Objectives We prospectively evaluated patient-reported lower limb lymphedema and quality of life (QoL) in women with early-stage cervical cancer undergoing radical surgery with sentinel lymph node (SLN) mapping.

Methods 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 tumors >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.

Results 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, physical, role, and social functioning and a higher level of fatigue.

Conclusions 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.