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Cervical cancer
959 Challenges in lower limb lymphoedema assessment based on limb volume change: lessons learnt from the SENTIX prospective multicentre study
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  1. M Borčinová1;2,
  2. R Kocián1;2,
  3. V Ragosch3,
  4. J Jarkovsky4,
  5. S Bajsová2;5,
  6. R Pilka2;6,
  7. B Gil Ibanez7,
  8. S Garrido-Mallach8,
  9. J Presl2;9,
  10. A Palop Moscardó10,
  11. S Tingulstad11,
  12. IB Vergote12;13,
  13. M Redecha2;14,
  14. F Raspagliesi15,
  15. W Szatkowski16,
  16. M Pakiz17,
  17. LC Snyman18,
  18. K Siegler3 and
  19. D Cibula1;2
  1. 1First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic, Gynecologic Oncology Center, Department of Obstetrics and Gynecology, Prague, Czech Republic
  2. 2Central and Eastern European Gynecologic Oncology Group, CEEGOG, Czech Republic
  3. 3Asklepios-Clinic Hamburg, Department of Special Operative and Oncologic Gynaecology, Germany
  4. 4Faculty of Medicine, Masaryk University, Institute of Biostatistics and Analyses, Brno, Czech Republic
  5. 5University Hospital Ostrava, Department of Obstetrics and Gynecology, Ostrava, Czech Republic
  6. 6Palacky University, University Hospital Olomouc, Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Olomouc, Czech Republic
  7. 7Hospital Clinic-Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Barcelona, Spain
  8. 8La Paz University Hospital, Gynecologic Oncology Unit, Madrid, Spain
  9. 9University Hospital in Pilsen, Department of Obstetrics and Gynecology, Pilsen, Czech Republic
  10. 10Instituto Valenciano de Oncologia (IVO), Gynecology Department, Valencia, Spain
  11. 11Trondheim University Hospital, Trondheim, Norway
  12. 12University Hospital Leuven, Leuven Cancer Institute, Department of Gynecology and Obstetrics, Leuven, Belgium
  13. 13Belgium and Luxembourg Gynaecological Oncology Group, BGOG
  14. 14University Hospital, Comenius University, Department of Gynaecology and Obstetrics, Bratislava, Slovakia
  15. 15Fondazione IRCCS Instituto Nazionale Tumori, Milan, Italy
  16. 16M. Sklodowska-Curie Memorial Institute, Krakow, Poland
  17. 17University medical Centre Maribor, Maribor, Slovenia
  18. 18Kalafong Provincial Tertiary Hospital, Pretoria, South Africa

Abstract

Introduction/Background*Lower limb lymphoedema (LLL) is the most disabling adverse effect of surgical staging of pelvic lymph nodes. In studies, LLL is often assessed by calculation of limb volumes based on five circumference measurements. However, the lack of standardisation of this method hinders direct comparison between the studies and makes LLL reporting unreliable. The aim of our study is to report outcomes from a prospective SENTIX trial that have implications for the standardisation of LLL assessment.

Methodology In the prospective international multicentre trial SENTIX (ENGOT-cx2/CEEGOG CX-01), a group of 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy was prospectively evaluated by objective LLL assessment, based on limb volume change (LVC) using circumferrential limb measurements and subjective patient-reported swelling. The assessments were conducted in six-month periods over 24 months post-surgery.

Result(s)*Patient LVC substantially fluctuated in both positive and negative directions (figure 1), which were comparable in frequency up to 14% +/- LVC increments. Thirty-eight patients experienced persistent LVC increase and >10% classified as LLL, for whom median time to onset was nine months (95% CI: 7.0-11.0). Some 34.2% of cases experienced onset later than one year after the surgery. Thirty-three patients (22%) experienced transient oedema characterised as LVC >10%, which resolved without intervention between two consequent follow-up visits (figure 2). No significant correlation between LVC >10% and a patient-reported swelling was observed.

Abstract 959 Figure 1
Abstract 959 Figure 1

Distribution of the limb volume change (from preoperative assesment; LVC) of right and left lower limb during the folloe-up-period. Each dot on the violin plot represents the LVC of one patient’s limb. 6M: six months post-surgery; 12M months post-surgery; 18M months post-surgery; 24M: 24 months post-surgery.

Abstract 959 Figure 2
Abstract 959 Figure 2

Incidence of transient oedema. Each dot marks the transient oedema (>10% LVC increase from preoperative measurement) of one patient. Boxplots depict the median value of respective transient oedema LVI (%); the percentile range was set at 25% and 50%; the whisker is between minimal and maximal calculated value. FU; follow-up; LVC: limb volume change.

Conclusion*Our study showed that lower-limb volumes after surgical treatment of cervical cancer significantly fluctuate in positive and negative directions. A diagnostic threshold for LLL should be increased to >15% LVC. Transient oedema occurs frequently, and its distinction from persistent LLL requires repeated measurements. One-third of new LLL cases were diagnosed in the second year of follow-up, highlighting the importance of a sufficient follow-up period duration. Finally, patient-reported limb swelling correlated poorly with LVC and should only be used as an adjunct to objective LLL assessment.

https://doi.org/10.1136/ijgc-2021-ESGO.81

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