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Braizat O, Jarrar S, El-Debs M, Al-Adwan MAO, Syaj S, Abuzanouneh F, Mohammed M, Mohammedali S, Quazi SJ, Muneer M. Comparing Different Donor Sites After Vascularized Lymph Node Transfer to the Lymphedematous Upper Limb: A Systematic Review and Meta-analysis of Clinical Outcomes. Ann Plast Surg 2024; 93:130-138. [PMID: 38885169 DOI: 10.1097/sap.0000000000003918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes from a donor site into a limb affected by lymphedema to restore the normal flow of lymphatic fluid. Despite the increasing clinical experience with VLNT, there remains insufficient data to support its routine use in clinical practice. Here, we aim to evaluate the effectiveness and safety of VLNTs for upper limb lymphedema and compare clinical outcomes when using different donor sites. METHODS We carried out a systematic search of the literature through PubMed and Scopus databases for studies on VLNT for upper limb lymphedema. Primary and secondary outcomes included circumference reduction rate (CRR) and infection reduction rate by postoperative cellulitis episodes for the efficacy and safety of VLNT. Pooled analysis was performed using the inverse variance weighting meta-analysis of single means using the meta package in R software. Subgroup analyses were performed for donor and recipient sites, age groups, follow-ups, and symptom durations. Quality assessment was performed using the Newcastle-Ottawa Scale for nonrandomized studies. RESULTS A total of 1089 studies were retrieved from the literature, and 15 studies with 448 upper limb lymphedema patients who underwent VLNT were included after eligibility assessment. The mean CRR was 34.6 (18.8) and the mean postoperative cellulitis episodes per year was 0.71 (0.7). The pooled analysis of CRR was 28.4% (95% confidence interval, 19.7-41.1) and postoperative cellulitis episodes showed a mean of 0.59 (95% confidence interval, 0.36-0.95) using the random-effect model. Subgroup analyses showed significant group differences in recipient site for CRR and postoperative cellulitis episodes with the wrist comprising the highest weights, and patients younger than 50 years showing a lower postoperative infection. CONCLUSIONS Vascularized lymph node transfer using gastroepiploic flaps at the wrists has shown a significant difference in reductions of limb circumference and cellulitis episodes in upper limb lymphedema patients when compared with other donor sites. However, further prospective studies are needed to consolidate this finding.
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Affiliation(s)
- Omar Braizat
- From the Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Salma Jarrar
- From the Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed El-Debs
- From the Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Sebawe Syaj
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Faris Abuzanouneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mazin Mohammed
- From the Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Shiyas Mohammedali
- From the Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Sohail Jamiluddin Quazi
- From the Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Muneer
- From the Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, Qatar
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Cucinella G, Di Donna MC, Casarin J, Schivardi G, Multinu F, Borsellino L, Buono N, Zaccaria G, Abbate A, Laganà AS, Chiantera V. Lower limb lymphedema after surgical staging for endometrial cancer: Current insights and future directions. Taiwan J Obstet Gynecol 2024; 63:500-505. [PMID: 39004476 DOI: 10.1016/j.tjog.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 07/16/2024] Open
Abstract
Lower extremity lymphedema (LEL) is a common complication following surgical staging of endometrial cancer. LEL is a chronic condition associated with significant impact on patient morbidity and quality of life (QoL). This review aimed to report the current evidence in the literature on secondary LEL after surgical staging for endometrial cancer, focusing on the incidence based on different approaches to lymph node staging, diagnosis, risk factors, and the impact on QoL. Due to the absence of a standardized agreement regarding the methodology for evaluating LEL, the documented frequency of occurrence fluctuates across different studies, ranging from 0% to 50%. Systematic pelvic lymphadenectomy appears to be the primary determinant associated with the emergence of LEL, whereas the implementation of sentinel lymph node biopsy has notably diminished the occurrence of this lymphatic complication after endometrial cancer staging. LEL is strongly associated with decreased QoL, lower limb function, and negative body image, and has a detrimental impact on cancer-related distress reported by survivors. Standardization of lymphedema assessment is needed, along with cross-cultural adaptation of subjective outcome measures for self-reported LEL. The advent of sentinel lymph node mapping represents the ideal approach for accurate nodal assessment with less short- and long-term morbidity. Further research is needed to definitively assess the prevalence and risk factors of LEL and to identify strategies to improve limb function and QoL in cancer survivors with this chronic condition.
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Affiliation(s)
- Giuseppe Cucinella
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy; Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy.
| | - Mariano Catello Di Donna
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy; Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Gabriella Schivardi
- Department of Gynecology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Francesco Multinu
- Department of Gynecology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Letizia Borsellino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
| | - Natalina Buono
- Ospedale San Leonardo, Castellammare di Stabia, ASL NA3 SUD, Naples, Italy
| | - Giulia Zaccaria
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
| | - Antonino Abbate
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", 90127 Palermo, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy; Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, 90127 Palermo, Italy
| | - Vito Chiantera
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
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Brown JA, Olshan AF, Bae-Jump VL, Ogunleye AA, Smith S, Black-Grant S, Nichols HB. Lymphedema self-assessment among endometrial cancer survivors. Cancer Causes Control 2024; 35:771-785. [PMID: 38175324 PMCID: PMC11045305 DOI: 10.1007/s10552-023-01838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Lower extremity lymphedema (LEL), which causes ankle, leg, and feet swelling, poses a significant challenge for endometrial cancer survivors, impacting physical functioning and psychological well-being. Inconsistent LEL diagnostic methods result in wide-ranging LEL incidence estimates. METHODS We calculated the cumulative incidence of LEL based on survivor-reported Gynecologic Cancer Lymphedema Questionnaire (GCLQ) responses in addition to survivor- and nurse-reported leg circumference measurements among a pilot sample of 50 endometrial cancer survivors (27 White, 23 Black) enrolled in the ongoing population-based Carolina Endometrial Cancer Study. RESULTS Self-leg circumference measurements were perceived to be difficult and were completed by only 17 survivors. Diagnostic accuracy testing measures (sensitivity, specificity, positive and negative predictive value) compared the standard nurse-measured ≥ 10% difference in leg circumference measurements to GCLQ responses. At a mean of ~11 months post-diagnosis, 54% of survivors met established criteria for LEL based on ≥ 4 GCLQ cutpoint while 24% had LEL based on nurse-measurement. Percent agreement, sensitivity, and specificity approximated 60% at a threshold of ≥ 5 GCLQ symptoms. However, Cohen's kappa, a measure of reliability that corrects for agreement by chance, was highest at ≥ 4 GCLQ symptoms (κ = 0.27). CONCLUSION Our findings emphasize the need for high quality measurements of LEL that are feasible for epidemiologic study designs among endometrial cancer survivors. Future studies should use patient-reported survey measures to assess lymphedema burden and quality of life outcomes among endometrial cancer survivors.
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Affiliation(s)
- Jordyn A Brown
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Victoria L Bae-Jump
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adeyemi A Ogunleye
- Division of Plastic Surgery and Reconstructive Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shawn Smith
- Endometrial Cancer Action Network for African Americans, Seattle, WA, USA
| | | | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA.
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
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Ueno Y, Yoshida E, Nojiri S, Kato T, Ohtsu T, Takeshita T, Suzuki S, Yoshida H, Kato K, Itoh M, Notomi T, Usui K, Sozu T, Terao Y, Kawaji H, Kato H. Use of clinical variables for preoperative prediction of lymph node metastasis in endometrial cancer. Jpn J Clin Oncol 2024; 54:38-46. [PMID: 37815156 PMCID: PMC10773201 DOI: 10.1093/jjco/hyad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE Endometrial cancer is the most common gynaecological cancer, and most patients are identified during early disease stages. Noninvasive evaluation of lymph node metastasis likely will improve the quality of clinical treatment, for example, by omitting unnecessary lymphadenectomy. METHODS The study population comprised 611 patients with endometrial cancer who underwent lymphadenectomy at four types of institutions, comprising seven hospitals in total. We systematically assessed the association of 18 preoperative clinical variables with postoperative lymph node metastasis. We then constructed statistical models for preoperative lymph node metastasis prediction and assessed their performance with a previously proposed system, in which the score was determined by counting the number of high-risk variables among the four predefined ones. RESULTS Of the preoperative 18 variables evaluated, 10 were significantly associated with postoperative lymph node metastasis. A logistic regression model achieved an area under the curve of 0.85 in predicting lymph node metastasis; this value is significantly higher than that from the previous system (area under the curve, 0.74). When we set the false-negative rate to ~1%, the new predictive model increased the rate of true negatives to 21%, compared with 6.8% from the previous one. We also provide a spreadsheet-based tool for further evaluation of its ability to predict lymph node metastasis in endometrial cancer. CONCLUSIONS Our new lymph node metastasis prediction method, which was based solely on preoperative clinical variables, performed significantly better than the previous method. Although additional evaluation is necessary for its clinical use, our noninvasive system may help improve the clinical treatment of endometrial cancer, complementing minimally invasive sentinel lymph node biopsy.
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Affiliation(s)
- Yuta Ueno
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Japan
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
- Department of Obstetrics and Gynecology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Emiko Yoshida
- Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Shuko Nojiri
- Clinical Research and Trial Center, Juntendo University, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center, Tokyo, Japan
| | - Takashi Ohtsu
- Division of Advanced Cancer Therapeutics, Kanagawa Cancer Center Research Institute, Yokohama, Japan
- Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Japan
| | - Toshiyuki Takeshita
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Yoshida
- Department of Diagnostic Pathology, National Cancer Center, Tokyo, Japan
| | - Ken Kato
- Clinical Research Support Office, Biobank Translational Research Support Section, National Cancer Center Hospital, Tokyo, Japan
| | - Masayoshi Itoh
- Laboratory for Advanced Genomics Circuit, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Tsuguto Notomi
- Department of Obstetrics and Gynecology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Kengo Usui
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Takashi Sozu
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yasuhisa Terao
- Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
| | - Hideya Kawaji
- Research Center for Genome and Medical Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hisamori Kato
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Japan
- Kanagawa Health Service Association, Yokohama, Japan
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Yoo MY, Woo KJ, Kang SY, Moon BS, Kim BS, Yoon HJ. Efficacy of preoperative lymphoscintigraphy in predicting surgical outcomes of lymphaticovenous anastomosis in lower extremity lymphedema: Clinical correlations in gynecological cancer-related lymphedema. PLoS One 2024; 19:e0296466. [PMID: 38165945 PMCID: PMC10760657 DOI: 10.1371/journal.pone.0296466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/13/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Lymphaticovenous anastomosis (LVA) is a promising microsurgical treatment for lower extremity lymphedema (LEL). Lymphoscintigraphy effectively assesses lower limb lymphatic systems before LVA, but its role in predicting the therapeutic outcomes of LVA is indeterminate. In this study we investigate the efficacy of preoperative lymphoscintigraphy using clinical findings to predict outcomes in gynecological cancer-related LEL patients who underwent LVA. METHODS A retrospective review was conducted on consecutive gynecological cancer patients with LEL who had undergone LVA between June 2018 and June 2021. The therapeutic efficacy was assessed by measuring the change rate of the lower extremity lymphedema index (LELi) six months after surgery. Clinical data and lymphoscintigraphic findings were analyzed to assess therapeutic efficacy of LVA. RESULTS Out of the 60 evaluated legs, 83.3% of the legs showed improved results after LVA. Univariable linear regression analysis revealed that higher preoperative LELi, and ovarian cancer were associated with superior LELi change rate (LC rate). Absence of dermal backflow (DBF) on lymphoscintigraphy was associated with inferior LC rate. Multivariable linear regression analysis identified ovarian cancer and higher preoperative LELi were independently correlated with favorable outcomes, while the absence of DBF was independently correlated with inferior outcomes. CONCLUSION The results of this study emphasizes the effectiveness of preoperative lymphoscintigraphy, preoperative LELi, and primary malignancy as predictors of LVA outcomes in gynecological cancer-related LEL patients.
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Affiliation(s)
- Min Young Yoo
- Department of Nuclear Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
- Department of Nuclear Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Kyong-Je Woo
- Department of Plastic Surgery, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Seo Young Kang
- Department of Nuclear Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Byung Seok Moon
- Department of Nuclear Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Bom Sahn Kim
- Department of Nuclear Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Daggez M, Koyuncu EG, Kocabaş R, Yener C. Prophylactic complex physiotherapy in gynecologic cancer survivors: patient-reported outcomes based on a lymphedema questionnaire. Int J Gynecol Cancer 2023; 33:1928-1933. [PMID: 37844965 DOI: 10.1136/ijgc-2023-004811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE Lower extremity lymphedema secondary to cancer treatment impacts quality of life for gynecological cancer survivors. Complex decongestive physiotherapy is applied when lymphedema is diagnosed, but prophylactic physiotherapy is not yet a standard of care. The aim of this study is to evaluate prophylactic complex physiotherapy in patients with gynecological cancer and its effects on patient-reported symptoms based on the Gynecologic Cancer Lymphedema Questionnaire. METHODS The data of patients diagnosed with gynecological cancers who underwent lymphadenectomy from July 2021 to June 2022 was evaluated. All patients were referred to the physiotherapy unit before adjuvant treatment. Patients who accepted prophylactic physiotherapy were informed and massage and exercise training were implemented, whereas patients who declined were solely informed. Bilateral lower extremity circumferences were measured at 1, 3, 6, and 12 months at the levels of 10 cm, 30 cm, and 50 cm above the heels. A translated form of the Gynecologic Cancer Lymphedema Questionnaire was administered to all patients at the last visit. RESULTS A total of 100 patients were included in the study. Patients were diagnosed with endometrial (50%), ovarian (32%), cervical (16%), and vulvar (2%) cancer. Overall, 70% underwent systematic pelvic±para-aortic lymphadenectomy whereas sentinel lymph node mapping was performed in 30%. Lymphedema was seen in 5% (n=3) of the prophylactic physiotherapy positive group and in 60% (n=24) of the physiotherapy negative group. The median score was 3 (range 1-5) in the physiotherapy positive group and 16 (range 9-20) in the physiotherapy negative group. In patients diagnosed with lymphedema in the physiotherapy negative group, systematic lymphadenectomy was performed in 91.7% (n=22) and a higher number of lymph nodes was extracted (median 45.5; p=0.002). CONCLUSION Prophylactic complex physiotherapy is associated with lower rates of lymphedema and better patient-reported symptom scores according to the Gynecologic Cancer Lymphedema Questionnaire.
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Affiliation(s)
- Mine Daggez
- Department of Gynecologic Oncology, Tekirdag Dr Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Esra Gizem Koyuncu
- Department of Physical Medicine and Rehabilitation, Tekirdag Dr Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Rukiye Kocabaş
- Department of Physical Medicine and Rehabilitation, Tekirdag Dr Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Cem Yener
- Obstetrics and Gynecology, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
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Alahwal AM, Aljaaly H. The Top 100 Most-Cited Articles on the Treatment of Lymphedema. Cureus 2023; 15:e50887. [PMID: 38130906 PMCID: PMC10734209 DOI: 10.7759/cureus.50887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 12/23/2023] Open
Abstract
A multitude of articles have been published on lymphedema management. We aim to identify the 100 most-cited articles on the management of lymphedema and perform a bibliometric analysis. In July 2023, a title-specific search was made on the Scopus database using "lymphedema" as the primary search term. The top 100 most-cited articles were reviewed. The top 100 most-cited articles on lymphedema received a mean citation of 81.7 ± 71.9 per article (range of 11.0 to 420.0). The publication dates ranged from 1977 to 2015. Most of the articles were original (63.0%), interventional studies (35.0%), randomized controlled trials (RCTs) (31.0%), and systematic reviews (32.0%). The largest number of articles (31) were found between 2007 and 2011. The top 10 articles' citation counts ranged from 164 to 420 (mean of 244.7 ± 83.9 citations). Five of these 10 articles were published between the years 1990 and 2000. Twenty-five countries contributed to the 100 most-cited articles. The United States produced the most number of articles (n = 32), followed by Italy (n = 11), Sweden, and Turkey, with seven articles each. Four of the top 10 articles were RCTs; the remaining six were systematic, retrospective, and prospective studies. The New England Journal of Medicine published two of these top 10 articles. Retrospective studies had the highest mean citation with 196.5, followed by RCTs with 100.9. We identified the 100 most-cited articles that depict the advancement in treatment methods for lymphedema. This extensive information directory can be an excellent source for further research.
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Affiliation(s)
- Abdullah M Alahwal
- Department of Otorhinolaryngology, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Hattan Aljaaly
- Department of Plastic Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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8
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Masui A, Harada T, Noda Y, Soeda R, Kida H, Tsuji T. Retrospective study on the trajectories of lower limb volume after outpatient-based complex decongestive therapy in post-operative gynecological cancer patients with lymphedema. Support Care Cancer 2023; 31:318. [PMID: 37148389 PMCID: PMC10164007 DOI: 10.1007/s00520-023-07783-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/26/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To determine the effect of outpatient-based complex decongestive therapy in patients with secondary lower limb lymphedema (LLL) after gynecologic cancer surgery using group-based trajectory modeling (GBTM), and to examine factors predictive of the treatment course. METHODS This retrospective study included participants who underwent surgery for gynecological cancer with pelvic lymph node dissection and subsequently visited the outpatient clinic for the treatment of stage II LLL according to the International Society of Lymphology. The improvement rate of edema at the initial visit and 3, 6, and 12 months later was assessed by calculating the volume of the lower extremity using the circumferential method. For evaluation of the patterns of treatment course, logistic regression analysis was performed after group estimation by the trend of the treatment course using GBTM. RESULTS A total of 148 women (mean age 60.6 years (standard deviation: 13.4 years)) were analyzed. Three improvement trajectories were identified: (1) no response group, with worsening rather than improvement (n = 26); (2) moderate response group, with a slow improvement rate (n = 89); and (3) high response group, with a high improvement rate (n = 33). In addition, adherence to compression therapy at 3 months post-intervention was found to be a predictor in the no response group. CONCLUSIONS GBTM estimated that there are three patterns of the treatment course in patients with LLL after gynecologic cancer surgery. Adherence to compression therapy at 3 months post-intervention is a predictor of the treatment effectiveness.
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Affiliation(s)
- Ayano Masui
- Department of Rehabilitation Medicine, Keio University Graduate School of Medicine, Shinjuku, Tokyo, Japan
| | - Tsuyoshi Harada
- Department of Rehabilitation Medicine, Keio University Graduate School of Medicine, Shinjuku, Tokyo, Japan
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Ryo Soeda
- Department of Rehabilitation Medicine, Keio University Graduate School of Medicine, Shinjuku, Tokyo, Japan
- Department of Rehabilitation, Tsurumaki-Onsen Hospital, Hadano, Kanagawa, Japan
| | - Hisashi Kida
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Lymphedema Treatment Center at, Keio University Hospital, Shinjuku, Tokyo, Japan.
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9
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Chang Y, Li G, Yang Z, Han G, Li X, Zhao Y, Yang Q, Wu G, Yang K, Zhao Y. Inguinal nodal clinical target volume delineation based on analysis of anatomical locations of normal and metastatic lymph nodes in pelvic malignant tumors. Radiother Oncol 2023; 183:109634. [PMID: 36963443 DOI: 10.1016/j.radonc.2023.109634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE To optimize inguinal nodal clinical target volume (CTV) delineation based on analysis of the anatomical locations and embryonic development of normal and metastatic inguinal lymph nodes (ILNs) in patients with pelvic malignant tumors, including cervical, vaginal, vulvar, and anal tumors. MATERIALS AND METHODS One hundred and eighty-one patients with pelvic malignancies and 415 involved ILNs treated with intensity-modulated radiation therapy were selected. First, the inguinal nodal CTV was divided into three fields as follows: I, horizontal superficial inguinal field; II, vertical superficial inguinal field; and III, deep inguinal field. Initial CTV delineation of each field was based on analysis of the anatomical locations and embryonic development of normal ILNs. Subsequently, the positions of metastatic ILNs relative to the proper anatomical landmarks or vessels were determined to optimally delineate the final ILN CTV contours. Eighty percent of the data acquired (n = 145) were used as test data for optimization and analysis, the remaining 20% (n = 36) were used for delineation validation. RESULTS In total, 252 positive ILNs in 103 cervical cancer patients, 94 positive ILNs in 41 vulvar cancer patients, 8 positive ILNs in 3 vaginal cancer patients, and 61 positive ILNs in 34 anal cancer patients were enrolled. Detailed target volume contouring guidelines for the three divisions were determined on images. All positive ILNs from the remaining 20% patients were located in the CTV boundaries delineated based on analysis of 80% of the data acquired. Importantly, the final inguinal nodal CTV field determined using our method was substantially smaller than defined by existing atlases, and the femoral vessels were excluded in the delineation. CONCLUSIONS This study provided anatomical, embryonic, surgical, and statistical evidence to facilitate ILN CTV delineation in radiotherapy planning for patients with pelvic malignancies.
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Affiliation(s)
- Yu Chang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Guilin Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Zhiyong Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Guang Han
- Department of Radiation Oncology, Hubei Cancer Hospital, The Seventh Clinical School Affiliated of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430060, China
| | - Xiangpan Li
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Ye Zhao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Qin Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Kunyu Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China.
| | - Yingchao Zhao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China.
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10
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Bjerre Trent P, Falk RS, Staff AC, Jorde D, Eriksson AG. Translation and cross-cultural adaptation of the Gynecologic Cancer Lymphedema Questionnaire and the Lower Extremity Lymphedema Screening Questionnaire. Int J Gynecol Cancer 2023; 33:231-235. [PMID: 36600491 PMCID: PMC9933152 DOI: 10.1136/ijgc-2022-003979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE There is a paucity of international data regarding self-reported lower extremity lymphedema and quality of life after surgery for gynecological cancer. Validated questionnaires are emerging, but translated versions are lacking. Cross-cultural adaptation is important to reduce the risk of introducing bias into a study. OBJECTIVE To translate and culturally adapt the Gynecologic Cancer Lymphedema Questionnaire and the Lower Extremity Lymphedema Screening Questionnaire for a Norwegian population. METHODS Permission to use the original English versions of the Gynecologic Cancer Lymphedema Questionnaire and the Lower Extremity Lymphedema Screening Questionnaire for translation was obtained. The questionnaires were translated using a procedure based on standard guidelines, including forward translation by native speakers of the target language, synthesis, back translation, and review. Seventeen patients from the Norwegian Radium Hospital gynecological cancer outpatient clinic, all expected to have stable disease, were invited for questionnaire test-retest by completing the same questionnaires twice at 3-4-week intervals. Internal consistency was assessed by calculating Cronbach's alpha. Test-retest reliability was assessed using an intra-class correlation coefficient. RESULTS Twelve patients completed the questionnaires twice. Cronbach's alpha was 0.75 for the Gynecologic Cancer Lymphedema Questionnaire and 0.89 for the Lower Extremity Lymphedema Screening Questionnaire. The intra-class correlation coefficient was 0.86 for the Gynecologic Cancer Lymphedema Questionnaire and 0.91 for the Lower Extremity Lymphedema Screening Questionnaire. CONCLUSIONS Translation and cross-cultural adaptation of these internationally validated patient-reported outcomes questionnaires for survivors of lower extremity lymphedema in gynecological cancer was feasible. The Norwegian translation of the Gynecologic Cancer Lymphedema Questionnaire and the Lower Extremity Lymphedema Screening Questionnaire showed acceptable internal consistency and the test-retest reliability was excellent.
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Affiliation(s)
- Pernille Bjerre Trent
- Department of Gynecological Oncology, Divison of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway,Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Centre of Biostatistics and Epidemiology, Research Support Centre, Oslo University Hospital, Oslo, Norway
| | - Anne Cathrine Staff
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway,Division of Obstetrics and Gyneacology, Oslo University Hospital, Oslo, Norway
| | - Doris Jorde
- Faculty of Education, University of Oslo, Oslo, Norway
| | - Ane Gerda Eriksson
- Department of Gynecological Oncology, Divison of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
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11
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Laas E, Fourchotte V, Gaillard T, Pauly L, Reyal F, Feron JG, Lécuru F. Sentinel Lymph Node Biopsy in Uterine Cancer: Time for a Modern Approach. Cancers (Basel) 2023; 15:cancers15020389. [PMID: 36672338 PMCID: PMC9856582 DOI: 10.3390/cancers15020389] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Since the validation of the sentinel node technique (SLN) for vulvar cancer 20 years ago, this technique has been introduced in the management of operable cervical cancer and endometrial cancer. For cervical cancer a "one fits all" attitude has mainly been presented. However, this approach, consisting of a frozen section during the operation, can be discussed in some stages. We present and discuss the main option for each stage, as well as some secondary possibilities. For endometrial cancer, SLN is now the technique of choice for the nodal staging of low- and intermediate-risk groups. Some discussion exists for the high-risk group. We also discuss the impacts of using preoperatively the molecular classification of endometrial cancer. Patients with POLE or TP53 mutations could have different nodal staging. The story of SLN in uterine cancers is not finished. We propose a comprehensive algorithm of SLN in early cervical and endometrial cancers. However, several ongoing trials will give us important data in the coming years. They could substantially change these propositions.
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Affiliation(s)
- Enora Laas
- Service de Chirurgie Sénologique, Gynécologique et Reconstructrice, Institut Curie, 26 Rue d’Ulm, 75005 Paris, France
- Correspondence:
| | - Virginie Fourchotte
- Service de Chirurgie Sénologique, Gynécologique et Reconstructrice, Institut Curie, 26 Rue d’Ulm, 75005 Paris, France
| | - Thomas Gaillard
- Service de Chirurgie Sénologique, Gynécologique et Reconstructrice, Institut Curie, 26 Rue d’Ulm, 75005 Paris, France
| | - Léa Pauly
- Service de Chirurgie Sénologique, Gynécologique et Reconstructrice, Institut Curie, 26 Rue d’Ulm, 75005 Paris, France
| | - Fabien Reyal
- Service de Chirurgie Sénologique, Gynécologique et Reconstructrice, Institut Curie, 26 Rue d’Ulm, 75005 Paris, France
- Faculté de Médecine, Université de Paris Cité, 75006 Paris, France
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, 75005 Paris, France
| | - Jean-Guillaume Feron
- Service de Chirurgie Sénologique, Gynécologique et Reconstructrice, Institut Curie, 26 Rue d’Ulm, 75005 Paris, France
| | - Fabrice Lécuru
- Service de Chirurgie Sénologique, Gynécologique et Reconstructrice, Institut Curie, 26 Rue d’Ulm, 75005 Paris, France
- Faculté de Médecine, Université de Paris Cité, 75006 Paris, France
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12
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Hsiao HY, Mackert GA, Chang YC, Liu JW, Chang FCS, Huang JJ. In vivo vascularized scaffold with different shear-exposed models for lymphatic tissue regeneration. J Tissue Eng 2023; 14:20417314231196212. [PMID: 37661967 PMCID: PMC10472829 DOI: 10.1177/20417314231196212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Current clinical treatments on lymphedema provide promising results, but also result in donor site morbidities. The establishment of a microenvironment optimized for lymphangiogenesis can be an alternative way to enhance lymphatic tissue formation. Hemodynamic flow stimuli have been confirmed to have an influential effect on angiogenesis in tissue engineering, but not on lymphatic vessel formation. Here, the three in vivo scaffolds generated from different blood stimuli in the subcutaneous layer, in the flow through pedicle, and in an arterio-venous (AV) loop model, were created to investigate potential of lymphangiogenesis of scaffolds containing lymphatic endothelial cells (LECs). Our results indicated that AV loop model displayed better lymphangiogenesis in comparison to the other two models with slower flow or no stimuli. Other than hemodynamic force, the supplement of LECs is required for lymphatic vessel regeneration. The in vivo scaffold generated from AV loop model provides an effective approach for engineering lymphatic tissue in the clinical treatment of lymphedema.
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Affiliation(s)
- Hui-Yi Hsiao
- Department of Biomedical Sciences, Chang Gung University, Taoyuan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
| | - Gina Alicia Mackert
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Yung-Chun Chang
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
| | - Jia-Wei Liu
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
| | - Frank Chun-Shin Chang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
- College of Medicine, Chang Gung University, Taoyuan
| | - Jung-Ju Huang
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
- College of Medicine, Chang Gung University, Taoyuan
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13
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Vignes S. Genital Lymphedema after Cancer Treatment: A Narrative Review. Cancers (Basel) 2022; 14:cancers14235809. [PMID: 36497291 PMCID: PMC9739141 DOI: 10.3390/cancers14235809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Genital lymphedema may affect males and females after cancer treatment (gynecological, such as cervical, uterine or ovarian, melanoma, prostate, anus…). It is frequently associated with lower limb lymphedema, and is responsible for discomfort, cosmetic disfigurement and functional disturbances. Impacts on body image, sexual function and quality of life are major, and difficult to explore because cancer treatment itself and lymphedema are so closely interwoven. Local complications, e.g., papillomatosis, warty growth, lymph vesicles with embarrassing lymph oozing and cellulitis, may occur. Usual lymphedema therapies, like bandaging and elastic compression, are poorly adapted to these sites. Surgery, essentially based on cutaneous resection techniques, is the primary symptomatic treatment; it achieves good efficacy, in adults and children, with possible recurrence requiring reintervention.
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Affiliation(s)
- Stéphane Vignes
- Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares (Lymphoedèmes Primaires), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
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14
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Predictive model for the preoperative assessment and prognostic modeling of lymph node metastasis in endometrial cancer. Sci Rep 2022; 12:19004. [PMID: 36347927 PMCID: PMC9643353 DOI: 10.1038/s41598-022-23252-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Lymph node metastasis (LNM) is a well-established prognostic factor in endometrial cancer (EC). We aimed to construct a model that predicts LNM and prognosis using preoperative factors such as myometrial invasion (MI), enlarged lymph nodes (LNs), histological grade determined by endometrial biopsy, and serum cancer antigen 125 (CA125) level using two independent cohorts consisting of 254 EC patients. The area under the receiver operating characteristic curve (AUC) of the constructed model was 0.80 regardless of the machine learning techniques. Enlarged LNs and higher serum CA125 levels were more significant in patients with low-grade EC (LGEC) and LNM than in patients without LNM, whereas deep MI and higher CA125 levels were more significant in patients with high-grade EC (HGEC) and LNM than in patients without LNM. The predictive performance of LNM in the HGEC group was higher than that in the LGEC group (AUC = 0.84 and 0.75, respectively). Patients in the group without postoperative pathological LNM and positive LNM prediction had significantly worse relapse-free and overall survival than patients with negative LNM prediction (log-rank test, P < 0.01). This study showed that preoperative clinicopathological factors can predict LNM with high precision and detect patients with poor prognoses. Furthermore, clinicopathological factors associated with LNM were different between HGEC and LGEC patients.
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15
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Clinical Characteristics and Implications of Indocyanine Green Lymphography-Identified Contralateral Inguinal Pathway of Lower-Limb Lymphedema. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Lymphedema after pelvic and para-aortic lymphadenectomy-results of a systematic evaluation in patients with cervical and endometrial carcinoma. Arch Gynecol Obstet 2022; 307:1557-1565. [PMID: 36222950 PMCID: PMC10110696 DOI: 10.1007/s00404-022-06779-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/01/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Lymphedema is a frequent complication after surgical treatment in gynecological oncology with substantial impact on patients´ Quality of Life (QoL). Little is known about screening instruments and prevention. Primary objective was to develop and validate the German version of a 13 items screening questionnaire (SQ) developed by Yost et al. to provide a valid instrument for early diagnosis of lower extremity lymphedema (LEL). METHODS After translation the SQ was used in pt. with cervical or endometrial cancer who underwent pelvic/paraaortic Lymphadenectomy. Sensitivity and specifity were analysed regarding possible prediction and influencing factors of LEL. RESULTS 67 pt. had LEL (N = 128). Nearly 50% of women in each group (38 in LEL + e 30 in LEL - ) had a body mass index (BMI) > 30 kg/m2. Number of removed lymphnodes, radiotherapy and were significantly associated with development of LEL. Translated Mayo Clinic questionnaire can be used with reliable specifity and sensitivity. Four additional questions improved the diagnostic accuracy of the SQ. CONCLUSIONS The translated SQ is a valuable and predictive tool for screening and early detection of LEL in Gynecological cancer surgery and can even improved by adding simple questions.
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17
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Determinants of Quality of Life related to Lower Limb Lymphedema in Women with Gynecological Cancer Surgery. Asia Pac J Oncol Nurs 2022; 10:100153. [DOI: 10.1016/j.apjon.2022.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open
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Beederman M, Garza RM, Agarwal S, Chang DW. Outcomes for Physiologic Microsurgical Treatment of Secondary Lymphedema Involving the Extremity. Ann Surg 2022; 276:e255-e263. [PMID: 32889875 DOI: 10.1097/sla.0000000000004457] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the long-term impact of physiologic surgical options, including VLNT and LVB, on patients with secondary lymphedema of the upper or lower extremity (UEL/LEL). SUMMARY BACKGROUND DATA VLNT and LVB have become increasingly popular in the treatment of lymphedema. However, there is a paucity of long-term data on patient outcomes after use of these techniques to treat lymphedema. METHODS An analysis of prospectively collected data on all patients who underwent physiologic surgical treatment of secondary lymphedema over a 5.5-year period was performed. Patient demographics, surgical details, subjective reported improvements, LLIS scores, and postoperative limb volume calculations were analyzed. RESULTS Two hundred seventy-four patients with secondary lymphedema (197 upper, 77 lower) were included in the study. More than 87% of UEL patients and 60% of LEL patients had reduction in excess limb volume postoperatively. At 3 months postoperatively, patients with UEL had a 31.1% reduction in volume difference between limbs, 33.9% at 6 months, 25.7% at 12 months, 47.4% at 24 months and 47.7% at 4 years. The reduction in limb volume difference followed a similar pattern but was overall lower for LEL patients. Greater than 86% of UEL and 75% of LEL patients also had improvement in LLIS scores postoperatively. Fifty-nine complications occurred (12.9%); flap survival was >99%. CONCLUSIONS Patients with secondary UEL/LEL who undergo VLNT/LVB demonstrate improved functional status and reduced affected limb volumes postoperatively. Patients with UEL seem to have a more substantial reduction in limb volume differential compared to LEL patients.
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Affiliation(s)
- Maureen Beederman
- Section of Plastic and Reconstructive Surgery, Department of Surgery, The University of Chicago, Chicago, Illinois
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Sakarya AH, Huang C, Yang C, Hsiao H, Chang FC, Huang J. Vascularized lymph node transplantation successfully reverses lymphedema and maintains immunity in a rat lymphedema model. Bioeng Transl Med 2022; 7:e10301. [PMID: 36176614 PMCID: PMC9471995 DOI: 10.1002/btm2.10301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 11/26/2022] Open
Abstract
Vascularized lymph node transplantation (VLNT) has shown inspiring results for the treatment of lymphedema. Nevertheless, it remains unclear how VLNT restores lymphatic drainage and whether or not immunity recovers after surgery. Hindlimb lymphedema model was created using rats with extensive groin and popliteal lymph node removable following with radiotherapy, and the lymphedema was confirmed using indocyanine green (ICG) lymphangiography and micro-computer tomography for volume measurement. VLNT was performed 1 month later. Volume measurement, ICG lymphangiography, histology, and immune reaction were done 1 month after surgery. VLNT successfully reduced the volume of the lymphedema hindlimb, restored lymphatic drainage function with proven lymphatic channel, and reduced lymphedema-related inflammation and fibrosis. It promotes lymphangiogenesis shown from ICG lymphangiography, histology, and enhanced lymphangiogenesis gene expression. Dendritic cell trafficking via the regenerated lymphatic channels was successfully restored, and maintained systemic immune response was proved using dinitrofluorobenzene sensitization and challenge. VLNT effectively reduces lymphedema and promotes lymphatic regeneration in the capillary lymphatic but not the collecting lymphatic vessels. Along with the re-established lymphatic system was the restoration of immune function locally and systemically. This correlated to clinical experience regarding the reduction of swelling and infection episodes after VLNT in lymphedema patients.
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Affiliation(s)
- Ahmet Hamdi Sakarya
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital, Linkou Medical CenterTaoyuanTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Chi‐Wei Huang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital, Linkou Medical CenterTaoyuanTaiwan
| | - Chin‐Yu Yang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital, Linkou Medical CenterTaoyuanTaiwan
- Center for Tissue EngineeringChang Gung Memorial Hospital, Linkou Medical CenterTaoyuanTaiwan
| | - Hui‐Yi Hsiao
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital, Linkou Medical CenterTaoyuanTaiwan
- Center for Tissue EngineeringChang Gung Memorial Hospital, Linkou Medical CenterTaoyuanTaiwan
| | - Frank Chun‐Shin Chang
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Division of Craniofacial Surgery, Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital, Linkou Medical CenterTaoyuanTaiwan
| | - Jung‐Ju Huang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital, Linkou Medical CenterTaoyuanTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Center for Tissue EngineeringChang Gung Memorial Hospital, Linkou Medical CenterTaoyuanTaiwan
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Review of Malpractice Litigation in the Diagnosis and Treatment of Venous & Lymphatic Disease. Ann Vasc Surg 2022; 88:274-282. [PMID: 35926792 DOI: 10.1016/j.avsg.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Malpractice claims involving nonthrombotic venous and lymphatic diseases and interventions have not been previously reported. We investigated common reasons for litigation, medical specialties involved, patient injuries, and case outcomes in malpractice litigation involving venous and lymphatic disease. METHODS Litigation cases entered into the Westlaw database from June 8th, 1984 to February 15th, 2018 were analyzed. Search terms included relevant words and phrases related to nonthrombotic venous, thoracic outlet syndrome and lymphatic disease and treatment. Data on physician specialty, malpractice claims, patient injuries jury outcomes, amount awarded to the plaintiff, and jury fees were collected and compared for each category. RESULTS A total of 144 cases were identified. 41 cases involved varicose veins, 11 spider veins, 35 thoracic outlet syndrome (TOS), 17 other venous diseases, and 40 lymphatic disease. Physician defendants were frequently vascular surgeons (23%) and general surgeons (15%). The majority of litigation claims involved "post-procedure complication" (77%), "lack of informed consent" (25%), "failure to diagnose & treat" (15%), and "intraoperative complications" (13%). The most common injuries were skin damage (27.8%), nerve damage (25%), and lymphedema (24%). Patient death occurred in 6% of cases. Out of venous malpractice cases with post-procedure complications, stab phlebectomy (27%) was the most common intervention followed by foam sclerotherapy (21%), rib resection (21%), laser spider vein removal (5%), and EVLT (3%). Of varicose vein cases, 15% included deep vein thrombosis or pulmonary embolism as post-procedure complications. In TOS rib resections, 65% of cases referenced nerve damage and 12% involved arterial injury. For lymphatic disease cases, general surgeons were frequently identified defendants (25%). Lymphedema (93%) and lymphangitis (7%) occurred as post-procedure complications after breast, gynecologic, orthopedic, and radiation procedures. A majority of complications occurred after breast cases (40%). Verdicts overall ruled in favor of the defendant in 71% (102/144) of cases and the plaintiff in 20% (29/144) of cases. Out of cases ruled in favor of the plaintiff, 31% were lymphatics, 24% varicose veins, and 24% TOS cases. Only 8% (12/144) of cases were settled and one outcome was unknown. The mean award was $820,193 (SD $1,226,008, Range $12,853 - $6,500,000). CONCLUSIONS The majority of venous and lymphatic litigation cases involve claims of post-procedure complications. Venous complications occurred after open and endovascular treatment of varicose veins, spider vein treatment, and surgical management of TOS. Lymphedema occurred after breast, oncology, and orthopedic procedures. These cases reflect opportunities for intervention to help potentially prevent litigation.
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Ritchie J, Heyward Q, Taylor N, Ko E, Haggerty AF, Graul A. The frequency and persistence of lymphedema diagnosis and self-reported symptoms over 5 years in patients with endometrial carcinoma. Gynecol Oncol Rep 2022; 41:100996. [PMID: 35592241 PMCID: PMC9112096 DOI: 10.1016/j.gore.2022.100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 11/16/2022] Open
Abstract
Numbness, aching, and poor physical function were commonly reported symptoms in endometrial cancer patients. Lymphedema symptoms that develop soon after diagnosis of endometrial cancer can persist for at least 5 years. Lymphedema symptoms could develop up to 7 years after initial diagnosis or treatment for endometrial cancer.
A potentially debilitating sequela of diagnosis or treatment for endometrial cancer islower limb lymphedema (LLL), which can have significant impacts on quality of life. Theobjective of this study was to determine the frequency of LLL symptoms in uterinecancer survivors over a 5-year study period. An IRB-approved prospective study of quality of life of endometrial cancer patients whounderwent surgical intervention was undertaken. The Gynecologic CancerLymphedema Questionnaire (GCLQ) was used to survey patients in 2011 and again in2016 to evaluate for symptoms of LLL.205 patients initially answered the survey, and 75 patients completed the follow upsurvey as well, with no differences in demographics between the cohorts. 90.7% ofpatients underwent lymph node dissection. Patients commonly reported symptoms ofnumbness (66.83%), aching (54.2%), and poor physical function (47.8%). On initialsurvey, 14.7% (n = 11) of patients met criteria for LLL by GCLQ criteria, with 8 patientsreporting improvement in symptoms and 3 reporting persistent diagnosis at follow up. At follow up survey, 12.0% (n = 9) patients meeting criteria five years later, with 6patients newly meeting criteria. The most persistent symptoms were poor physicalfunction (70.6%), numbness (72.5%), general swelling (55.6%), aching (64.1%), andlimb-related swelling (60%).While the rate of LLL was similar to previous reports, there were a number of newdiagnoses of LLL at interval follow up distant from surgery, up to 7 years later.Symptoms of LLL also persisted for many years after diagnosis.
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Affiliation(s)
- Julia Ritchie
- Division of Gynecologic Oncology, St. Luke’s University Health Network, Bethlehem, PA, USA
| | - Quetrell Heyward
- Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Nicholas Taylor
- Division of Gynecologic Oncology, St. Luke’s University Health Network, Bethlehem, PA, USA
| | - Emily Ko
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Ashley F. Haggerty
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Ashley Graul
- Division of Gynecologic Oncology, St. Luke’s University Health Network, Bethlehem, PA, USA
- Corresponding author at: 701 Ostrum Street, Suite 502, Bethlehem, PA 18015, USA.
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Sponholtz SE, Ezendam NPM, de Rooij BH, Parner E, Mogensen O, Hildebrandt MG, Schledermann D, Markauskas A, Frøding LP, Fuglsang K, Bjørnholt SM, Jensen PT. SENTIREC - The sentinel node mapping in women with cervical cancer study - Patient-reported early lymphedema and its impact on quality of life. Gynecol Oncol 2022; 164:463-472. [PMID: 34973844 DOI: 10.1016/j.ygyno.2021.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate patient-reported incidence and severity of early lymphedema and its impact on quality of life (QoL) after sentinel lymph node (SLN) mapping only and after SLN and pelvic lymphadenectomy (PL) in women undergoing surgery for early-stage cervical cancer. METHODS In a national prospective multicenter 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 PL. The incidence and severity of early lymphedema and its influence on QoL were evaluated using validated patient-reported outcome measures before surgery and three months postoperative. We investigated changes over time using linear regression. RESULTS Two hundred of 245 (81.6%) included women completed questionnaires at baseline and three months postoperatively. The incidence of early lymphedema was 5.6% (95% CI 2.1-11.8%) and 32.3% (95% CI 22.9-42.7%) in women who underwent SLN mapping only and SLN + PL, respectively. Lymphedema symptoms in the legs, genitals, and groins increased in both groups postoperatively but three times more in women who underwent PL. Lymphedema symptoms after SLN + PL significantly impaired physical performance (p = 0.001) and appearance (p = 0.007). Reporting lymphedema was significantly associated with impaired body image, physical-, role-, and social functioning, and a high level of fatigue. CONCLUSIONS SLN mapping alone carries a low risk of lymphedema in women undergoing surgery for early-stage cervical cancer. In contrast, completion PL is associated with a high incidence of early lymphedema. Reporting lymphedema is associated with significant impairment of several physical, psychological, and social aspects of QoL.
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Affiliation(s)
- Sara Elisabeth Sponholtz
- Department of Gynecology and Obstetrics, Odense University Hospital, Denmark; Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Denmark.
| | - Nicole P M Ezendam
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, the Netherlands; The Netherlands Comprehensive Cancer Organization, the Netherlands
| | - Belle H de Rooij
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, the Netherlands; The Netherlands Comprehensive Cancer Organization, the Netherlands
| | - Erik Parner
- Deparment of Public Health, Aarhus University, Denmark
| | - Ole Mogensen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark; Institute of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
| | - Malene Grubbe Hildebrandt
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark; Department of Nuclear Medicine, Odense University Hospital, Denmark; Center for Innovative Medical Technology (CIMT), Odense University Hospital and University of Southern Denmark, Denmark
| | - Doris Schledermann
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark; Department of Clinical Pathology, Odense University Hospital, Denmark
| | - Algirdas Markauskas
- Department of Gynecology and Obstetrics, Odense University Hospital, Denmark
| | | | - Katrine Fuglsang
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark
| | - Sarah Marie Bjørnholt
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark; Institute of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
| | - Pernille Tine Jensen
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark; Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark; Institute of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
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23
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Hayashi A, Visconti G, Yang CS(J, Hayashi N, Yoshimatsu H. Additional Lymphaticovenular Anastomosis on the Posterior Side for Treatment of Primary Lower Extremity Lymphedema. J Clin Med 2022; 11:jcm11030867. [PMID: 35160317 PMCID: PMC8836829 DOI: 10.3390/jcm11030867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/23/2022] [Accepted: 02/02/2022] [Indexed: 02/01/2023] Open
Abstract
The efficacy of lymphaticovenular anastomosis (LVA) for the treatment of primary lymphedema has been reported. Previous research suggested the efficacy of LVA on the anterior side of the lower limb, but no research has yet underlined the effectiveness of LVA on the posterior side. In the present study, we aimed to investigate the efficacy of LVA on the posterior side of the lower leg for treatment of primary lymphedema, i.e., whether further improvement of primary lower extremity lymphedema could be expected by performing LVA on the posterior side of the lower limb in addition to the LVA on the anterior side, which is usually performed. Forty-five patients with primary lower extremity lymphedema who underwent LVA twice between March 2018 and September 2020 were retrospectively investigated. Patients were classified into two groups: those who underwent LVA on the posterior side in the second operation (PoLVA group) and those who underwent LVA on the medial and anterior sides again in the second operation (MeLVA group). All patients underwent LVA on the medial and anterior sides in the first operation, but no sufficient improvement was observed. The following factors in the second operation were compared between the two groups: skin incision length, the number of anastomoses, the diameters of the lymphatic vessels, the time required for the dissection of the lymphatic vessels and veins and the reduction in volume. LVA resulted in 227 anastomoses (106 anastomoses in the PoLVA group and 121 anastomoses in the MeLVA group) in 26 patients with primary lymphedema of the lower extremities in two surgeries. The reduction in lower extremity lymphedema index was significantly greater in the PoLVA group than that in the MeLVA group (10.5 ± 4.5 vs. 5.5 ± 3.6; p = 0.008), and the number of anastomoses in the PoLVA group was significantly lower than that in the MeLVA group (3.5 ± 0.6 vs. 4.6 ± 1.0; p = 0.038). LVA on the posterior side subsequent to LVA on the medial and anterior sides resulted in the further improvement of primary lower extremity lymphedema with fewer numbers of anastomoses.
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Affiliation(s)
- Akitatsu Hayashi
- Department of Lymphedema Center, Kameda General Hospital, Chiba 296-0041, Japan
- Correspondence: ; Tel.: +81-470-92-2211 (ext. 6150)
| | - Giuseppe Visconti
- Department of Plastic and Reconstructive Surgery, Università Cattolica del “Sacro Cuore”, University Hospital “A. Gemelli”, Rome 00168, Italy;
| | - Chia-Shen (Johnson) Yang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
| | | | - Hidehiko Yoshimatsu
- Department of Plastic Surgery, Cancer Institute Hospital of the JFCR, Tokyo 135-0063, Japan;
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24
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Yoshihara M, Kitamura K, Tsuru S, Shimono R, Sakuda H, Mayama M, Tano S, Uno K, Ukai MO, Kishigami Y, Oguchi H, Hirota A. Factors associated with response to compression-based physical therapy for secondary lower limb lymphedema after gynecologic cancer treatment: a multicenter retrospective study. BMC Cancer 2022; 22:25. [PMID: 34980013 PMCID: PMC8722292 DOI: 10.1186/s12885-021-09163-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background Lower limb lymphedema (LLL) is one of the most refractory and debilitating complications related to gynecological cancer treatment. We investigated factors associated with response to compression-based physical therapy (CPT) for secondary LLL after gynecologic cancer treatment. Methods We performed a multicenter retrospective study using the records of seven medical institutions from 2002 and 2014. Patients who developed LLL after gynecological cancer treatment were included. Limb volumes were calculated from the lengths of the limb circumferences at four points. All participants underwent compression-based physical therapy for LLL. Factors, including MLD, indicative of circumference reductions in LLL were determined. Results In total, 1,034 LLL met the required criteria of for the study. A multivariate linear regression analysis identified age; body mass index (BMI); endometrial cancer; radiotherapy; and initial limb circumference as significant independent prognostic factors related to improvement in LLL. In analysis of covariance for improvement in LLL adjusted by the initial limb circumference and stratified by BMI and radiotherapy, patients with BMI 28 kg/m2 or higher and receiving radiation rarely responded to CPT. Conclusions Improvements in the lower limb circumference correlated with clinical histories and physical characteristics, which may be used as independent prognostic factors for successful CPT for LLL after gynecological cancer treatment.
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Affiliation(s)
- Masato Yoshihara
- Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Obstetrics and Gynecology, TOYOTA Memorial Hospital, 1-1 Heiwa-cho, Toyota, Aichi, 471-8513, Japan
| | - Kaoru Kitamura
- Department of Breast Surgery, Kaizuka Hospital, 7-7-27 Hakozaki, Higashi-ku, Fukuoka, Fukuoka, 812-0053, Japan
| | - Satoko Tsuru
- School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan.
| | - Ryoko Shimono
- Organization for Interdisciplinary Research Project, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Hiromi Sakuda
- Graduate School of Nursing, Osaka City University, 3-3-138, Sugimoto, Sumiyoshi-ku, Osaka-shi, 558-8585, Japan
| | - Michinori Mayama
- Obstetrics and Gynecology, TOYOTA Memorial Hospital, 1-1 Heiwa-cho, Toyota, Aichi, 471-8513, Japan.,Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Kita 8, Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-0808, Japan
| | - Sho Tano
- Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Obstetrics and Gynecology, TOYOTA Memorial Hospital, 1-1 Heiwa-cho, Toyota, Aichi, 471-8513, Japan
| | - Kaname Uno
- Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Obstetrics and Gynecology, TOYOTA Memorial Hospital, 1-1 Heiwa-cho, Toyota, Aichi, 471-8513, Japan
| | - Mayu Ohno Ukai
- Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Obstetrics and Gynecology, TOYOTA Memorial Hospital, 1-1 Heiwa-cho, Toyota, Aichi, 471-8513, Japan
| | - Yasuyuki Kishigami
- Obstetrics and Gynecology, TOYOTA Memorial Hospital, 1-1 Heiwa-cho, Toyota, Aichi, 471-8513, Japan
| | - Hidenori Oguchi
- Obstetrics and Gynecology, TOYOTA Memorial Hospital, 1-1 Heiwa-cho, Toyota, Aichi, 471-8513, Japan
| | - Akio Hirota
- Hirota Internal Medicine Clinic, 5-19-10 Minami-karasuyama, Setagaya-ku, Tokyo, 157-0062, Japan
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25
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Wong M, Eaton PK, Zanichelli C, Moore C, Hegarty C, MacDonald N. The prevalence of undiagnosed postoperative lower limb lymphedema among gynecological oncology patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 48:1167-1172. [PMID: 34980543 DOI: 10.1016/j.ejso.2021.12.464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/13/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Lower limb lymphedema (LLL) is a common postoperative complication among gynecological oncology patients following lymph node resection. In the absence of a screening strategy, LLL is frequently diagnosed only through patient's self-reported symptoms. This study investigated the prevalence of undiagnosed postoperative LLL among gynecological oncology patients and identified the associated risk factors. MATERIALS AND METHODS This was a cross-sectional postal questionnaire survey at a tertiary gynecological oncology center. Women with gynecological malignancies who underwent lymph node (inguinal/pelvic/para-aortic) resection between 2010 and 2017 were eligible. The Gynecological Cancer Lymphedema Questionnaire (GCLQ) was used and those with a score of ≥4 were referred to a lymphedema specialist for clinical confirmation. RESULTS Among 376 eligible women, postoperative LLL was already diagnosed in 45/376 (12%) women. In the remaining women, 117/331 (35.3%) completed the GCLQ, of which 67/117 (57.3%) scored ≥4. Fifty-five women (55/67, 82.1%) were assessed by a lymphedema specialist and eight cases of postoperative LLL were confirmed. In the 12/67 who declined a clinical assessment, they reported no evidence of LLL. The prevalence of undiagnosed postoperative LLL in our study was 8/117 (6.8%, 95% C.I. 2.3-11.4). On univariate analysis, older women were more likely to have undiagnosed postoperative LLL. CONCLUSIONS Undiagnosed postoperative LLL is not uncommon among gynecological oncology patients, especially in older patients. No vulvar cancer patient had undiagnosed LLL. Increased awareness and improved strategies for lymphedema screening are required after lymph node surgery in gynecological oncology.
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Affiliation(s)
- Michael Wong
- Department of Gynecological Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Patricia Kay Eaton
- Lymphedema Service, Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Carla Zanichelli
- Lymphedema Service, Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Christina Moore
- Lymphedema Service, Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Catherine Hegarty
- Lymphedema Service, Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Nicola MacDonald
- Department of Gynecological Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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26
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AlMahdy AM, Elassall GM, Abdelbadee AY, Abd-Elkariem AY, Atef F, Ahmed IA, Sayed EG, Salah MA, Ali AK, Ragab EY, Abd Elazeem HAS, Saad MM, Shazly SA. Prognostic value of systematic lymphadenectomy in patients with ovarian cancer: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 267:179-185. [PMID: 34814044 DOI: 10.1016/j.ejogrb.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/17/2020] [Accepted: 02/09/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To appraise clinical outcomes of systematic lymphadenectomy in women with ovarian cancer based on stage, control group and type of chemotherapy. STUDY DESIGN A literature search was conducted on SCOPUS, PUBMED, COCHRANE, MEDLINE, and WEB OF SCIENCE databases. All comparative studies that assess outcomes of systematic lymphadenectomy in patients with ovarian cancer were eligible. Overall survival was analyzed by pooling log hazard ratio (HR) and standard error of multivariable Cox regression models. MOGGE Meta-analysis Matrix is a novel illustration tool that was used to demonstrate multiple subgroup analyses of included studies. RESULTS Twenty-two studies were eligible. Systematic lymphadenectomy was associated with better overall survival, that was close to significance, compared to control group (HR 0.93, 95 %CI 0.86-1.00). Among women treated with adjuvant chemotherapy, overall survival improved in women with stage IIB-IV who underwent systematic lymphadenectomy (HR 0.91, 95 %CI 0.84-0.99) and was most significant among patients with stage III to IV (HR 0.85, 95 %CI 0.73-0.99). Systematic lymphadenectomy did not improve survival in women who received neoadjuvant chemotherapy (HR 0.97, 95 %CI 0.73-1.29). Systematic lymphadenectomy was associated with improved progress-free survival compared to control group (HR 0.88, 95 %CI 0.79-0.99). CONCLUSION Although data from clinical trials do not support role of systematic lymphadenectomy in advanced ovarian cancer, overall data conveys stage-specific survival benefit. Further clinical trials may be warranted to assess substage survival outcomes in women with advanced stages.
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Affiliation(s)
- AlBatool M AlMahdy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Gena M Elassall
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Y Abdelbadee
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Y Abd-Elkariem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Fatma Atef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Islam A Ahmed
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa G Sayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Ashraf Salah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed K Ali
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa Y Ragab
- Department of Anaesthesia, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Mahmoud M Saad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sherif A Shazly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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27
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Yoshida S, Koshima I, Imai H, Roh S, Mese T, Uchiki T, Sasaki A, Nagamatsu S. Effect of Postoperative Compression Therapy on the Success of Liposuction in Patients with Advanced Lower Limb Lymphedema. J Clin Med 2021; 10:jcm10214852. [PMID: 34768372 PMCID: PMC8584961 DOI: 10.3390/jcm10214852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: There is limited information on postoperative care after liposuction for lymphedema limb. The aim of this retrospective study was to identify the threshold compression pressure and other factors that lead liposuction for lower limb lymphedema to success. Materials and Methods: Patients were divided according to whether they underwent compression therapy with both stockings and bandaging (SB group), stockings alone (S group), or bandaging alone (B group) for 6 months after liposuction. The postoperative compression pressure and rate of improvement were compared according to the postoperative compression method. We also investigated whether it was possible to decrease the compression pressure after 6 months. Liposuction was considered successful if improvement rate was >15. Results: Mean compression pressure was significantly lower in the S group than in the SB group or B group. The liposuction success rate was significantly higher in the SB group than in the B group or S group. There was not a significant difference between the values at 6 months after liposuction and at 6 months after a decrease in compression pressure in the successful group. Conclusion: Our results suggest that stable high-pressure postoperative compression therapy is key to the success of liposuction for lower limb lymphedema and is best achieved by using both stockings and bandages. The postoperative compression pressure required for liposuction to be successful was >40 mmHg on the lower leg and >20 mmHg on the thigh. These pressures could be decreased after 6 months.
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Affiliation(s)
- Shuhei Yoshida
- The International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (I.K.); (H.I.); (S.R.); (T.M.)
- Correspondence: ; Tel.: +81-82-257-5555; Fax: +81-82-257-5851
| | - Isao Koshima
- The International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (I.K.); (H.I.); (S.R.); (T.M.)
| | - Hirofumi Imai
- The International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (I.K.); (H.I.); (S.R.); (T.M.)
| | - Solji Roh
- The International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (I.K.); (H.I.); (S.R.); (T.M.)
| | - Toshiro Mese
- The International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (I.K.); (H.I.); (S.R.); (T.M.)
| | - Toshio Uchiki
- Plastic and Reconstructive Surgery, Hiroshima University, Hiroshima 739-8511, Japan; (T.U.); (A.S.); (S.N.)
| | - Ayano Sasaki
- Plastic and Reconstructive Surgery, Hiroshima University, Hiroshima 739-8511, Japan; (T.U.); (A.S.); (S.N.)
| | - Shogo Nagamatsu
- Plastic and Reconstructive Surgery, Hiroshima University, Hiroshima 739-8511, Japan; (T.U.); (A.S.); (S.N.)
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Lin YS, Liu CJ. Predictors of severity of lymphosclerosis in extremity lymphedema. J Vasc Surg Venous Lymphat Disord 2021; 10:721-727.e2. [PMID: 34637953 DOI: 10.1016/j.jvsv.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lymphovenous anastomosis (LVA) is an accepted method for treating lymphedema, and its efficacy could be greatly affected by the severity of lymphosclerosis. In the present study, we analyzed the intraoperative findings of lymphatic ducts in our patients who had undergone LVA to find predictive factors for the severity of lymphosclerosis. METHODS The medical records of the patients who had undergone LVA for managing extremity lymphedema from September 2017 to December 2020 were reviewed. The severity of lymphosclerosis was evaluated intraoperatively under a surgical microscope and stratified using the NECST (normal, ectasia, contraction, sclerosis type) classification. Patient age, gender, body mass index (BMI), lymphoscintigraphy stage, and lymphatic duct locations were included for analysis. RESULTS Multivariate linear regression analysis showed that location in a lower extremity (regression coefficient, -0.38; P = .03) and more advanced Taiwan lymphoscintigraphy stage (regression coefficient, 0.27; P < .001) were associated with more severe lymphosclerosis. In a subgroup analysis of lower extremity lymphedema, in addition to the Taiwan lymphoscintigraphy stage (regression coefficient, 0.24; P < .001), age (regression coefficient, 0.02; P = .001), and BMI (regression coefficient, 0.04; P = .005) were also associated with the severity of lymphosclerosis. CONCLUSIONS The severity of lymphosclerosis in extremity lymphedema correlated positively with the Taiwan lymphoscintigraphy stage and was more severe in lower limb lymphedema. In lower limb lymphedema, a higher BMI and older age also contributed to more severe lymphosclerosis.
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Affiliation(s)
- Ying-Sheng Lin
- Division of Plastic and Reconstructive Surgery, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan; Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chia-Ju Liu
- Department of Nuclear Medicine, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan
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29
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Huang CW, Chang YC, Hsiao HY, Liu JW, Chang FCS, Huang JJ. Creation of a rat lymphedema model using extensive lymph node dissection and circumferential soft tissue resection: Is this a reliable model? Microsurgery 2021; 41:762-771. [PMID: 34617323 DOI: 10.1002/micr.30817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The medical demand for lymphedema treatment is huge since the disease mechanism remains unclear, and management are difficult. Our purpose was to develop a reliable lymphedema model mimicking the clinical scenario and allows a microsurgical approach. MATERIALS AND METHODS Male Lewis rats weighing 400 to 450 g were used to create lymphedema with groin and popliteal lymph node dissection and creation of 5 mm circumferential skin defect (n = 6). A skin incision was made and closed primarily for control group (n = 5). Evaluation included indocyanine green (ICG) lymphangiography 1 and 2 months postoperatively, volume difference between bilateral hindlimbs measured using micro-CT, and the skin was harvested for histological evaluation 2 months postoperatively. RESULTS Larger volume differences present in the lymphedema group (17.50 ± 7.76 vs. 3.73 ± 2.66%, p < .05). ICG lymphangiography indicated dermal backflow only in the lymphedema group. Increased thickness of the epidermis was noted in lymphedema group (28.50 ± 12.61 μm vs. 15.10 ± 5.41 μm, p < .0001). More CD45+ (35.6 ± 26.68 vs. 2.8 ± 4.23 cells/high power field [HPF], p < .0001), CD3+ (38.39 ± 20.17 vs. 9.73 ± 8.62 cells/HPF, p < .0001), and CD4+ cell infiltration (11.7 ± 7.71 vs. 2.0 ± 2.67 cells/HPF, p < .0001) were observed in the lymphedema group. Collagen type I deposition was more in the lymphedema group (0.15 ± 0.06 vs. 0.07 ± 0.03, p < .0005). CONCLUSIONS A rat lymphedema model was successfully established. The model can be applied in lymphedema related research.
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Affiliation(s)
- Chi-Wei Huang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yung-Chun Chang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hui-Yi Hsiao
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jia-Wei Liu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Frank Chun-Shin Chang
- Division of Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jung-Ju Huang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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30
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Guerrini S, Gentili F, Mazzei FG, Gennaro P, Volterrani L, Mazzei MA. Magnetic resonance lymphangiography: with or without contrast? ACTA ACUST UNITED AC 2021; 26:587-595. [PMID: 33032980 DOI: 10.5152/dir.2020.19482] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Lymphedema is an important medical issue around the world, caused by an anomalous collection of fluid in soft tissue due to congenital malformations or stenosis or obstruction of lymphatic vessels. Magnetic resonance lymphangiography (MRL) is an emerging technique focused on noninvasive or minimally invasive imaging of lymphatics with the goal to diagnose and treat lymphedema. This review will briefly discuss lymphatic imaging starting with lymphography and radionuclide lymphoscintigraphy up to the newest methods, focusing on MRL, a rising technique, and highlighting the technical aspects fundamental for achieving high-resolution MRL.
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Affiliation(s)
- Susanna Guerrini
- Department of Radiological Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Francesco Gentili
- Department of Radiological Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Francesco Giuseppe Mazzei
- Department of Radiological Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Paolo Gennaro
- Department of Maxillofacial Surgery, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luca Volterrani
- Department of Medical, Surgical and Neurosciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Antonietta Mazzei
- Department of Medical, Surgical and Neurosciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Xia L, Cui C, Nicoli F, Al-Mousawi A, Campisi CC, Lazzeri D, Liu NF, Xie B, Li K, Zhang Y. Far Infrared Radiation Therapy for Gynecological Cancer-Related Lymphedema Is an Effective and Oncologically Safe Treatment: A Randomized-Controlled Trial. Lymphat Res Biol 2021; 20:164-174. [PMID: 34028298 DOI: 10.1089/lrb.2019.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Gynecological cancer-related lymphedema (GCRL) is a devastating condition that adversely influences function, health, and quality of life. We conducted a randomized-controlled clinical study as well as in vitro experiments to investigate the efficacy and safety of far infrared radiation (FIR) to treat lymphedema in patients having previously undergone surgery for gynecological tumors. Materials and Methods: Seventy-four women with GCRL, cancer free for 5 years or more, were randomly allocated into two treatment groups: standard of care with bandage treatment and treatment with FIR plus bandage. Variations of fluid, circumference of lymphedematous limbs, serum tumor markers (cancer antigen 125 [CA125]), inguinal-pelvic lymph nodes, vagina, lungs, and adverse reactions were assessed after 1 year. In vitro experiments examined the effects on cell viability, proliferation, apoptosis, and the cell cycle of fibroblast, A2780, SKOV-3, HELA, and Ishikawa cells. Results: The FIR+bandage group showed significantly decreased tissue fluid and reduced limb circumference (p < 0.05) in comparison with the control group at 1 year. There was no increase of serum CA125 in both groups, and no recurrence of neoplasia or lymphadenopathy was detected. No adverse reactions were recorded. In addition, no changes were detected after FIR treatment for fibroblast, A2780, SKOV-3, HELA, and Ishikawa cells in cell viability, proliferation, apoptosis, and cell cycle. Conclusion: FIR can be used to treat patients with GCRL following gynecological cancer treatment. Following clinical and experimental studies, we confirm that FIR is an oncologically safe treatment for lymphedema in gynecological tumor patients.
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Affiliation(s)
- Liang Xia
- Department of Oral and Cranio-Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chunxiao Cui
- Department of Facial Plastic and Reconstructive Surgery, Fudan University, Eye & ENT Hospital, Shanghai, China
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata," Rome, Italy.,Department of Plastic and Reconstructive Surgery, Northumbria Healthcare NHS Foundation Trust, Northumberland, United Kingdom.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary Hospital Newcastle NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ahmed Al-Mousawi
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary Hospital Newcastle NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Corrado Cesare Campisi
- Unit of Lymphatic Surgery, Department of Surgery, University of Genoa, IRCCS University Hospital San Martino-IST National Institute for Cancer Research, Genoa, Italy
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy
| | - Ning Fei Liu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Bingying Xie
- Department of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Ke Li
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Yixin Zhang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
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Ward J, King I, Monroy-Iglesias M, Russell B, van Hemelrijck M, Ramsey K, Khan AA. A meta-analysis of the efficacy of vascularised lymph node transfer in reducing limb volume and cellulitis episodes in patients with cancer treatment-related lymphoedema. Eur J Cancer 2021; 151:233-244. [PMID: 34092349 DOI: 10.1016/j.ejca.2021.02.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Lymphoedema after cancer treatment is a chronic and disabling complication that presents a significant health care burden during survivorship with limited treatment options. Vascularised lymph node transfer (VLNT) can reconstruct lymphatic flow to reduce limb volumes, but limited higher-order evidence exists to support its effectiveness. AIM The aim of the study was to systematically review and meta-analyse the effectiveness of VLNT in reducing upper limb (UL) or lower limb (LL) volume and cellulitis episodes in patients with cancer treatment-related lymphoedema (CTRL). METHODS PubMed, Medline (Ovid) and Embase databases were searched between January 1974 and December 2019. Full-length articles where VLNT was the sole therapeutic procedure for CTRL, reporting volumetric limb, frequency of infection episodes and/or lymphoedema-specific quality-of-life data, were included in a random-effects meta-analysis of circumferential reduction rate (CRR). Methodological quality was assessed using STROBE/CONSORT, and a novel, lymphoedema-specific scoring tool was used to assess lymphoedema-specific methodological reporting. Sensitivity analyses on the site of VLNT harvest and recipient location were performed. RESULTS Thirty-one studies (581 patients) were eligible for inclusion. VLNT led to significant limb volume reductions in UL (above elbow pooled CRRs [CRRP] = 42.7% [95% confidence interval (CI): 36.5-48.8]; below elbow CRRP = 34.1% [95% CI: 33.0-35.1]) and LL (above knee CRRP = 46.8% [95% CI: 43.2-50.4]; below knee CRRP = 54.6% [95% CI: 39.0-70.2]) CTRL. VLNT flaps from extra-abdominal donor sites were associated with greater volume reductions (CRRP = 49.5% [95% CI: 46.5-52.5]) than those from intra-abdominal donor sites (CRRP = 39.6% [95% CI: 37.2-42.0]) and synchronous autologous breast reconstruction/VLNT flaps (CRRP = 32.7% [95% CI: 11.1-54.4]) (p < 0.05). VLNT was also found to reduce the mean number of cellulitis episodes by 2.1 episodes per year (95% CI: -2.7- -1.4) and increased lymphoedema-specific quality-of-life scores (mean difference in Lymphoedema-Specific Quality of Life (LYMQOL) "overall domain" = +4.26). CONCLUSIONS VLNT is effective in reducing excess limb volume and cellulitis episodes in both UL and LL lymphoedema after cancer treatment. However, significant heterogeneity exists in outcome reporting, and standardisation of reporting processes is recommended.
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Affiliation(s)
- Joseph Ward
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ian King
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Maria Monroy-Iglesias
- Department of Translational Oncology and Urology Research, King's College London, London, UK
| | - Beth Russell
- Department of Translational Oncology and Urology Research, King's College London, London, UK
| | - Mieke van Hemelrijck
- Department of Translational Oncology and Urology Research, King's College London, London, UK
| | - Kelvin Ramsey
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Aadil A Khan
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, London, UK.
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Cibula D, Borčinová M, Marnitz S, Jarkovský J, Klát J, Pilka R, Torné A, Zapardiel I, Petiz A, Lay L, Sehnal B, Ponce J, Felsinger M, Arencibia-Sánchez O, Kaščák P, Zalewski K, Presl J, Palop-Moscardó A, Tingulstad S, Vergote I, Redecha M, Frühauf F, Köhler C, Kocián R. Lower-Limb Lymphedema after Sentinel Lymph Node Biopsy in Cervical Cancer Patients. Cancers (Basel) 2021; 13:cancers13102360. [PMID: 34068399 PMCID: PMC8153612 DOI: 10.3390/cancers13102360] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Lower-limb lymphedema (LLL) is a well-recognized adverse outcome of the surgical management of cervical cancer. Recently, sentinel lymph node (SLN) biopsy has emerged as an alternative procedure to systematic pelvic lymphadenectomy (PLND) aiming to decrease the risk of complications, especially LLL development. Our study represents the first prospective analysis of LLL incidence in cervical cancer patients after a uterine procedure with SLN biopsy, without systematic PLND. In an international multicenter trial SENTIX, the group of 150 patients was prospectively evaluated using both objective and subjective LLL assessments in 6 months intervals for 2 years. Contrary to the expectations, our results showed that SLN biopsy does not eliminate the risk of LLL development which occurred in a mild or moderate stage in about 26% of patients with a median interval to the onset of 9 months. Abstract Background: To prospectively assess LLL incidence among cervical cancer patients treated by uterine surgery complemented by SLN biopsy, without PLND. Methods: A prospective study in 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy. Objective LLL assessments, based on limb volume increase (LVI) between pre- and postoperative measurements, and subjective patient-perceived swelling were conducted in six-month periods over 24-months post-surgery. Results: The cumulative incidence of LLL at 24 months was 17.3% for mild LLL (LVI 10–19%), 9.2% for moderate LLL (LVI 20–39%), while only one patient (0.7%) developed severe LLL (LVI > 40%). The median interval to LLL onset was nine months. Transient edema resolving without intervention within six months was reported in an additional 22% of patients. Subjective LLL was reported by 10.7% of patients, though only a weak and partial correlation between subjective-report and objective-LVI was found. No risk factor directly related to LLL development was identified. Conclusions: The replacement of standard PLND by bilateral SLN biopsy in the surgical treatment of cervical cancer does not eliminate the risk of mild to moderate LLL, which develops irrespective of the number of SLN removed.
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Affiliation(s)
- David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
- Correspondence: ; Tel.: +420-224-967-451
| | - Martina Borčinová
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
| | - Simone Marnitz
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (S.M.); (C.K.)
| | - Jiří Jarkovský
- Data Analysis Department, Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
| | - Jaroslav Klát
- Department of Obstetrics and Gynecology, University Hospital Ostrava, 70800 Ostrava Poruba, Czech Republic;
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, 77900 Olomouc, Czech Republic;
| | - Aureli Torné
- Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clinic-Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain;
| | - Almerinda Petiz
- Serviço de Ginecologia, Instituto Portugues de Oncologia do Porto, 1099-023 Porto, Portugal;
| | - Laura Lay
- Department of Gynaecology, Institute of Oncology Angel H Roffo University of Bueno s Aires, Buenos Aires C1417 DTB, Argentina;
| | - Borek Sehnal
- Department of Obstetrics and Gynecology, First Faculty of Medicine, University Hospital Bulovka, Charles University, 18081 Prague, Czech Republic;
| | - Jordi Ponce
- Department of Gynecology, Biomedical Research Institute of Bellvitge (IDIBELL), University Hospital of Bellvitge, University of Barcelona, 08908 Barcelona, Spain;
| | - Michal Felsinger
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, 60177 Brno, Czech Republic;
| | - Octavio Arencibia-Sánchez
- Departments of Gynecologic Oncology, University Hospital of the Canary Islands, 35016 Las Palmas de Gran Canaria, Spain;
| | - Peter Kaščák
- Department of Obstetrics and Gynecology, Faculty Hospital Trencin, 911 71 Trencin, Slovakia;
| | - Kamil Zalewski
- Department of Gynecologic Oncology, Holycross Cancer Center, 25-734 Kielce, Poland;
| | - Jiri Presl
- Department of Obstetrics and Gynecology, Faculty of Medicine Pilsen, University Hospital in Pilsen and Charles University, 30460 Pilsen, Czech Republic;
| | - Alicia Palop-Moscardó
- Gynecology Department, Instituto Valenciano de Oncologia (IVO), 46009 Valencia, Spain;
| | - Solveig Tingulstad
- Department of Obstetrics and Gynecology, Trondheim University Hospital, 7030 Trondheim, Norway;
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Leuven Cancer Institute, University Hospital Leuven, 3000 Leuven, Belgium;
| | - Mikuláš Redecha
- Department of Gynaecology and Obstetrics, University Hospital, Comenius University, 814 99 Bratislava, Slovakia;
| | - Filip Frühauf
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
| | - Christhardt Köhler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (S.M.); (C.K.)
| | - Roman Kocián
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
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Bok SK, Cho DJ, Yoo HJ, Ahn SY. Body Fluid Trend and Prevalence of Lymphedema After Gynecological Cancer Surgery. Lymphat Res Biol 2021; 20:185-190. [PMID: 33970692 DOI: 10.1089/lrb.2020.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed at understanding the trend in extracellular fluid (ECF) change and estimating the efficacy of the early complex decongestive therapy (CDT) program in terms of prevalence of lower limb lymphedema, as well as at identifying the quality of life (QoL) associated with response to CDT after gynecological cancer therapy. Methods and Results: Thirty-one patients undergoing gynecological cancer treatment were enrolled and randomly assigned to the CDT and control groups. In the CDT group, CDT was started within 2 weeks after surgery for 30 minutes a day, for 2 weeks (5 days per week). The patients' QoL was assessed through the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire; version 3. Inbody S10® (Biospace, Seoul, South Korea) was used to calculate the ECF. The assessment was performed at pre- and post-surgery and at 3, 6, and 12 months after surgery. Statistically significant differences, in favor of the CDT group, were encountered at the 3-month follow-up visit, especially with respect to the QoL score. Regarding the prevalence of lymphedema, no significant difference was observed between groups. The mean value of the impedance ratio was low in the CDT group during the entire 12 month follow-up. Conclusions: The results of the present study show that early CDT had a positive effect on the prevalence of lymphedema and body composition. Long-term follow-up studies with a larger sample size are needed to warrant the time-group effect of early rehabilitation.
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Affiliation(s)
- Soo Kyung Bok
- Department of Rehabilitation Medicine and College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Dong Joon Cho
- Department of Rehabilitation Medicine and College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Heon Jong Yoo
- Department of Obstetrics and Gynecology, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - So Young Ahn
- Department of Rehabilitation Medicine and College of Medicine, Chungnam National University, Daejeon, South Korea
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Lakhman Y, Vargas HA, Reinhold C, Akin EA, Bhosale PR, Huang C, Kang SK, Khanna N, Kilcoyne A, Nicola R, Paspulati R, Rauch GM, Shinagare AB, Small W, Glanc P. ACR Appropriateness Criteria® Staging and Follow-up of Vulvar Cancer. J Am Coll Radiol 2021; 18:S212-S228. [PMID: 33958115 DOI: 10.1016/j.jacr.2021.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/21/2022]
Abstract
Vulvar cancer is an uncommon gynecologic tumor and one of several human papillomavirus-associated malignancies. Squamous cell carcinoma is the most prevalent histologic subtype of vulvar cancer, accounting for the majority of cases. Imaging plays an important role in managing vulvar cancer. At initial diagnosis, imaging is useful to assess the size and extent of primary tumor and to evaluate the status of inguinofemoral lymph nodes. If recurrent disease is suspected, imaging is essential to demonstrate local extent of tumor and to identify lymph node and distant metastases. In this publication, we summarize the recent literature and describe the panel's recommendations about the appropriate use of imaging for various phases of patient management including initial staging, surveillance, and restaging of vulvar cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Hebert Alberto Vargas
- Memorial Sloan Kettering Cancer Center, New York, New York, Chief, Body Imaging Service, Memorial Sloan Kettering Cancer Center
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | | | - Chenchan Huang
- New York University Langone Medical Center, New York, New York
| | - Stella K Kang
- New York University Medical Center, New York, New York
| | - Namita Khanna
- Emory University, Atlanta, Georgia, Society of Gynecologic Oncology
| | | | - Refky Nicola
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, Buffalo, New York
| | | | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Atul B Shinagare
- Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois, Professor and Chairman, Department of Radiation Oncology, Loyola University, Director, Cardinal Bernardin Cancer Center
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Eidenberger M. Patient-Reported Outcome Measures With Secondary Lower Limb Lymphedemas: A Systematic Review. J Adv Pract Oncol 2021; 12:174-187. [PMID: 34109049 PMCID: PMC8017801 DOI: 10.6004/jadpro.2021.12.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Patient-reported outcome measures are measures of patients' health-related quality of life. They should be added to other lymphedema measurements. With an improved disease-free survival of secondary lower limb lymphedema, attention must focus on such assessments. Objective The objectives of this study were to locate and critically appraise suitable patient-reported outcomes measures for lower limb lymphedemas and search for existing valid translations for native German speakers. Methods A systematic literature research was conducted. 20 semantical categories for qualitative analysis were evolved. Six questionnaires available in English and some in validated translations remained for analysis. Results Lower limb lymphedema patients experience poor quality of life, and one of the most critical denominators is skin quality. To establish skin care and prevent cellulitis, patients must learn about skin problems. Only two tools asked for past infections. This is considered crucial because of knowledge building and prophylactic behavior. Questions on movement restrictions were available in one questionnaire. As these have a close connection to one's ability to perform activities of daily life, they can affect quality of life. Afflicted patients have problems with the choice and availability of clothing. Only three questionnaires asked questions about clothing or shoes. Lymphedema patients are exposed to more psychological stress than healthy subjects, but only three questionnaires covered questions about this burden. There was a lack of reporting on psychometric data (Cronbach's alpha, intraclass correlation), which hinders the external validity. Analyzed questionnaires were available in English but only one in German. Conclusions The analyzed questionnaires were in English, and only one was adapted and tested for native German speakers. For clinical practice, Devoogdt's questionnaire is recommended despite some shortcomings. There is a need for validated lymphedema questionnaires in German.
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Affiliation(s)
- Margit Eidenberger
- University of Applied Sciences for Health Professions Upper Austria, Steyr, Austria
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37
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Jia W, Hitchcock-Szilagyi H, He W, Goldman J, Zhao F. Engineering the Lymphatic Network: A Solution to Lymphedema. Adv Healthc Mater 2021; 10:e2001537. [PMID: 33502814 PMCID: PMC8483563 DOI: 10.1002/adhm.202001537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/06/2020] [Indexed: 12/18/2022]
Abstract
Secondary lymphedema is a life-long disorder characterized by chronic tissue swelling and inflammation that obstruct interstitial fluid circulation and immune cell trafficking. Regenerating lymphatic vasculatures using various strategies represents a promising treatment for lymphedema. Growth factor injection and gene delivery have been developed to stimulate lymphangiogenesis and augment interstitial fluid resorption. Using bioengineered materials as growth factor delivery vehicles allows for a more precisely targeted lymphangiogenic activation within the injured site. The implantation of prevascularized lymphatic tissue also promotes in situ lymphatic capillary network formation. The engineering of larger scale lymphatic tissues, including lymphatic collecting vessels and lymph nodes constructed by bioengineered scaffolds or decellularized animal tissues, offers alternatives to reconnecting damaged lymphatic vessels and restoring lymph circulation. These approaches provide lymphatic vascular grafting materials to reimpose lymphatic continuity across the site of injury, without creating secondary injuries at donor sites. The present work reviews molecular mechanisms mediating lymphatic system development, approaches to promoting lymphatic network regeneration, and strategies for engineering lymphatic tissues, including lymphatic capillaries, collecting vessels, and nodes. Challenges of advanced translational applications are also discussed.
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Affiliation(s)
- Wenkai Jia
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77845
| | | | - Weilue He
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Jeremy Goldman
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Feng Zhao
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77845
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Togami S, Kubo R, Kawamura T, Yanazume S, Kamio M, Kobayashi H. Risk factors for lymphatic complications following lymphadenectomy in patients with endometrial cancer. Taiwan J Obstet Gynecol 2021; 59:420-424. [PMID: 32416891 DOI: 10.1016/j.tjog.2020.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Lymph node (LN) metastasis is among the important prognostic factors for survival in endometrial cancer (EC). This study aimed to evaluate the occurrence of lymphatic complications following lymphadenectomy in patients with EC. MATERIALS AND METHODS EC patients were retrospectively evaluated. Lower extremity lymphedema (LEL) and pelvic lymphocele (PL) were evaluated according to the International Society of Lymphology guidelines and the National Cancer Institute Common Terminology Criteria for Adverse Events, respectively. RESULTS A total of 289 patients were enrolled. Surgery was performed via laparotomy and laparoscopy in 200 (69.2%) and 89 (30.8%) patients, respectively. LEL and PL occurred in 43 (14.9%) and 33 (11.4%) patients, respectively. In multivariate logistic regression analysis, circumflex iliac node (CIN) removal (odds ratio [OR]: 3.22; 95% CI: 1.43-7.98; P = 0.004) was an independent risk factor for LEL, while the surgical approach (OR: 4.46; 95% CI: 1.13-29.9; P = 0.004) was an independent risk factor for PL. CONCLUSION CIN dissection was a significant risk factor for LEL, while laparotomy was an independent risk factor for PL compared to laparoscopy in EC patients. This suggests that laparoscopic surgery combined with sentinel lymph node navigation surgery will prevent lymphatic complications in low-risk EC patients.
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Affiliation(s)
- Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Japan.
| | - Rintaro Kubo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Japan
| | - Toshihiko Kawamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Japan
| | - Shintaro Yanazume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Japan
| | - Masaki Kamio
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Japan
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Abstract
Well executed multicenter clinical trials often provide significant evidence and support for, or against, foundational aspects of clinical procedures perceived to improve clinical management of a medical condition. In this review, discussed are reports of multicenter clinical trials designed to investigate sentinel lymph node biopsy procedures in seven types of cancer: breast, melanoma, head and neck, gastric, colon, uterine, and vulvar-with focus on the most recent reports of the hypotheses, objectives, parameters, data, results, implications, and impacts of the included trials. Such trials generally enroll more subjects, in shorter time periods, than do single-center studies. Such studies generally also have greater diversities among investigator practitioners and investigative environments than do single-center studies. The greater number of subjects provides more power to statistical analyses performed in such studies. The more rapid accrual usually results in data being more consistently acquired. The diversities of practitioners and environments may produce results that are more conservative than might be obtained from more "focused" studies; however, diversities in a study often identify implicitly results that are more robust-that is results applicable by more practitioners and applicable in more environments.
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Affiliation(s)
- Valeria M Moncayo
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Erin E Grady
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Naomi P Alazraki
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA; Nuclear Medicine Service, Atlanta Veterans Affairs Healthcare System, Decatur, GA
| | - John N Aarsvold
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA; Nuclear Medicine Service, Atlanta Veterans Affairs Healthcare System, Decatur, GA.
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Lymph Node to Vein Anastomosis (LNVA) for lower extremity lymphedema. J Plast Reconstr Aesthet Surg 2021; 74:2059-2067. [PMID: 33640308 DOI: 10.1016/j.bjps.2021.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 12/02/2020] [Accepted: 01/23/2021] [Indexed: 11/21/2022]
Abstract
The microsurgical options for lower limb lymphedema is a challenge. In search to improve the overall result, we hypothesized it would be beneficial to add the functioning lymph nodes to vein anastomosis (LNVA) in addition to lymphovenous anastomosis (LVA). This is a retrospective study of 160 unilateral stage II & III lower extremity lymphedema comparing the outcome between the LNVA + LVA group and the LVA only group from May 2013 to June 2018. MRI was used to identify the functioning lymph nodes. Patient outcome, including lower extremity circumference, body weight, bio impedance test, and other data were analyzed to evaluate whether lymph nodes to vein anastomosis (LNVA) improved outcome. The LNVA + LVA group showed significantly better results for circumference reduction rate, body weight reduction rate, and extracellular fluid reduction rate of the affected limb as compared to the LVA only group for both stage II and III lymphedema. The MRI imaging revealed that 9 cases had no identifiable lymph nodes of the affected limb and 54 cases with a nonfunctioning lymph node upon exploration despite positive imaging. Correlation showed the lymph node size needed to be at least 8 mm in the MRI to be functional. The LNVA + LVA approach for lymphedema has the benefit of better reduction as compared to LVA alone in the lower limb as well as the suprapubic region. Preoperative MRI will help to identify the functioning lymph node by increasing the overall probability of positive outcome.
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Hoppenot C, Littell RD, DeEulis T, Hartenbach EM. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Cervical Cancer. J Palliat Med 2021; 24:438-442. [PMID: 33513069 DOI: 10.1089/jpm.2021.0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cervical cancer is the most common gynecologic cancer worldwide. Almost all are related to human papillomavirus exposure. Cervical cancer treatment is associated with significant morbidity that is likely to require support from palliative care teams. In these pearls on cervical cancer, we hope to inform providers about the common treatments and issues for cervical cancer patients. Treatment modalities include surgery for early-stage disease, radiation therapy for locally advanced disease, and pelvic exenteration, chemotherapy, or immunotherapy for recurrent disease. Cervical cancer causes pain and bleeding. Radiation can affect ovarian, urinary, and bowel function. Chemotherapy and immunotherapy are associated with fatigue and nausea. Fistulas between the vagina and bowel or bladder can occur due to cancer or to cancer treatments. Physical and emotional supportive care is important for women with cervical cancer.
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Affiliation(s)
- Claire Hoppenot
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Ramey D Littell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, San Francisco, California, USA
| | - Timothy DeEulis
- Division of Gynecologic Oncology, Huntington, West Virginia, USA
| | - Ellen M Hartenbach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin, USA
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Shallwani SM, Towers A, Newman A, Salvador S, Yung A, Gilbert L, Gotlieb WH, Zeng X, Thomas D. Feasibility of a Pilot Randomized Controlled Trial Examining a Multidimensional Intervention in Women with Gynecological Cancer at Risk of Lymphedema. Curr Oncol 2021; 28:455-470. [PMID: 33450972 PMCID: PMC7903266 DOI: 10.3390/curroncol28010048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 01/21/2023] Open
Abstract
There is limited knowledge on non-invasive lymphedema risk-reduction strategies for women with gynecological cancer. Understanding factors influencing the feasibility of randomized controlled trials (RCTs) can guide future research. Our objectives are to report on the design and feasibility of a pilot RCT examining a tailored multidimensional intervention in women treated for gynecological cancer at risk of lymphedema and to explore the preliminary effectiveness of the intervention on lymphedema incidence at 12 months. In this pilot single-blinded, parallel-group, multi-centre RCT, women with newly diagnosed gynecological cancer were randomized to receive post-operative compression stockings and individualized exercise education (intervention group: IG) or education on lymphedema risk-reduction alone (control group: CG). Rates of recruitment, retention and assessment completion were recorded. Intervention safety and feasibility were tracked by monitoring adverse events and adherence. Clinical outcomes were evaluated over 12 months: presence of lymphedema, circumferential and volume measures, body composition and quality of life. Fifty-one women were recruited and 36 received the assigned intervention. Rates of recruitment and 12-month retention were 47% and 78%, respectively. Two participants experienced post-operative cellulitis, prior to intervention delivery. At three and six months post-operatively, 67% and 63% of the IG used compression ≥42 h/week, while 56% engaged in ≥150 weekly minutes of moderate-vigorous exercise. The cumulative incidence of lymphedema at 12 months was 31% in the CG and 31.9% in the IG (p = 0.88). In affected participants, lymphedema developed after a median time of 3.2 months (range, 2.7-5.9) in the CG vs. 8.8 months (range, 2.9-11.8) in the IG. Conducting research trials exploring lymphedema risk-reduction strategies in gynecological cancer is feasible but challenging. A tailored intervention of compression and exercise is safe and feasible in this population and may delay the onset of lymphedema. Further research is warranted to establish the role of these strategies in reducing the risk of lymphedema for the gynecological cancer population.
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Affiliation(s)
- Shirin M. Shallwani
- Lymphedema Program, McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.T.); (A.N.); (A.Y.); (D.T.)
- Physiotherapy Department, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Anna Towers
- Lymphedema Program, McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.T.); (A.N.); (A.Y.); (D.T.)
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
| | - Anne Newman
- Lymphedema Program, McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.T.); (A.N.); (A.Y.); (D.T.)
| | - Shannon Salvador
- Gynecologic Oncology Program, Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (S.S.); (W.H.G.)
| | - Angela Yung
- Lymphedema Program, McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.T.); (A.N.); (A.Y.); (D.T.)
- Physiotherapy Department, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Lucy Gilbert
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC H4A 3J1, Canada;
- Gynecologic Oncology Division, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Walter H. Gotlieb
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Gynecologic Oncology Program, Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (S.S.); (W.H.G.)
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Xing Zeng
- Gynecologic Oncology Division, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Doneal Thomas
- Lymphedema Program, McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.T.); (A.N.); (A.Y.); (D.T.)
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Shylasree TS, Ranade R, Kattepur AK, Kaur S, Dusane R, Maheshwari A, Mahantshetty U, Chopra S, Engineer R, Kerkar RA. Quality of life in long term survivors of cervical cancer: A cross sectional study. Indian J Cancer 2021; 58:171-178. [PMID: 34100410 DOI: 10.4103/ijc.ijc_712_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Quality of life (QOL) is an important parameter to evaluate and modify in patients treated for cervical cancer as long-term survival is excellent in early-stage and reasonably good in locally advanced stage compared to other solid cancers. The aim of the study was the cross sectional evaluation of the quality of life in survivors completing at least 3 years of follow-up after curative therapy for cervical cancer at a tertiary cancer institute. Methods All patients, following primary curative treatment with no evidence of recurrence and completing at least 3 years follow-up, were assessed for QOL using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-30 and its cervical cancer module (Cx24). Patients were subdivided based on the modality of treatment. Analysis was done using Kruskal-Wallis and Mann-Whitney U test. Results One hundred seven patients were analyzed out of the 113 patients initially included. Treated patients showed good global QOL (mean value: 84.07) and functional scores (covering all domains). In the cervical cancer module, sexual activity, sexual enjoyment, and sexual function were low in the majority of the respondents. Chronic lymphedema, symptom experience, and sexual worry were significant across all the treatment arms. Conclusion Cervical cancer survivors have an overall good QOL. However, certain concerns related to the sexual quality of life, symptom experience, and chronic lymphedema need to be addressed appropriately.
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Affiliation(s)
- T S Shylasree
- Department of Gynecological Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Rohit Ranade
- Department of Gynecological Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Abhay K Kattepur
- Department of Gynecological Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Satinder Kaur
- Department of Gynecological Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Rohit Dusane
- Department of Biostatistics and Clinical Research Methodology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Department of Gynecological Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Rajendra A Kerkar
- Department of Gynecological Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, Maharashtra, India
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Devenney K, Murphy N, Ryan R, Grant C, Kennedy J, Manecksha RP, Sheils O, McNeely ML, Hussey J, Sheill G. The feasibility of implementing an exercise programme for deconditioned cancer survivors in a national cancer centre: FIXCAS Study. HRB Open Res 2020; 2:24. [PMID: 33870087 PMCID: PMC8030104 DOI: 10.12688/hrbopenres.12925.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction: As both the number of cancer survivors and the length of survival time are increasing, long-term health issues related to cancer and its treatment are becoming more prevalent. Research suggests that exercise can mitigate several negative health consequences in cancer survivors and improve physical function and quality of life. Multi-modal exercise interventions have been proposed as a cornerstone for survivorship care. However, studies evaluating exercise programmes within the Irish population are lacking. Purpose: To evaluate the introduction, implementation and acceptability of a multi-modal exercise rehabilitation programme for deconditioned cancer survivors in a real-world, standard practice setting. Methods and analysis: In this single-arm prospective feasibility study, cancer survivors (n=40) will undergo a 10-week multi-modal exercise programme. The study population will comprise of cancer survivors attending outpatient services in an Irish national cancer centre. Participants will be aged 18 or older and have completed treatment with curative intent. Feasibility will be evaluated in terms of recruitment, adherence and compliance to the programme. Secondary outcomes will examine physical function and quality of life measures. In addition, the acceptability of the programme will be assessed through stakeholder feedback. Ethics and dissemination: Ethical approval through the St. James's Hospital and Tallaght University Hospital Research and Ethics Committee is currently pending. The study results will be used to optimise the intervention content and may serve as the foundation for a larger definitive trial. Results will be disseminated through peer-review journals, congresses and relevant clinical groups. Trial registration: ClinicalTrials.gov NCT04026659 (19/07/19).
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Affiliation(s)
| | | | - Ronan Ryan
- St. James's Hospital, Dublin, Dublin, Ireland
| | | | | | - Rustom P. Manecksha
- University of Dublin, Dublin, Ireland
- St. James's Hospital, Dublin, Dublin, Ireland
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Glaser G, Dinoi G, Multinu F, Yost K, Al Hilli M, Larish A, Kumar A, McGree M, Weaver AL, Cheville A, Dowdy S, Mariani A. Reduced lymphedema after sentinel lymph node biopsy versus lymphadenectomy for endometrial cancer. Int J Gynecol Cancer 2020; 31:85-91. [DOI: 10.1136/ijgc-2020-001924] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022] Open
Abstract
ObjectiveEndometrial cancer surgical staging includes lymph node assessment which can lead to lower extremity lymphedema. The aim of this study was to estimate prevalence after sentinel lymph node biopsy versus lymphadenectomy.MethodsConsecutive patients who underwent minimally invasive surgery at the Mayo Clinic, Rochester, Minnesota, USA, between January 2009 and June 2016 for newly diagnosed endometrial cancer were mailed our validated 13 item lower extremity lymphedema screening questionnaire. We also ascertained via questionnaire whether the patient was ever diagnosed with lower extremity lymphedema.ResultsAmong 378 patients included in the analysis, 127 (33.5%) had sentinel lymph node biopsy with or without side specific lymphadenectomy (sentinel lymph node cohort) and 251 (66.4%) underwent bilateral lymphadenectomy prior to sentinel lymph node biopsy implementation at our institution or as 'backup' after sentinel lymph node mapping (lymphadenectomy cohort). The prevalence of lower extremity lymphedema was 41.5% (157/378), with 69 patients (18.3%) self-reporting a lower extremity lymphedema diagnosis after their endometrial cancer surgery at a median of 54.3 months (interquartile range 31.2–70.1 months), and an additional 88 patients (23.3%) identified by the screening questionnaire. The prevalence of lower extremity lymphedema was significantly higher in the lymphadenectomy cohort compared with the sentinel lymph node group (49.4% (124/251) vs 26.0% (33/127); p<0.001). When the cohorts were restricted to patients surgically managed after the introduction of sentinel lymph node, the prevalence of lower extremity lymphedema was still significantly higher in the lymphadenectomy cohort compared with the sentinel lymph node cohort (39.0% (41/105) vs 26.0% (33/127); p=0.03). In a multivariable analysis adjusted for body mass index, receipt of adjuvant external beam radiation, diabetes, congestive heart failure, and International Federation of Gynecology and Obstetrics grade, the adjusted odds ratio for the association between type of nodal sampling (lymphadenectomy cohort vs sentinel lymph node cohort) and lower extremity lymphedema was 2.75 (95% confidence interval 1.69 to 4.47, p<0.001).ConclusionsSentinel lymph node biopsy was associated with a decreased risk of post-treatment lymphedema compared with lymphadenectomy in patients who underwent surgical staging for endometrial carcinoma.
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Cea García J, Márquez Maraver F, Rodríguez Jiménez I, Ríos-Pena L, Rubio Rodríguez MDC. Treatment and Impact of Cervical-Cancer-Related Lymphatic Disorders on Quality of Life and Sexuality Compared with Controls. Lymphat Res Biol 2020; 19:274-285. [PMID: 33226889 DOI: 10.1089/lrb.2020.0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Lymphatic disorders are frequent complications related to treatment for cervical cancer (CC). The aims of the study are to evaluate the impact of lymphatic disorders on quality of life (QOL) and sexuality in CC survivors after the completion of oncological treatment and to compare them with controls. Methods and Results: An ambispective cohort study was performed by using the Functional Assessment Cancer Therapy (FACT)-Cervix (Cx) fourth version, the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF), and the Female Sexual Function Index (FSFI). Twelve patients affected by lymphatic disorders comprised the study group, 251 comprised the CC control group, and 185 comprised the non-CC control group. Regarding QOL, there were no statistically significant differences between the lymphatic disorder-unaffected and non-CC control groups, except in the WHOQOL-BREF environment domain. A weak positive correlation between lymphatic disorder and FACT-Cx additional concerns (σ = 0.135) was observed. Regarding sexuality, a weak negative correlation was detected between lymphatic disorders and FSFI sexual satisfaction (σ = -0.200) and a weak positive correlation was observed between lymphatic disorders and FSFI dyspareunia (σ = 0.148). We did not observe statistically significant differences in QOL satisfaction between the lymphatic disorder-affected and non-CC control groups. Symptomatic controls reported significantly higher physical health scores than the lymphatic disorder-affected group (p < 0.05). Regarding the psychological domain, the asymptomatic controls obtained significantly higher scores than the lymphatic disorder-affected group (p = 0.003). Conclusions: Lymphatic disorders notably influenced the QOL of CC survivors compared with the non-CC control groups. Lymphatic disorders had a significant negative impact on physical and psychological health. Sexuality was scarcely affected by lymphatic disorders.
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Affiliation(s)
- Jorge Cea García
- Clinical Management Unit for Obstetrics and Gynecology, University Hospital Virgen Macarena, Seville, Spain
| | - Francisco Márquez Maraver
- Advanced Gynecological Surgery Unit for Women in Ginemed-INSEGO, Vithas-Nisa Aljarafe Hospital, Castilleja de la Cuesta, Spain
| | | | - Laura Ríos-Pena
- Institute of Science and Technology of the Loyola University, Dos Hermanas, Spain
| | - María Del Carmen Rubio Rodríguez
- Department of Radiation Oncology, HM University Sanchinarro Hospital, Madrid, Spain.,HM University Puerta del Sur Hospital, Móstoles, Madrid, Spain
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Cea García J, Rodríguez Jiménez I, Ríos-Pena L, Márquez Mareaver F, Rubio Rodríguez MDC. Incidence and univariate models for lymphatic drainage disorders following management for cervical cancer. J Obstet Gynaecol Res 2020; 47:343-351. [PMID: 33191618 DOI: 10.1111/jog.14530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022]
Abstract
AIM To clarify the incidence of lymphatic drainage disorders (LLD) after treatment for cervical cancer (CC) and to establish univariate models for their occurrence. METHODS A total of 263 eligible patients with CC were identified between 2010 and 2019. We conducted a case-control study and divided the study population into two subsamples of 12 and 251 CC survivors based on the presence/absence of LLD, respectively. The cumulative incidence was evaluated using the Kaplan-Meier method. Univariate models based on Pearson correlation coefficient were used to evaluate associations between explanatory variables and LLD. RESULTS The cumulative incidence of LLD began at 3.3% after the 7-month follow-up, reaching a plateau of 21.2% between 130 and 250 months of follow-up. We detected correlation between LLD and number of removed para-aortic lymph nodes (r = -0.39), number of pelvic lymphadenopathies (r = 0.16), pelvic lymphadenectomy (PL) (r = 0.16), age at diagnosis of CC (r = -0.1) and primary surgery (r = 0.1). CONCLUSION We observed a cumulative incidence of LLD of 21.2%, which is in accord with other retrospective studies. Number of removed para-aortic lymph nodes, number of pelvic lymphadenopathies, PL, age at diagnosis of CC and primary surgery were the most influential clinical factors associated with the occurrence of LLD in CC survivors.
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Affiliation(s)
- Jorge Cea García
- Clinical Management Unit for Obstetrics and Gynecology, University Hospital Virgen Macarena, Seville, Spain
| | | | - Laura Ríos-Pena
- Institute of Science and Technology, Loyola University, Seville, Spain
| | | | - María Del Carmen Rubio Rodríguez
- Department of Radiation Oncology, HM University Sanchinarro Hospital, Madrid, Spain.,Department of Radiation Oncology, HM University Puerta del Sur Hospital, Madrid, Spain
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The Quality of Life and Psychosocial Implications of Cancer-Related Lower-Extremity Lymphedema: A Systematic Review of the Literature. J Clin Med 2020; 9:jcm9103200. [PMID: 33023211 PMCID: PMC7601061 DOI: 10.3390/jcm9103200] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/20/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Lower-extremity lymphedema (LEL) is a progressive, lifelong complication of cancer that places a substantial burden upon cancer survivors' quality of life (QOL) and psychosocial well-being. Despite its prevalence, cancer-related LEL is inconsistently diagnosed, treated, and poorly recognized by health care professionals. The purpose of this systematic review was to summarize and appraise the quantitative literature evaluating the impact of cancer-related LEL on patients' psychosocial well-being and QOL. Three databases (PubMed, PROQuest, and Scopus) were searched for observational research articles published before May 1st, 2020. Twenty-one articles were eligible (cross-sectional (n = 16), prospective cohort designs (n = 3), and retrospective cohort designs (n = 2)). The majority of studies reported a negative relationship between cancer-related LEL and global QOL and/or one or more psychosocial domains including (1) physical and functional; (2) psycho-emotional; (3) social, relational and financial. A greater number of LEL symptoms and higher LEL severity were associated with poorer QOL. Although the evidence to date suggests a negative relationship between cancer-related LEL and patients' QOL and psychosocial well-being, there is a substantial need for longitudinal analyses to examine the directionality and temporality of this effect in order to inform cancer survivorship care modelling and improve patient outcomes after cancer.
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Kim WJ, Kim J, Kang M, Park DH, Jeon JY. Usefulness of computed tomography venography in gynecologic cancer patients with lower extremity edema. Medicine (Baltimore) 2020; 99:e21818. [PMID: 32925718 PMCID: PMC7489682 DOI: 10.1097/md.0000000000021818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lower extremity (LEx) edema is a common complication in gynecologic cancer patients. There are 2 main causes of edema in these patients such as deep vein thrombosis (DVT) and lymphedema. Early diagnosis and treatment of DVT are certainly important, but it is often difficult to evaluate proximal DVT by using ultrasound. The aim of this study is to demonstrate the usefulness of computed tomography venography of the lower extremity (CTV LEx) for the diagnosis of the DVT and investigate predictive factor of DVT in gynecologic cancer patients with LEx edema.The medical records of 415 gynecologic cancer patients who were referred to the department of rehabilitation medicine with LEx edema were retrospectively reviewed in this case-controlled study. We categorized CTV LEx findings as follows: DVT proximal to the inguinal ligament (inferior vena cava or iliac vein thrombosis) and DVT distal to the inguinal ligament (femoral, popliteal, or calf vein thrombosis). We also evaluated patient characteristics including D-dimer level. We analyzed the correlation of each factor with DVT frequency and used receiver operating characteristic curve analysis to determine the appropriate D-dimer threshold.Sixty-six patients were diagnosed with DVT; of them, 35 (53%) had DVT proximal to the inguinal ligament. Twenty-two patients were diagnosed with pulmonary embolism, of whom 15 had proximal DVT. Patients with proximal DVT tended to have pulmonary embolism (P < .001). Distal organ metastasis (odds ratio [OR], 2.88; P = .002) and a high D-dimer level (OR, 1.13; P = .001) were correlated with DVT.CTV LEx is a useful diagnostic tool for gynecologic cancer patients with LEx edema, particularly high-risk patients, that should be performed at the initial evaluation.
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Cellina M, Martinenghi C, Panzeri M, Soresina M, Menozzi A, Daniele G, Oliva G. Noncontrast MR Lymphography in Secondary Lower Limb Lymphedema. J Magn Reson Imaging 2020; 53:458-466. [PMID: 32798265 DOI: 10.1002/jmri.27328] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Invasive imaging techniques have been applied for lymphedema (LE) assessment; noncontrast MR lymphography (NCMLR) has potential as an alternative, but its performance is not known in secondary lower limb LE. PURPOSE To assess the role of NCMRL for the classification and characterization of secondary lower limb LE. STUDY TYPE Retrospective. POPULATION Fifty adults with clinically diagnosed secondary LE. FIELD STRENGTH/SEQUENCE 1.5T, 3D T2 -weighted turbo spin-echo, 3D T2 -weighted turbo spin-echo short tau inversion recovery. ASSESSMENT Three radiologists assessed the following characteristics on NCMRL: honeycomb pattern, dermal thickening, muscular abnormalities, distal dilated lymphatics, inguinal lymph node number, appearance of iliac lymphatic trunks. An LE grading based on the MR images was assigned. The relationship between imaging findings and clinical staging was evaluated, as well as between dermal backflow at lymphoscintigraphy and MR staging, and between the limb swelling duration and peripheral lymphatics dilatation. STATISTICAL TESTS Pearson's correlation test and Cramer's V coefficient were computed to measure the strength of association. The Mann-Whitney test was used to compare the limb swelling duration between patients with and without dilated distal vessels. Agreement among raters was assessed through Kendall's W coefficient of correlation. RESULTS Clinical stage and the MR grading were correlated, with Cramer's V coefficient of 1 for reader 1 (P < 0.05), 0.846 for reader 2 (P < 0.05), and 0.912 (P < 0.05) for reader 3; agreement between interraters was very good (W = 0.0.75; P = 0.05). A honeycomb pattern (P < 0.05), dermal thickening (P < 0.001), muscular abnormalities (P < 0.05), iliac lymphatic trunks appearance (P < 0.05), distal dilated vessels (P < 0.05), and lymph nodes number (P < 0.05) were significantly correlated with LE clinical stage. Dermal backflow at lymphoscintigraphy was described in 10 (20%) patients and showed a significant correlation with the MR grading (P < 0.05). DATA CONCLUSION These preliminary results suggest that NCMRL may provide information useful for the staging and management of patients affected by secondary lower limb LE. Level of Evidence 4 Technical Efficacy Stage 2 J. MAGN. RESON. IMAGING 2021;53:458-466.
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Affiliation(s)
| | | | - Marta Panzeri
- Radiology Department, San Raffaele Hospital, Milan, Italy
| | - Massimo Soresina
- Plastic Surgery Department, Fatebenefratelli Hospital, Milan, Italy
| | - Andrea Menozzi
- Plastic Surgery Department, Fatebenefratelli Hospital, Milan, Italy
| | - Gibelli Daniele
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Giancarlo Oliva
- Radiology Department, Fatebenefratelli Hospital, Milan, Italy
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