Introduction/Background Multimodal treatments have significantly improved oncological outcomes in patients with endometrial cancer. Therefore most of the patients are long-term survivors and may experience adverse effects related to treatment. Lymph node dissection in patients who undergo total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH+BSO) may be associated with adverse effects such as lymphedema. Several factors including number of removed lymph nodes and extent of lymph node dissection have been postulated to be associated with adverse events. However, in most studies the definition of the complications is poorly described and contradicting findings exist. In this prospective study we aim to assess the complications related to lymph node dissection in patients who undergo TAH+BSO and potential factors that predict adverse events.
Methodology We conducted this prospective study to assess the complications related to lymph node dissection in patients who underwent TAH+BSO for endometrial cancer. Patients with prior history of lower limb surgery, pelvic radiation and prior history of cancer treatment were excluded from study. Additional exclusion criteria were heart failure, uncontrolled thyroid abnormalities and other disorders associated with impaired lymphatic drainage and/or lower limb edema.Demographic and clinical characteristics including age, body mass index, pathologic stage, and extent of lymph node dissection were recorded. We also assessed complications related to lymph node dissection i.e. lymphedema, lymphatic leakage and lymphocele. Lymphedema was defined based on American Physical Therapy Association criteria. We applied Gynecologic Cancer Lymphedema Questionnaire to evaluate severity of symptoms related to lymphedema.Written informed consent was obtained from all patients and institutional review board approved the study.
Results A total of 135 patients with a mean age of 57.6±11.5 underwent TAH+BSO during the study period. Lymph node dissection was performed in 83 (61.4%) patients. The extent of lymph node dissection was limited to pelvis in 18 (33.3%) patients, whereas, 3 (2.2%) patients underwent pelvic and para-aortic lymph node dissection. Median number of dissected lymph nodes was 11 (interquartile range: 5.7–21.2). Among patients who underwent lymph node dissection, 14 (16.3%) patients showed lymph node involvement. Stage I, II and III were recorded in 97(71.9%), 13 (9.6%), and 25 (18.5%) patients respectively. We did not observe lymphedema in our study participants. Other complications related to lymph node dissection were low grade and were not associated with age, BMI, extent of lymph node dissection, total number of dissected lymph nodes, lymph node involvement and disease stage.
Conclusion Complications related to lymph node dissection including lymphedema are rare after TAH+BSO for endometrial cancer and the extent of lymph node dissection or disease stage is not associated with higher risk of such complications.
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