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Original research
Incidence, prevalence, and factors associated with lymphedema after treatment for cervical cancer: a systematic review
  1. Alberto Ferreira Bona1,
  2. Kamila Rodrigues Ferreira2,
  3. Raquel Boechat de Moura Carvalho2,
  4. Luiz Claudio Santos Thuler1 and
  5. Anke Bergmann1
  1. 1 Clinical Research, Instituto Nacional de Cancer, Rio de Janeiro, Rio de Janeiro, Brazil
  2. 2 Physical Therapy Service, Hospital of Cancer II, Instituto Nacional de Cancer, Rio de Janeiro, Rio de Janeiro, Brazil
  1. Correspondence to Dr Anke Bergmann, Clinical Research, Instituto Nacional de Cancer, Rio de Janeiro, Rio de Janeiro, Brazil; abergmann{at}inca.gov.br

Abstract

Background Lower limb lymphedema is a frequent and debilitating complication after cervical cancer treatment.

Objective To evaluate the incidence and prevalence of lymphedema after treatment for cervical cancer and evaluate the factors associated with this outcome.

Methods The study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Eligible studies were identified through the databases Medline (via PubMed), LILACS, Scopus, and Web of Science. For the search, descriptors, keywords, and synonyms were used for cervical cancer, lymphedema, and outcomes of interest (incidence, prevalence, frequency, occurrence, morbidity, risk factors, and prognosis). Observational studies were included that were published in English, Portuguese, or Spanish, between January 1, 2013 and December 31, 2019, with frequency data and associated factors for lymphedema after cervical cancer treatment. Studies that evaluated the presence of lymphedema less than 6 months after surgery or radiotherapy and those in which frequency data were not stratified by tumor topography, were excluded.

Results Twenty-three studies were included. The incidence of lymphedema varied between 0% and 69%. Different designs and methods were employed for lymphedema assessment. The main factors associated with lymphedema included extension of lymphadenectomy, number of lymph nodes removed, removal of circumflex iliac lymph nodes, and adjuvant radiotherapy. Other factors associated with lymphedema included cellulitis, lymphocyst formation, increased age, invasive lymph node staging, higher body mass index, and insufficient physical activity.

Conclusions The frequency of lymphedema after treatment for cervical cancer is variable. The different designs and methodology to measure this complication make it difficult to draw definitive conclusions about its prevalence. The method used for lymphedema assessment is not standardized.

  • cervical cancer
  • postoperative complications
  • radiation
  • SLN and lympadenectomy

https://doi.org/10.1136/ijgc-2020-001682

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    Footnotes

    • Contributors AFB: conception and design of study, acquisition of data in the literature search, analysis and interpretation of data collected, and drafting of article and/or critical revision. KRF and RBdMC: acquisition of data in the literature search, analysis and interpretation of data collected, and drafting of article and/or critical revision. LCST and AB: conception and design of study, acquisition of data in the literature search, analysis and interpretation of data collected, drafting of article and/or critical revision, and supervision. All authors approved the final version of the manuscript.

    • 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.

    • Patient consent for publication Not required.

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

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.