Introduction/Background*Sentinel lymph node (SLN) mapping represents a less invasive and more accurate staging technique in women with early-stage cervical cancer, which may reduce or prevent late effects as lymphedema. Despite the increased implementation of SLN mapping, evidence on the potential reduction of lymphedema and its effects on quality of life (QoL) in these women remains scarce. We prospectively evaluated patient-reported lower limb lymphedema and QoL in women with early-stage cervical cancer undergoing radical surgery with SLN mapping.
Methodology In a national multi-institutional study, we included women with early-stage cervical cancer from March 2017-January 2021 to undergo radical surgery including SLN mapping. Women with tumours >20 mm underwent completion pelvic lymphadenectomy (PL). The incidence and severity of lymphedema and QoL were evaluated using validated patient-reported outcome measures before surgery and three months postoperative. Changes over time were investigated using linear regression.
Result(s)*Two hundred of 245 (81.6%) included women completed the baseline and three-month questionnaires. The incidence of lymphedema was 7.2% versus 31.5% in women who underwent SLN mapping alone and completion PL, respectively (p < 0.001). Lymphedema scores in the leg, genital, and groin were affected in both groups, but significantly more after PL. The differences between groups remained significant in a multivariate analysis adjusting for, e.g., adjuvant therapy and age. PL significantly affected the severity of lymphedema regarding physical performance (p = 0.001), appearance (p = 0.008), besides heaviness, weakness, and pain in the legs (p < 0.001). Lymphedema was negatively associated with impaired body image (p = 0.002), physical (p = 0.008), role (p = 0.04), and social functioning (p = 0.007) and a higher level of fatigue (p = 0.01).
Conclusion*SLN mapping combined with PL is associated with a significantly higher incidence and more severe lymphedema three months postoperatively than SLN mapping alone. Lymphedema was associated with lower QoL in several domains.
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