Yost KJ, Cheville AL, Al-Hilli MM, Mariani A, Barrette BA, McGree ME, Weaver AL, Dowdy SC, et al.
Obstetrics and gynecology. Date of publication 2014 Aug 1;volume 124(2 Pt 1):307-15.
1. Obstet Gynecol. 2014 Aug;124(2 Pt 1):307-15. doi: 10.1097/AOG.0000000000000372.
Lymphedema after surgery for endometrial cancer: prevalence, risk factors, and
quality of life.
Yost KJ(1), Cheville AL, Al-Hilli MM, Mariani A, Barrette BA, McGree ME, Weaver
AL, Dowdy SC.
Author information:
(1)Departments of Gynecologic Surgery, Physical Medicine and Rehabilitation,
Gynecology, Biomedical Statistics and Informatics, and Health Sciences Research,
Mayo Clinic, Rochester, Minnesota.
OBJECTIVE: To estimate lower extremity lymphedema prevalence in patients
surgically treated for endometrial cancer, identify predictors of lymphedema, and
evaluate the effects of lymphedema on quality of life.
METHODS: One thousand forty-eight consecutive patients who were operated on
between 1999 and 2008 at the Mayo Clinic were mailed a survey, which included our
validated 13-item lymphedema screening questionnaire and two validated
quality-of-life measures. Logistic regression models were fit to identify factors
associated with prevalent lymphedema; a multivariable model was obtained using
stepwise and backward variable selection methods. The relationship between
lymphedema and obesity with each quality-of-life score was evaluated separate
multivariable linear models.
RESULTS: There were 591 responders (56%) after exclusions. Our questionnaire
revealed a previous self-reported lymphedema diagnosis in 103 (17%) patients and
identified undiagnosed lymphedema in 175 (30%) (overall prevalence 47.0%, median
6.2 years follow-up). Lymphedema prevalence in patients treated with hysterectomy
alone compared with lymphadenectomy was 36.1% and 52.3%, respectively
(attributable risk 23%). Lymphedema risk was not associated with the number of
nodes removed or the extent of lymphadenectomy after adjusting for other factors.
On multivariable analysis, higher body mass index, congestive heart failure,
performance of lymphadenectomy, and radiation therapy were associated with
prevalent lymphedema. Multiple quality-of-life scores were worse in women with
lymphedema.
CONCLUSION: The attributable risk of developing lower extremity lymphedema was
23% for patients with endometrial cancer who underwent lymphadenectomy compared
with hysterectomy alone with an overall prevalence of 47%. Lymphedema was
associated with reductions in multiple quality-of-life domains.
LEVEL OF EVIDENCE: II.
DOI: 10.1097/AOG.0000000000000372
PMCID: PMC4269467
PMID: 25004343 [Indexed for MEDLINE]
