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Cervical cancer
114 Lower-limb lymphedema after sentinel lymph node biopsy in cervical cancer patients
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  1. R Poncová1,
  2. R Kocián1,
  3. S Marnitz2,
  4. J Jarkovský3,
  5. J Klát4,
  6. R Pilka5,
  7. A Torné6,
  8. I Zapardiel7,
  9. A Petiz8,
  10. L Lay9,
  11. B Sehnal10,
  12. J Ponce11,
  13. M Felsinger12,
  14. O Arencibia-Sanchéz13,
  15. P Kaščák14,
  16. K Zalewski15,
  17. C Köhler2,
  18. F Frühauf1,
  19. M Borčinová1 and
  20. D Cibula1
  1. 1Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
  2. 2Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
  3. 3Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
  4. 4Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava Poruba, Czech Republic (Central and Eastern European Gynecologic Oncology Group, CEEGOG)
  5. 5Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic (Central and Eastern European Gynecologic Oncology Group, CEEGOG)
  6. 6Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clinic-Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
  7. 7Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
  8. 8Instituto Portugues de Oncologia do Porto, Portugal
  9. 9Department of Gynaecology, Institute of Oncology Angel H Roffo University of Bueno s Aires, Buenos Aires, Argentina
  10. 10Department of Obstetrics and Gynecology, University Hospital Bulovka, First Faculty of Medicine, Charles University, Prague, Czech Republic (Central and Eastern European Gynecologic Oncology Group, CEEGOG)
  11. 11Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, (IDIBELL), University of Barcelona, Barcelona, Spain
  12. 12Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, Brno, Czech Republic (Central and Eastern European Gynecologic Oncology Group, CEEGOG)
  13. 13University Hospital of the Canary Islands, Las Palmas de Gran Canaria, Spain
  14. 14Department of Obstetrics and Gynecology, Faculty Hospital Trencin, Trencin, Slovakia (Central and Eastern European Gynecologic Oncology Group, CEEGOG)
  15. 15Department of Gynecologic Oncology, Holycross Cancer Center, Kielce, Poland (Central and Eastern European Gynecologic Oncology Group, CEEGOG)

Abstract

Introduction/Background*Lower-limb lymphedema (LLL) is a well-recognized adverse outcome of the surgical management of cervical cancer. Recently, sentinel lymph node (SLN) biopsy has emerged as an alternative procedure to systematic pelvic lymphadenectomy (PLND) aiming to decrease the risk of complications, especially LLL development. Our study represents the first prospective analysis of LLL incidence in cervical cancer patients after a uterine procedure with SLN biopsy, without systematic PLND.

Methodology In a prospective international multicenter trial SENTIX, the group of 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy was prospectively evaluated using both objective LLL assessments, based on limb volume increase (LVI) between pre- and postoperative measurements, and subjective patient-perceived swelling were conducted in six-month periods over 24-months post-surgery. The characteristics of the patients are summarized in table 1.

Result(s)*The cumulative incidence of LLL at 24 months was 17.3% for mild LLL (LVI 10-19%), 9.2% for moderate LLL (LVI 20-39%), while only one patient (0.7%) developed severe LLL (LVI >40%). The median interval to LLL onset was nine months (figure 1). A transient edema resolving without intervention within six months was reported in an additional 22% of patients. Subjective LLL was reported by 10.7% of patients, though only a weak and partial correlation between subjective-report and objective-LVI was found. No risk factor directly related to LLL development was identified.

Abstract 114 Figure 1
Abstract 114 Figure 1
Abstract 114 Figure 2
Abstract 114 Figure 2

Conclusion*Contrary to the expectations, the replacement of standard PLND by bilateral SLN biopsy in the surgical treatment of cervical cancer does not eliminate the risk of mild to moderate LLL, which develops irrespective of the number of SLN removed.

Trial registration ClinicalTrials.gov: NCT02494063

Funding This work was supported by Charles University in Prague (UNCE 204065 and PROGRES Q28/LF1) and by a grant from the Czech Health Research Council (NV19-03-00023). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Conflicts of Interest The authors declare no conflict of interest.

https://doi.org/10.1136/ijgc-2021-ESGO.7

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