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Reduced lymphedema after sentinel lymph node biopsy versus lymphadenectomy for endometrial cancer
  1. Gretchen Glaser1,
  2. Giorgia Dinoi2,
  3. Francesco Multinu3,
  4. Kathleen Yost4,
  5. Mariam Al Hilli5,
  6. Alyssa Larish6,
  7. Amanika Kumar7,
  8. Michaela McGree8,
  9. Amy L Weaver9,
  10. Andrea Cheville10,
  11. Sean Dowdy11 and
  12. Andrea Mariani12
  1. 1 Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
  3. 3 Gynecologic Oncology, Istituto Europeo di Oncologia, Milan, Italy
  4. 4 Health Sciences Research, Mayo Clinic Rochester, Rochester, Minnesota, USA
  5. 5 Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, USA
  6. 6 Obstetrics and Gynecology, Mayo Clinic Health System, Austin, Minnesota, USA
  7. 7 Mayo Clinic Minnesota, Rochester, New York, USA
  8. 8 Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
  9. 9 Mayo Clinic Rochester, Rochester, Minnesota, USA
  10. 10 Physical Medicine and Rehabilitation, Mayo Clinic Rochester, Rochester, Minnesota, USA
  11. 11 Gynecologic Surgery, Mayo Clinic, Rochester, New York, USA
  12. 12 Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
  1. Correspondence to Dr Gretchen Glaser, Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; glaser.gretchen{at}mayo.edu

Abstract

Objective Endometrial cancer surgical staging includes lymph node assessment which can lead to lower extremity lymphedema. The aim of this study was to estimate prevalence after sentinel lymph node biopsy versus lymphadenectomy.

Methods Consecutive patients who underwent minimally invasive surgery at the Mayo Clinic, Rochester, Minnesota, USA, between January 2009 and June 2016 for newly diagnosed endometrial cancer were mailed our validated 13 item lower extremity lymphedema screening questionnaire. We also ascertained via questionnaire whether the patient was ever diagnosed with lower extremity lymphedema.

Results Among 378 patients included in the analysis, 127 (33.5%) had sentinel lymph node biopsy with or without side specific lymphadenectomy (sentinel lymph node cohort) and 251 (66.4%) underwent bilateral lymphadenectomy prior to sentinel lymph node biopsy implementation at our institution or as 'backup' after sentinel lymph node mapping (lymphadenectomy cohort). The prevalence of lower extremity lymphedema was 41.5% (157/378), with 69 patients (18.3%) self-reporting a lower extremity lymphedema diagnosis after their endometrial cancer surgery at a median of 54.3 months (interquartile range 31.2–70.1 months), and an additional 88 patients (23.3%) identified by the screening questionnaire. The prevalence of lower extremity lymphedema was significantly higher in the lymphadenectomy cohort compared with the sentinel lymph node group (49.4% (124/251) vs 26.0% (33/127); p<0.001). When the cohorts were restricted to patients surgically managed after the introduction of sentinel lymph node, the prevalence of lower extremity lymphedema was still significantly higher in the lymphadenectomy cohort compared with the sentinel lymph node cohort (39.0% (41/105) vs 26.0% (33/127); p=0.03). In a multivariable analysis adjusted for body mass index, receipt of adjuvant external beam radiation, diabetes, congestive heart failure, and International Federation of Gynecology and Obstetrics grade, the adjusted odds ratio for the association between type of nodal sampling (lymphadenectomy cohort vs sentinel lymph node cohort) and lower extremity lymphedema was 2.75 (95% confidence interval 1.69 to 4.47, p<0.001).

Conclusions Sentinel lymph node biopsy was associated with a decreased risk of post-treatment lymphedema compared with lymphadenectomy in patients who underwent surgical staging for endometrial carcinoma.

  • SLN and lympadenectomy
  • endometrial neoplasms
  • lymphatic system

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Footnotes

  • Twitter @Fmultinu

  • Contributors GG and AM conceived the project idea and obtained institutional review board approval. GG, GD, KY, ALW, and MM completed the chart review and survey information compilation, as well as conducted the data analysis. GG wrote the manuscript. FM, MA, AL, AK, AC, SD, and AM participated with edits of the manuscript and offered mentorship for completion of the project.

  • 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.

  • Ethics approval The study was approved by the Mayo Clinic institutional review board.

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

  • Data availability statement Deidentified patient data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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