggio Emilia, Italy
  4. 4 Department of Gynecologic Oncology, ARNAS Civico Hospital of Palermo, University of Palermo, Palermo, Italy
  1. Correspondence to Giulio Sozzi, Department of Gynecology Oncology, ARNAS Civico Hospital of Palermo, Palermo 90127, Italy; giuliosozzi{at}hotmail.it

Abstract

Objective To determine the incidence of long term lymphadenectomy complications in primary surgery for endometrial cancer and to elucidate risk factors for these complications.

Methods A retrospective chart review was carried out for all patients with endometrial cancer managed at Parma University Hospital Unit of Gynecology and Obstetrics between 2010 and 2016. Inclusion criteria were surgical procedure including hysterectomy and lymphadenectomy (pelvic or pelvic and aortic). We identified patients with postoperative lymphocele and lower extremity lymphedema. Logistic regression analysis was used to identify predictive factors for postoperative complications.

Results Of the 249 patients tested, 198 underwent pelvic lymphadenectomy (79.5%), and 51 (20.5%) of those underwent both pelvic and para-aortic lymphadenectomy. Among the 249 patients, 92 (36.9 %) developed lymphedema while 43 (17.3%) developed lymphocele. Multivariate analysis showed that addition of para-artic lymphadenectomy was an independent predictor for both lymphedema (odds ratio (OR) 2.764, 95% confidence interval (CI) 1.023 to 7.470) and lymphocele (OR 5.066, 95% CI 1.605 to 15.989). Moreover, postoperative adjuvant radiotherapy (OR 2.733, 95% CI 1.149 to 6.505) and identification of any positive lymph node (OR 19.391, 95% CI 1.486 to 253.0) were significantly correlated with lymphedema, while removal of circumflex iliac nodes (OR 8.596, 95% CI 1.144 to 65.591) was associated with lymphoceles occurrence.

Conclusion Although sentinel lymph node navigation is a promising option, lymphadenectomy represents the primary treatment in many patients with endometrial cancer. However, comprehensive nodal dissection remains associated with a high rate of long term complications, such as lymphedema and lymphocele. Avoiding risk factors that are related to the development of these postoperative complications is often difficult and, therefore, the strategy to assess lymph nodal status in these women must be tailored to obtain the maximum results in terms of oncological and functional outcome.

  • endometrial cancer
  • lymphadenectomy
  • lymphocele
  • lymphedema

https://doi.org/10.1136/ijgc-2018-000084

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • LV and GS contributed equally.

    • Correction notice This article has been corrected since it was published Online First. An author name was corrected and an erroneous word was removed from the title.

    • 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 None declared.

    • Ethics approval The ethics committee at each institution approved the data collection for scientific purposes and institutional review board approval was not required because the study analyzed existing data.

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