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  • #630 Lower-limb lymphedema after sentinel lymph node biopsy in cervical cancer patients: final results of the SENTIX prospective international study (CEEGOG CX-01/ENGOT-Cx2)

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10. Quality of life after treatment
#630 Lower-limb lymphedema after sentinel lymph node biopsy in cervical cancer patients: final results of the SENTIX prospective international study (CEEGOG CX-01/ENGOT-Cx2)
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  1. Christhardt Köhler1,
  2. David Cibula2,
  3. Martina Romanova3,
  4. Martina Borcinova4,
  5. Maria Letizia Di Meo5,
  6. Lus Van Lonkhuijzen6,
  7. Rene Laky7,
  8. Sergey Baydo8,
  9. Cristina Zorrero9,
  10. Mathieu Luyckx10,
  11. Marcin Misiek11,
  12. Pluvio J Coronado12,
  13. Maxime Fastrez13,
  14. Grzegorz Szewczyk14,
  15. Barbara Kipp15,
  16. Soveig Tingulstad16,
  17. Javier De Santiago17,
  18. Robert Poka18,
  19. Andrea Plaikner1 and
  20. Roman Kocian4
  1. 1Asklepios-Clinic Hamburg Altona, Department of Gynaecology, Hamburg, Germany, Hamburg, Germany
  2. 2First Faculty of Medicine, Charles University and General University Hospital in Prague, Department of Obstetrics and Gynecology, Prague, Czech Republic, CEEGOG, Hamburg, Czech Republic
  3. 3University Hospital Ostrava, Department of Obstetrics and Gynecology, Ostrava, Czech Republic, CEEGOG, Ostrava, Czech Republic
  4. 4First Faculty of Medicine, Charles University and General University Hospital in Prague, Department of Obstetrics and Gynecology, Prague, Czech Republic, CEEGOG, Prague, Czech Republic
  5. 5San Gerardo Hospital, Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology Surgery, Monza, Italy, Monza, Italy
  6. 6Amsterdam University Medical Centers, Center for Gynecologic Oncology, Cancer Center Amsterdam, Amsterdam, the Netherlands, Amsterdam, The Netherlands
  7. 7Medical University of Graz, University Hospital for Gynecology and Obstetrics, Department of Gynecology, Graz, Austria, Graz, Austria
  8. 8LISOD – Israeli Oncological Hospital, Plyuty, Ukraine, CEEGOG, Plyuty, Ukraine
  9. 9Instituto Valenciano de Oncologia (IVO), Gynecology Department, Valencia, Spain, Valencia, Spain
  10. 10Cliniques universitaires Saint-Luc, Brussels, Belgium, BGOG, Bruessels, Belgium
  11. 11Holycross Cancer Center, Department of Gynecologic Oncology Kielce, Poland, CEEGOG, Kielce, Poland
  12. 12Hospital Clinico San Carlos, Department of Gynecology and Obstetrics, Madrid, Spain, Madrid, Spain
  13. 13Universite Libre de Bruxelles (ULB), Hopital Universitaire de Bruxelles (HUB), CUB Erasme, Brussels, Belgium, BGOG, Brussels, Belgium
  14. 14Medical University of Warsaw, Department of Biophysics, Physiology and Pathophysiology; Department of Obstetrics, Perinatology and Gynecology, Warsaw, Poland, CEEGOG, Warsaw, Poland
  15. 15Cantonal Hospital of Lucerne, Department of Obstetrics and Gynecology, Lucerne, Switzerland, Lucerne, Switzerland
  16. 16St. Olav’s University Hospital, Department of Gynaecology, Trondheim, Norway, Trondheim, Norway
  17. 17MD Anderson Cancer Center, Madrid, Spain, Madrid, Spain
  18. 18University of Debrecen, Faculty of Medicine, Department of Obstetrics and Gynecology, Debrecen, Hungary, CEEGOG, Debrecen, Hungary

Abstract

Introduction/Background Background The sentinel lymph node (SLN) concept was developed with the purpose of alleviating postoperative morbidity, particularly lower limb lymphedema (LLL). We report the final analysis of the occurrence of LLL after SLN biopsy or systematic pelvic lymph node dissection (PLND) in the prospective SENTIX study.

Methodology SENTIX was conducted at 47 sites in 18 countries. Patients with stages 1A1/LVSI+ to 1B2 (FIGO 2018), usual histological types, and no suspicious lymph nodes on imaging were prospectively enrolled between 05/2016 and 10/2020. All patients underwent SLN biopsy and hysterectomy/trachelectomy. Patients with unilaterally detected/undetected SLNs and those in whom the SLN was intraoperatively positive, underwent systematic PLND. LLL was assessed at 6-month intervals for the period of 2 years. The assessment was based on a persistent limb volume increase [LVI] calculated using serial limb circumference measurements.

Results Among 578 evaluable patients, 486 underwent SLN biopsy only and 92 underwent PLND. The cumulative incidence of LLL at 24 months in the SLN and PLND groups was 28.0% and 29.0% (p=0.900). Persistent LVI >40% occurred at a similar frequency in both groups, with cumulative rates of 1.8% and 1.1% in the SLN and PLND groups, respectively (p=1.0) (figure 1). Although we observed a tendency towards more frequent mild LLL in the SLN group, the difference was not statistically significant (p=0.256). The median interval to LLL onset was 9 months in both groups. Transient oedema that resolved without intervention within 6 months was reported in an additional 15.2% and 13.0% of patients in the SLN and PLND groups, respectively.

Abstract #630 Figure 1
Abstract #630 Figure 1

Postoperative cumulative incidence of LLL in the SLN and PLND cohorts. LLL: limb lymphedema defined as a limb volume increase black (LVI); black (LVI >40%); dark grey: moderate LLL (LVI 20–39%); light grey: mild LLL (LVI 10–19%)

Conclusion Severe persistent LLL occurred rarely after surgical pelvic LN staging in cervical cancer patients. Contrary to our expectations, de-escalation from systematic PLND to SLN biopsy was not associated with a significantly decreased risk of mild-to-moderate LLL.

https://doi.org/10.1136/ijgc-2023-ESGO.47

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