Introduction/Background Sentinel lymph node (SLN) biopsy has replaced lymphadenectomy (LND) in staging of endometrial carcinoma (EC). The aims of this study were to:
Explore prevalence of lower extremity lymphedema (LEL) in EC survivors stratified by nodal assessment (LND, SLN and hysterectomy alone).
Identify patient- and treatment-related factors associated with LEL.
Compare quality of life (QoL) using novel thresholds of clinical importance.
Assess correlation between different questionnaires.
Methodology Women operated for EC in 2006–2021 retrospectivly completed the Lower Extremity Lymphedema Screening Questionnaire (LELSQ), EORTC QLQ-C30, QLQ-EN24 and EQ-5D-5L. Appropriate statistics were applied to assess study aims.
Results Of 2156 invited survivors, 61% participated in the study, 1127 (99%) were evaluable by LELSQ. LEL prevalence was 51%, 36% and 40% after LND, SLN and hysterectomy, respectively (p<0.001). Higher BMI, LND and chemotherapy were associated with LEL; OR 1.07 (95% CI 1.05–1.09), 1.42 (95% CI 1.03–1.97) and 1.43 (95% CI 1.08–1.89) respectively. Subgroup analysis demonstrated that musculoskeletal complaints were more prevalent in patients reporting LEL (figure 1). In women with musculoskeletal complaints the prevalence of LEL did not differ between nodal assessment groups; 59%, 50% and 53% after LND, SLN and hysterectomy (p=0.115), respectively, compared to 39%, 17% and 18% (p<0.001) in women without musculosceletal complaints. Women with LEL had worse QoL in all domains than those without LEL (p<0.001). Spearman’s correlation between questionnaires varied from 0.67 to 0.83.
Conclusion For the whole cohort, SLN implementation is not associated with increased LEL prevalence compared to hysterectomy alone, but is associated with a significantly lower prevalence compared to LND. However, this difference was not seen in women reporting musculoskeletal complaints. Available questionnaires may not distinguish between LEL and musculoskeletal disease, warranting further investigation. LEL may cause clinically worsened QoL. We demonstrate moderate to strong correlation between questionnaires measuring LEL and QoL.
Disclosures Dr Eriksson reports conflicts of interest: receiving consultation fees from Intuitive Surgical and Astra Zeneca. No other authors report conflicts of interests.
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