Introduction/Background Lower extremity lymphedema after gynecological cancer treatment is common complication and negatively affects the quality of life and function of patients. This study investigated the cumulative incidence and risk factors of lymphedema in patients with gynecological cancer, as well as utilization of health care resources for post-treatment lymphedema.

Methodology Using the Korean National Health Insurance Service (NHIS) database, we conducted a nationwide, retrospective cohort study of patients with cervical, endometrial, and ovarian cancer with cancer-direct treatment. The patients were categorized by age, region, income, and treatment modality. To analyze the incidence and risk factors of lymphedema, cox proportional hazards regression models were used. We also analyzed diagnostic and treatment claim codes to find out trend or costs of utilization of health care resources for lymphedema treatment.

Results A total of 93,218 patients with gynecological cancer were evaluated between January 2004 and December 2017. Among them, total 10,451(11.2%) developed lymphedema. Incidences of lymphedema were 11.4%, 13.1%, and 9.16% in cervical cancer, endometrial cancer and ovarian cancer respectively. Age and multimodal treatment are considered to be possible risk factors for lymphedema in patients with gynecological cancer (p < 0.001), while residence and income quartile were not associated with lymphedema in gynecologic cancer patients. The expands of health care resources for the treatment of lymphedema has increased over the years.

Conclusion Lymphedema is a common complication affecting women with gynecological cancer. This is the first population-based the first population-based study to identify risk factors for lymphedema in gynecological cancer patients. National healthcare costs for lymphedema treatment are increasing in Korean society. Health care providers should give attentions for high-risk lymphedema group during and after cancer-related treatment.