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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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Kleeven A, Jonis YMJ, Tielemans H, van Kuijk S, Kimman M, van der Hulst R, Vasilic D, Hummelink S, Qiu SS. The N-LVA Study: effectiveness and cost-effectiveness of lymphaticovenous anastomosis (LVA) for patients with cancer who suffer from chronic peripheral lymphoedema - study protocol of a multicentre, randomised sham-controlled trial. BMJ Open 2024; 14:e086226. [PMID: 38626967 PMCID: PMC11029230 DOI: 10.1136/bmjopen-2024-086226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Cancer-related lymphoedema is one of the most debilitating side-effects of cancer treatment with an overall incidence of 15.5%. Patients may suffer from a variety of symptoms, possibly resulting in a diminished health-related quality of life (HRQoL). A microsurgical technique known as lymphaticovenous anastomosis (LVA) might be a promising treatment option. The objective of this study is to evaluate whether LVA is effective and cost-effective compared with sham surgery in improving the HRQoL. METHODS AND ANALYSIS A multicentre, double-blind, randomised sham-controlled trial conducted in three university hospitals in the Netherlands. The study population comprises 110 patients over the age of 18 years with unilateral, peripheral cancer-related lymphoedema, including 70 patients with upper limb lymphoedema and 40 patients with lower limb lymphoedema. A total of 55 patients will undergo the LVA operation, while the remaining 55 will undergo sham surgery. The follow-up will be at least 24 months. Patients are encouraged to complete the follow-up by explaining the importance of the study. Furthermore, patients may benefit from regular monitoring moments for their lymphoedema. The primary outcome is the HRQoL. The secondary outcomes are the limb circumference, excess limb volume, changes in conservative therapy, postoperative complications, patency of the LVA and incremental cost-effectiveness. ETHICS AND DISSEMINATION The study was approved by the Medical Ethical Committee of Maastricht University Medical Center on 20 September 2023 (NL84169.068.23). The results will be presented at scientific conferences and published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT06082349.
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Affiliation(s)
- Alieske Kleeven
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Yasmine M J Jonis
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke Tielemans
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Merel Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - René van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dalibor Vasilic
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Hummelink
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shan Shan Qiu
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Tashiro K, Yoshioka Y, Ochiya T. Extracellular Vesicles from Adipose-Derived Stem Cells Relieve Extremity Lymphedema in Mouse Models. Plast Reconstr Surg 2023; 152:1011-1021. [PMID: 36877751 PMCID: PMC10586786 DOI: 10.1097/prs.0000000000010388] [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: 09/02/2021] [Accepted: 09/23/2022] [Indexed: 03/07/2023]
Abstract
BACKGROUND Transplantation of adipose-derived mesenchymal stem cells (ADSCs) has been reported to improve the severity of chronic lymphedema. Extracellular vesicles (EVs) derived from mesenchymal stem cells have been reported to exert effects such as the promotion of angiogenesis, suppression of inflammation, and regeneration of damaged organs. In this study, the authors show that lymphangiogenesis was induced by EVs derived from ADSCs and reveal the therapeutic potential of these EVs for the treatment of lymphedema. METHODS The authors examined the in vitro effects of ADSC-EVs to lymphatic endothelial cells (LECs). Next, they conducted an in vivo analysis of ADSC-EVs to mouse lymphedema models. Bioinformatics analysis was also performed to evaluate the implications of the altered microRNA expression. RESULTS The authors showed that ADSC-EVs promoted the proliferation, migration, and tube formation of LECs, and the gene expression of lymphatic markers was elevated in the ADSC-EV-treated group. Notably, a mouse lymphedema model revealed that legs treated with ADSC-EVs had markedly improved edema, with increased numbers of capillary vessels and lymphatic channels. Bioinformatics analysis revealed that ADSC-EV-associated microRNAs, such as miR-199a-3p, miR-145-5p, miR-143-3p, miR-377-3p, miR-100-3p, miR-29a-3p, miR-495-3p, and miR-29c-3p, targeted mouse double minute 2 homolog, which contributed to the stability of hypoxia-inducible factor 1α and resulted in angiogenesis and lymphangiogenesis in LECs. CONCLUSIONS The present study showed lymphangiogenic effects of ADSC-EVs, which will lead to new treatment options for chronic lymphedema. Cell-free therapy with EVs has fewer potential risks, such as poor engraftment efficiency and potential tumor formation, than stem cell transplantation and could be a promising tool for patients with lymphedema. CLINICAL RELEVANCE STATEMENT This study may open up new possibilities for novel therapies for lymphedema.
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Affiliation(s)
- Kensuke Tashiro
- From the Department of Plastic and Reconstructive Surgery, Asahi General Hospital
- Department of Molecular and Cellular Medicine, Institute of Medical Science, Tokyo Medical University
| | - Yusuke Yoshioka
- Department of Molecular and Cellular Medicine, Institute of Medical Science, Tokyo Medical University
| | - Takahiro Ochiya
- Department of Molecular and Cellular Medicine, Institute of Medical Science, Tokyo Medical University
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Chae Woon P, Kim I, Kim JH, Hwang JH. Association of clinical manifestations of secondary lymphedema and lymph node dissection sites in the lower extremities of patients with melanoma. Acta Oncol 2023; 62:880-888. [PMID: 37656769 DOI: 10.1080/0284186x.2023.2238547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/29/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Lymphedema is a chronic, debilitating disease that often requires life-long management. Predicting clinical manifestations and prognosis is crucial in clinical practice because the treatment of lymphedema should be individualized for best clinical outcome. The aim of this study is to explore the location and severity of lymphedema secondary to inguinal and/or iliac lymph node dissection (LND) in patients with melanoma. METHODS Patients with melanoma who received LND at a single tertiary medical center between 1 January 2010 and 31 September 2022 were retrospectively reviewed. Patient who received inguinal LND only were designate as the inguinal group while those who received both ilioinguinal LND were included in the ilioinguinal group. Volumetric measurement was used to objectify the severity and location of lymphedema. Clinical data was acquired for 12-15 months of follow-up. RESULTS Among 81 patients, 43 (53%) had developed lymphedema in the lower extremities at an average of 33 days after the surgery. Initially, patients manifested with medial thigh lymphedema in the inguinal group while patients were presented with whole leg lymphedema in the ilioinguinal group. Lower leg volume of the ilioinguinal group was significantly higher than the inguinal group. After more than 12 months of lymphedema treatment, upper leg volume was higher in the ilioinguinal group than the inguinal group (12.7% vs 5.4%, p < 0.05). CONCLUSION Lymphedema developed in early post-op period. The ilioinguinal group presented with a larger volume of lymphedema in the distal area of the legs. Even after sufficient treatment, predominant lymphedema remained in the proximal leg for the ilioinguinal group. Patients with both inguinal and iliac LND were associated with more severe lymphedema. Based on the dissection sites, the clinical manifestations and prognosis of leg lymphedema can vary widely. Thus, clinicians should consider the dissection site when approaching melanoma patients with lymphedema.
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Affiliation(s)
- Paek Chae Woon
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Inah Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Han Kim
- Division of Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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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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Otsuka I. Therapeutic Benefit of Systematic Lymphadenectomy in Node-Negative Uterine-Confined Endometrioid Endometrial Carcinoma: Omission of Adjuvant Therapy. Cancers (Basel) 2022; 14:cancers14184516. [PMID: 36139675 PMCID: PMC9497184 DOI: 10.3390/cancers14184516] [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: 08/15/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Endometrial cancer is the most common gynecological tract malignancy in developed countries. Extrauterine disease, in particular lymph node metastasis, is an important prognostic factor. Nevertheless, pelvic lymphadenectomy is not considered to have a therapeutic benefit, as it did not improve survival in randomized studies. However, lymphadenectomy may have a therapeutic benefit if adjuvant therapy can be omitted without decreasing oncological outcomes, as the long-term quality of life is maintained by avoiding morbidities associated with adjuvant therapy. In intermediate- and high-risk endometrioid endometrial carcinomas, adjuvant therapy may be safely omitted without decreasing long-term survival by open surgery including systematic pelvic and para-aortic lymphadenectomy when patients are node-negative. Systematic lymphadenectomy may remove undetectable low-volume lymph node metastasis in both pelvic and para-aortic regions, and open surgery may reduce vaginal recurrence even without vaginal brachytherapy. However, lymphadenectomy may not improve survival in elderly patients and patients with p53-mutant tumors. Abstract Endometrial cancer is the most common gynecological tract malignancy in developed countries, and its incidence has been increasing globally with rising obesity rates and longer life expectancy. In endometrial cancer, extrauterine disease, in particular lymph node metastasis, is an important prognostic factor. Nevertheless, pelvic lymphadenectomy is not considered to have a therapeutic benefit, as it did not improve survival in randomized studies. However, lymphadenectomy may have a therapeutic benefit if adjuvant therapy can be omitted without decreasing oncological outcomes, as the long-term quality of life is maintained by avoiding morbidities associated with adjuvant therapy. In intermediate- and high-risk endometrioid endometrial carcinomas, adjuvant therapy may be safely omitted without decreasing long-term survival by open surgery including systematic pelvic and para-aortic lymphadenectomy when patients are node-negative. Systematic lymphadenectomy may remove undetectable low-volume lymph node metastasis in both pelvic and para-aortic regions, and open surgery may reduce vaginal recurrence even without vaginal brachytherapy. However, lymphadenectomy may not improve survival in elderly patients and patients with p53-mutant tumors. In this review, I discuss the characteristics of lymph node metastasis, the methods of lymph node assessment, and the therapeutic benefits of systematic lymphadenectomy in patients with intermediate- and high-risk endometrioid endometrial carcinoma.
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Affiliation(s)
- Isao Otsuka
- Department of Obstetrics and Gynecology, Kameda Medical Center, Kamogawa 296-8602, Chiba, Japan
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Jebens Nordskar N, Hagen B, V Vesterfjell E, Salvesen Ø, Aune G. “Long-term outcome in endometrial cancer patients after robot-assisted laparoscopic surgery with sentinel lymph node mapping”. Eur J Obstet Gynecol Reprod Biol 2022; 271:77-82. [DOI: 10.1016/j.ejogrb.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
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Moussa AM, Camacho JC, Maybody M, Gonzalez-Aguirre AJ, Ridouani F, Kim D, Laudone VP, Santos E. Percutaneous Lymphatic Embolization as Primary Management of Pelvic and Retroperitoneal Iatrogenic Lymphoceles. J Vasc Interv Radiol 2021; 32:1529-1535. [PMID: 34363941 PMCID: PMC9150443 DOI: 10.1016/j.jvir.2021.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy of lymphatic embolization (LE) in decreasing catheter output and dwell time in iatrogenic lymphoceles after percutaneous catheter drainage. MATERIALS AND METHODS Retrospective review of patients who underwent intranodal lymphangiography (INL) with or without LE for management of iatrogenic lymphoceles between January 2017 and November 2020 was performed. Twenty consecutive patients (16 men and 4 women; median age, 60.5 years) underwent a total of 22 INLs and 18 LEs for 15 pelvic and 5 retroperitoneal lymphoceles. Lymphatic leaks were identified in 19/22 (86.4%) of the INLs. Three patients underwent INL only because a leak was not identified or was identified into an asymptomatic lymphocele. One patient underwent repeat INL and LE after persistent high catheter output, and 1 patient underwent repeat INL with LE after the initial INL did not identify a leak. Catheter output was assessed until catheter removal, and changes in output before and after the procedure were reported. The patients were followed up for 2-30 months, and procedural complications were reported. RESULTS The median catheter output before the procedure was 210 mL/day (50-1,200 mL/day), which decreased to a median of 20 mL/day (0-520 mL/day) 3 days after the procedure, with a median output decrease of 160 mL (0-900 mL). The median time between INL with LE and catheter removal was 6 days, with no recurrence requiring redrainage. Four patients experienced minor complications of low-grade fever (n = 2) and lower limb edema (n = 2). CONCLUSIONS Lymphangiogram and LE are safe and effective methods for the management of lymphoceles.
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Affiliation(s)
- Amgad M Moussa
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Juan C Camacho
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Majid Maybody
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adrian J Gonzalez-Aguirre
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fourat Ridouani
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - DaeHee Kim
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vincent P Laudone
- Department of Surgery, Division of Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ernesto Santos
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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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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Sentinel lymph node biopsy and morbidity outcomes in early cervical cancer: Results of a multicentre randomised trial (SENTICOL-2). Eur J Cancer 2021; 148:307-315. [PMID: 33773275 DOI: 10.1016/j.ejca.2021.02.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/24/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Pelvic lymph node dissection has been the standard of care for patients with early cervical cancer. Sentinel node (SN) mapping is safe and feasible and may increase the detection of metastatic disease, but benefits of omitting pelvic lymph node dissection in terms of decreased morbidity have not been demonstrated. MATERIALS AND METHODS In an open-label study, patients with early cervical carcinoma (FIGO 2009 stage IA2 to IIA1) were randomly assigned to SN resection alone (SN arm) or SN and pelvic lymph node dissection (SN + PLND arm). SN resection was followed by radical surgery of the tumour (radical hysterectomy or radical trachelectomy). The primary end-point was morbidity related to the lymph node dissection; 3-year recurrence-free survival was a secondary end-point. RESULTS A total of 206 patients were eligible and randomly assigned to the SN arm (105 patients) or SN + PLND arm (101 patients). Most patients had stage IB1 lesion (87.4%). No false-negative case was observed in SN + PLND arm. Lymphatic morbidity was significantly lower in the SN arm (31.4%) than in the SN + PLND arm (51.5%; p = 0.0046), as was the rate of postoperative neurological symptoms (7.8% vs. 20.6%, p = 0.01, respectively). However, there was no significant difference in the proportion of patients with significant lymphoedema between the two groups. During the 6-month postoperative period, the difference in morbidity decreased over time. The 3-year recurrence-free survival was not significantly different (92.0% in SN arm and 94.4% in SN + PLND arm). CONCLUSION SN resection alone is associated with early decreased lymphatic morbidity when compared with SN + PLND in early cervical cancer.
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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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12
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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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13
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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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14
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Helgers RJ, Winkens B, Slangen BF, Werner HM. Lymphedema and Post-Operative Complications after Sentinel Lymph Node Biopsy versus Lymphadenectomy in Endometrial Carcinomas-A Systematic Review and Meta-Analysis. J Clin Med 2020; 10:jcm10010120. [PMID: 33396373 PMCID: PMC7795280 DOI: 10.3390/jcm10010120] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/14/2020] [Accepted: 12/27/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Lymph node dissection (LND) is recommended as staging procedure in presumed low stage endometrial cancer. LND is associated with risk of lower-extremity lymphedema and post-operative complications. The sentinel lymph node (SLN) procedure has been shown to have high diagnostic accuracy, but its effects on complication risk has been little studied. This systematic review compares the risk of lower-extremity lymphedema and post-operative complications in SLN versus LND in patients with endometrial carcinoma. Methods: A systematic search was conducted in PubMed and Cochrane Library. Results: Seven retrospective and prospective studies (total n = 3046 patients) were included. Only three studies reported the odds ratio of lower-extremity lymphedema after SLN compared to LND, which was 0.05 (95% CI 0.01-0.37; p = 0.067), 0.07 (95% CI 0.00-1.21; p = 0.007) and 0.54 (95% CI 0.37-0.80; p = 0.002) in these studies. The pooled odds ratio of any post-operative complications after SLN versus LND was 0.52 (95% CI 0.36-0.73; I2 = 48%; p < 0.001). For severe post-operative complications the pooled odds ratio was 0.52 (95% CI 0.28-0.96; I2 = 0%; p = 0.04). Conclusions: There are strong indications that SLN results in a lower incidence of lower-extremity lymphedema and less often severe post-operative complications compared to LND. In spite of the paucity and heterogeneity of studies, direction of results was similar in all studies, supporting the aforementioned conclusion. These results support the increasing uptake of SLN procedures in endometrial cancer.
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Affiliation(s)
- Rianne J.A. Helgers
- Faculty of Health, Medicine and Life Sciences, Maastricht University, 6202 AZ Maastricht, The Netherlands;
| | - Bjorn Winkens
- Department of Methodology & Statistics, CAPHRI, Care and Public Health Research Institute, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
| | - Brigitte F.M. Slangen
- Department of Obstetrics and Gynecology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
| | - Henrica M.J. Werner
- Department of Obstetrics and Gynecology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
- Correspondence: ; Tel.: +31-4338-765-43
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15
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Rebegea LF, Stoleriu G, Manolache N, Serban C, Craescu M, Lupu MN, Voinescu DC, Firescu D, Ciobotaru OR. Associated risk factors of lower limb lymphedema after treatment of cervical and endometrial cancer. Exp Ther Med 2020; 20:181. [PMID: 33101471 PMCID: PMC7579779 DOI: 10.3892/etm.2020.9311] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022] Open
Abstract
The scope of the study was to identify the associated risk factors of lower limb lymphedema development in cervical and endometrial cancer patients. We retrospectively analysed 326 patients: 186 cases (57.06%) with cervical cancer and 140 cases (42.94%) with endometrial cancer were treated in Surgery, Radiotherapy, Oncology and Gynaecology Clinics of ‘St. Apostle Andrew’ Emergency Clinical Hospital Galati over 9 years. Adjuvant radiotherapy was performed in 83.57% of endometrial cancer cases. Adjuvant chemotherapy was performed in 45.16% of cervical cancer cases. Over 10 lymph nodes were removed in 74.73% of cervical cancer patients. Incidence of lymphedema was 15.05% in cervical cancer patients and 10% in endometrial cancer patients, P=0.06. Analysed risk factors for lower limb lymphedema occurrence were: Age, disease stage, radiotherapy, number of invaded lymph nodes (for cervical cancer patients), number of removed lymph nodes (for cervical cancer patients) and obesity. Multivariate analysis for associated risk factors of lower limb lymphedema development in cervical cancer showed that number of removed lymph nodes, OR=2.109 (0.907-4.903), P<0.0001, number of lymph nodes with metastasis, OR=1.903 (0.253-4.332), P=0.004 and obesity, OR=1.713 (0.226-2.967), P=0.006 were found as statistically significant risk factors for lower limb lymphedema onset. For endometrial cancer patients, obesity, OR=1.518 (0.721-2.75), P=0.0003, was the only associated risk factor with statistical significance for the lower limb lymphedema development. Lower limb lymphedema represents one of the adverse reactions of multimodal treatment in gynaecological cancers which affects patient's quality of life. Lower limb lymphedema occurrence is related with number of risk factors, the most important being removed lymph nodes, obesity and radiotherapy.
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Affiliation(s)
- Laura Florentina Rebegea
- Department of Radiotherapy and Oncology, 'St. Apostle Andrew' County Emergency Clinical Hospital, 800179 Galați, Romania.,Clinical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800008 Galati, Romania
| | - Gabriela Stoleriu
- Clinical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800008 Galati, Romania
| | - Nicuta Manolache
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800008 Galati, Romania
| | - Cristina Serban
- Second Surgery Clinic, 'St. Apostle Andrew' County Emergency Clinical Hospital, 800179 Galati, Romania.,Department of Surgery, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800008 Galati, Romania
| | - Mihaela Craescu
- Department of Radiotherapy and Oncology, 'St. Apostle Andrew' County Emergency Clinical Hospital, 800179 Galați, Romania.,Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800008 Galati, Romania
| | - Mary-Nicoleta Lupu
- Department of Surgery, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800008 Galati, Romania.,Anaesthesia and Intensive Care Clinic, 'St. Apostle Andrew' County Emergency Clinical Hospital, 800179 Galați, Romania
| | - Doina Carina Voinescu
- Clinical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800008 Galati, Romania
| | - Dorel Firescu
- Second Surgery Clinic, 'St. Apostle Andrew' County Emergency Clinical Hospital, 800179 Galati, Romania.,Department of Surgery, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800008 Galati, Romania
| | - Oana Roxana Ciobotaru
- Clinical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800008 Galati, Romania
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16
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Yoshida S, Koshima I, Imai H, Sasaki A, Nagamatsu S, Yokota K. Lymphaticovenular anastomosis for recurrent cellulitis in a dementia patient with lymphedema. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:340-343. [PMID: 32715167 PMCID: PMC7371726 DOI: 10.1016/j.jvscit.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 11/15/2022]
Abstract
We describe a dementia patient with comorbid recurrent cellulitis and lymphedema in the left lower limb who was treated successfully for recurrent cellulitis by lymphaticovenular anastomosis (LVA). The patient, an 83-year-old woman, suffered from recurrent cellulitis three times a year on average for 15 years. Compression therapy was impossible because of dementia. After LVA, there has been no recurrence of cellulitis for 2 years. It is difficult to administer decongestive lymphatic therapy in some patients, such as patients with dementia. LVA is a promising treatment for recurrent cellulitis in a dementia patient with lymphedema.
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Affiliation(s)
- Shuhei Yoshida
- International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, Japan
| | - Isao Koshima
- International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirofumi Imai
- International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, Japan
| | - Ayano Sasaki
- Department of Plastic and Reconstructive Surgery, Hiroshima University, Hiroshima, Japan
| | - Shogo Nagamatsu
- Department of Plastic and Reconstructive Surgery, Hiroshima University, Hiroshima, Japan
| | - Kazunori Yokota
- Department of Plastic and Reconstructive Surgery, Hiroshima University, Hiroshima, Japan
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17
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Pigott A, Obermair A, Janda M, Vagenas D, Ward LC, Reul-Hirche H, Hayes SC. Incidence and risk factors for lower limb lymphedema associated with endometrial cancer: Results from a prospective, longitudinal cohort study. Gynecol Oncol 2020; 158:375-381. [PMID: 32499070 DOI: 10.1016/j.ygyno.2020.04.702] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Evidence on the incidence and risk factors for lower limb lymphedema (LLL) associated with endometrial cancer is limited. Our objective was to use data from a prospective, longitudinal gynecological cancer cohort study to determine LLL incidence up to 24 months post-diagnosis of endometrial cancer and to explore the relationship between personal and treatment-related factors and risk of developing LLL. METHODS Women recently diagnosed with endometrial cancer (n = 235) were evaluated at regular intervals post-diagnosis (up to 3-monthly) using bioimpedance spectroscopy (BIS) and self-reported leg swelling (SRLS). RESULTS Incidence of LLL at 24 months post-diagnosis was 33% and 45% according to BIS and SRLS, respectively. When analyses were restricted to obese women, incidence at 24 months post-diagnosis increased to 67% (BIS) and 54% (SRLS). Following adjusted analyses, higher body mass index was associated with higher odds of baseline lymphedema (BIS: OR 1.91, 95% CI 1.47-2.49, p < .01; SRLS: OR 1.06, 95% CI 1.00-1.12, p < .01) and LLL incidence by 24 months post-diagnosis (BIS: OR 1.29, 95% CI: 0.99-1.68, p = .055; SRLS: OR 1.06, 95% CI 1.02-1.11, p = .008). According to SRLS, presence of comorbidities was also associated with baseline lymphedema (OR: 1.43, 95% CI: 1.15-1.78, p = .001), and more extensive lymph node dissection (OR 1.06, 95% CI: 1.01-1.12, p = .026) and receipt of chemotherapy (OR: 2.65, 95% CI: 1.12-6.29, p = .027) were identified as risk factors for lymphedema incidence. CONCLUSIONS These findings suggest that LLL following endometrial cancer is common, particularly in women with high body mass index, or comorbidities, and those requiring more extensive lymph node dissection or chemotherapy. Future studies should examine the potential of weight loss intervention as a strategy to reduce LLL incidence.
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Affiliation(s)
- Amanda Pigott
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Occupational Therapy Department, Brisbane, Queensland, Australia.
| | - Andreas Obermair
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Queensland Centre of Gynaecological Research, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Hildegard Reul-Hirche
- Royal Brisbane and Women's Hospital, Physiotherapy Department, Brisbane, Queensland, Australia
| | - Sandra C Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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18
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Allam O, Park KE, Chandler L, Mozaffari MA, Ahmad M, Lu X, Alperovich M. The impact of radiation on lymphedema: a review of the literature. Gland Surg 2020; 9:596-602. [PMID: 32420295 PMCID: PMC7225495 DOI: 10.21037/gs.2020.03.20] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/24/2019] [Indexed: 12/27/2022]
Abstract
Radiation therapy (RT) is a common adjunct therapy in oncology. However, it carries a significant risk of lymphedema when utilized in some anatomic locations. Recent studies have provided insight into lymphedema pathophysiology, diagnostic techniques, and RT. This review will examine the role of RT in upper and lower extremity lymphedema. Radiation's role in increasing the risk of lymphedema through decreased lymphatic proliferation potential, interstitial fibrosis compressing lymphatic vessels, and mechanical insufficiency of the lymphatic system will be reviewed.
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Affiliation(s)
- Omar Allam
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Kitae E Park
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Ludmila Chandler
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | | | - Maham Ahmad
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Xiaona Lu
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Michael Alperovich
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
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19
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Wang X, Ding Y, Cai HY, You J, Fan FQ, Cai ZF, An P. Effectiveness of modified complex decongestive physiotherapy for preventing lower extremity lymphedema after radical surgery for cervical cancer: a randomized controlled trial. Int J Gynecol Cancer 2020; 30:757-763. [PMID: 32107315 DOI: 10.1136/ijgc-2019-000911] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is a lack of evidence in support of any prophylactic measure to prevent secondary lower extremity lymphedema after radical hysterectomy among patients with cervical cancer. This study aimed to determine the effectiveness of modified complex decongestive physiotherapy in reducing the risk of secondary lower extremity lymphedema after radical surgery. METHODS A randomized single-blind clinical trial was conducted in 120 patients with cervical cancer who underwent laparoscopic radical hysterectomy with pelvic lymphadenectomy between January 2016 and April 2017 in the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Participants were randomly assigned to a modified complex decongestive physiotherapy intervention group (n=60) or control group (n=60). The intervention group received a modified complex decongestive physiotherapy program, which included manual lymph drainage, compression hosiery, regular exercise, and health education. The control group only received a health education program. The main outcome was the incidence of secondary lower extremity lymphedema. RESULTS A total of 117 patients with cervical cancer completed a 1-year follow-up. Twenty-eight (23.9%) patients developed secondary lower extremity lymphedema (20 (34.5%) patients in the control group and 8 (13.6%) in the intervention group). The incidence of secondary lower extremity lymphedema was significantly higher in the control group than in the intervention group (p=0.008; OR 0.30 (95% CI 0.12 to 0.75). The median percentage of excess volume was significantly less in the intervention group (2.1%, IQR 0.5-3.4%) than in the control group (2.96%, IQR 1.1-4.98%); (p=0.042). The mean (SD) onset time of lymphedema was 8 (2.00) months vs 4.6 (2.82) months in the intervention and control groups, respectively (p=0.004). CONCLUSIONS This randomized trial showed that modified complex decongestive physiotherapy is effective for preventing lower extremity lymphedema in patients with cervical cancer after laparoscopic radical hysterectomy with pelvic lymphadenectomy.
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Affiliation(s)
- Xia Wang
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yan Ding
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Hui-Yuan Cai
- Department of Lymphedema Rehabilitation Clinic, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jing You
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Fang-Qin Fan
- Department of Lymphedema Rehabilitation Clinic, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Zhi-Fang Cai
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Pei An
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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20
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Risk factors for lower limb lymphedema in gynecologic cancer patients after initial treatment. Int J Clin Oncol 2020; 25:963-971. [PMID: 31907719 PMCID: PMC7192861 DOI: 10.1007/s10147-019-01608-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022]
Abstract
Background Most studies on lower limb lymphedema have been conducted in gynecologic cancer patients who underwent surgery for gynecologic malignancy. This study aimed to evaluate the risk factors for lower limb lymphedema development in gynecologic cancer patients who underwent initial treatment. Methods A retrospective cohort design was used to follow 903 gynecologic cancer patients who underwent treatment at Kurume University Hospital between January 1, 2013 and December 31, 2015. Data analyses were performed in 356 patients, and the patients were followed up until December 31, 2017. The model comprised two components to facilitate statistical model construction. Specifically, a discrete survival time model was constructed, and a complementary log–log link model was fitted to estimate the hazard ratio. Associations between risk factors were estimated using generalized structural models. Results The median follow-up period was 1083 (range 3–1819) days, and 54 patients (15.2%) developed lower limb lymphedema, with a median onset period of 240 (range 3–1415) days. Furthermore, 38.9% of these 54 patients developed lower limb lymphedema within 6 months and 85.2% within 2 years. International Federation of Gynecology and Obstetrics stage, radiotherapy, and number of lymph node dissections (≥ 28) were significant risk factors. Conclusion Simultaneous examination of the relationship between lower limb lymphedema and risk factors, and analysis among the risk factors using generalized structural models, enabled us to construct a clinical model of lower limb lymphedema for use in clinical settings to alleviate this condition and improve quality of life.
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Fuzzard SK, Mah E, Choong PFM, Grinsell D. Lymphoedema rates in pedicled anterolateral thigh flaps for coverage of irradiated groin defects. ANZ J Surg 2019; 90:135-138. [PMID: 31840376 DOI: 10.1111/ans.15576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 09/30/2019] [Accepted: 10/14/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limb salvage surgery in conjunction with adjuvant radiotherapy is the preferred treatment for soft tissue sarcoma. This study aims to determine if ipsilateral pedicled anterolateral thigh (ALT) flap reconstruction of groin defects post soft tissue sarcoma resection results in acceptable rates of lymphoedema, while also providing good soft tissue cover and minimal donor site morbidity. METHODS A retrospective chart audit was conducted with ethics approval, obtaining a case series of 16 patients operated on at a single institution by the senior surgeon. Patients who underwent ipsilateral pedicled ALT flap coverage of irradiated groin defects following soft tissue sarcoma resection were included. Comparative six-point limb circumference measurements were utilized to diagnose lymphoedema, with a difference of 10% when compared to the non-operative side being deemed significant. RESULTS Lymphoedema was noted in three patients (18.8%) with an average follow-up period of 40.9 (range 8-59) months. CONCLUSION Previously published lymphoedema rates in sarcoma limb salvage surgery of 15.5-30% are comparable to the rates obtained in this cohort. Lymphoedema rates do not appear to be higher in patients undergoing ipsilateral pedicled ALT flap reconstruction, thus making it a useful soft tissue coverage technique in this cohort.
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Affiliation(s)
- Sibon K Fuzzard
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Eldon Mah
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Damien Grinsell
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
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22
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Carlson JW, Kauderer J, Hutson A, Carter J, Armer J, Lockwood S, Nolte S, Stewart BR, Wenzel L, Walker J, Fleury A, Bonebrake A, Soper J, Mathews C, Zivanovic O, Richards WE, Tan A, Alberts DS, Barakat RR. GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecol Oncol 2019; 156:467-474. [PMID: 31837831 DOI: 10.1016/j.ygyno.2019.10.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To evaluate the incidence and risk factors for lymphedema associated with surgery for gynecologic malignancies on GOG study 244. METHODS Women undergoing a lymph node dissection for endometrial, cervical, or vulvar cancer were eligible for enrollment. Leg volume was calculated from measurements at 10-cm intervals starting 10 cm above the bottom of the heel to the inguinal crease. Measurements were obtained preoperatively and postoperatively at 4-6 weeks, and at 3-, 6-, 9-, 12-, 18-, and 24- months. Lymphedema was defined as a limb volume change (LVC) ≥10% from baseline and categorized as mild: 10-19% LVC; moderate: 20-40% LVC; or severe: >40% LVC. Risk factors associated with lymphedema were also analyzed. RESULTS Of 1054 women enrolled on study, 140 were inevaluable due to inadequate measurements or eligibility criteria. This left 734 endometrial, 138 cervical, and 42 vulvar patients evaluable for LVC assessment. Median age was 61 years (range, 28-91) in the endometrial, 44 years (range, 25-83) in the cervical, and 58 years (range, 35-88) in the vulvar group. The incidence of LVC ≥10% was 34% (n = 247), 35% (n = 48), and 43% (n = 18), respectively. The peak incidence of lymphedema was at the 4-6 week assessment. Logistic regression analysis showed a decreased risk with advanced age (p = 0.0467). An exploratory analysis in the endometrial cohort showed an increased risk with a node count >8 (p = 0.033). CONCLUSIONS For a gynecologic cancer, LVC decreased with age greater than 65, but increased with a lymph node count greater than 8 in the endometrial cohort. There was no association with radiation or other risk factors.
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Affiliation(s)
- Jay W Carlson
- Cancer Research for the Ozarks, 1235 E. Cherokee, Springfield, MO, 65804, USA.
| | - James Kauderer
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Elm & Carlton Sts., Buffalo, NY, 14263, USA.
| | - Alan Hutson
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Elm & Carlton Sts., Buffalo, NY, 14263, USA.
| | - Jeanne Carter
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA.
| | - Jane Armer
- Sinclair School of Nursing, DC 116.05, Mizzou North Suite 415, 115 Business Loop 70 West, Columbia, MO, 65010, USA.
| | - Suzy Lockwood
- Texas Christian University, Harris College of Nursing & Health Sciences, TCU Box 298620, Ft Worth, TX, 76129, USA.
| | - Susan Nolte
- Abington Memorial Hospital, 1200 Old York Road, Abington, PA, 19001, USA.
| | - Bob R Stewart
- Sinclair School of Nursing, DC 116.05, Mizzou North Suite 415, 115 Business Loop 70 West, Columbia, MO, 65010, USA.
| | - Lari Wenzel
- Program in Public Health, University of California, Irvine, Irvine, CA, USA; Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA.
| | - Joan Walker
- Stephenson Cancer Center, OUHSC, Oklahoma City, OK, 73104, USA.
| | - Aimee Fleury
- Women's Cancer Center of Nevada, 3131 la Canada St. Ste 241, Las Vegas, NV, 89169, USA.
| | - Albert Bonebrake
- Cancer Research for the Ozarks-Cox Health. Ferrell Duncan Clinic GYN-ONC, Springfield, MO, 65807, USA.
| | - John Soper
- B110 Physicians' Office BLDG, 170 Manning Drive, UNC School of Medicine, Chapel Hill, NC, 27599, USA.
| | - Cara Mathews
- Division of Gynecologic Oncology, Women & Infants Hospital of Rhode Island, Alpert School of Medicine at Brown University, 101 Dudley St., Providence, RI, 02905, USA.
| | - Oliver Zivanovic
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Wm Edward Richards
- Director of Gynecologic Oncology and Surgical Specialists, St. Joseph's/Candler Health System, 225 Candler Dr., Savannah, GA, 31405, USA.
| | - Annie Tan
- Minnesota Oncology, 11850 Blackfoot Street, NW, Suite 100, Coon Rapids MN 55433, USA.
| | - David S Alberts
- Department of Medicine, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA.
| | - Richard R Barakat
- Northwell Health Cancer Institute, 1111 Marcus Avenue, New Hyde Park, NY, 11042, USA.
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Ezawa M, Sasaki H, Yamada K, Takano H, Iwasaka T, Nakao Y, Yokochi T, Okamoto A. Long term outcomes from lymphatic venous anastomosis after total hysterectomy to prevent postoperative lymphedema in lower limb. BMC Surg 2019; 19:177. [PMID: 31771562 PMCID: PMC6878618 DOI: 10.1186/s12893-019-0628-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphedema in lower limb is one of major postoperative complications followed by a total hysterectomy with lymph node dissection. The objective of this report is to examine a long-term result of lymphaticovenous anastomosis procedure as a preventive surgery. METHODS Sixteen patients with endometrial cancer underwent an abdominal hysterectomy with a bilateral salpingo-oophorectomy. Just after pelvic lymph node dissection, either end-to-end or sleeve anastomosis utilizing venules and suprainguinal lymph vessels was performed. During the observation period from 4 to 13 years, the symptom of lymphedema in lower extremities has been assessed. RESULTS Among 16 patients, 1 presented postoperative lymphedema grade 3 (CTCAE (Common Terminology Criteria for Adverse Events) Ver. 4.0, 10025233) in lower limb, and a second surgery at 7 years after the first one was required. Other 6 patients showed non-severe symptoms of lymphedema, diagnosed as grade 1. The rest 9 patients did not show any symptoms of postoperative lymphedema in a long term (up to 13 years). CONCLUSION From the long term outcomes of our 16 cases, we propose that a direct lymphaticovenous microsurgery immediately after a hysterectomy with lymphadenectomy of external inguinal lymph node is one of the appropriate therapeutic choices to prevent severe lymphedema in lower limb.
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Affiliation(s)
- Masahiro Ezawa
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Sasaki
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan. .,Department of Gynecology, Chiba Tokushukai Hospital, Chiba, Japan.
| | - Kyosuke Yamada
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirokuni Takano
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Iwasaka
- Department of Obstetrics and Gynecology, Saga University School of Medicine, Saga, Japan
| | | | - Tomoki Yokochi
- Department of Clinical Research, Chiba Tokushukai Hospital, Chiba, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, Jemal A, Kramer JL, Siegel RL. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin 2019; 69:363-385. [PMID: 31184787 DOI: 10.3322/caac.21565] [Citation(s) in RCA: 2795] [Impact Index Per Article: 559.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.
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Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | - Ahmedin Jemal
- Surveillance Research, American Cancer Society, Atlanta, Georgia
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Joan L Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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Chen CE, Chiang NJ, Perng CK, Ma H, Lin CH. Review of preclinical and clinical studies of using cell-based therapy for secondary lymphedema. J Surg Oncol 2019; 121:109-120. [PMID: 31385308 DOI: 10.1002/jso.25661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/25/2019] [Indexed: 12/14/2022]
Abstract
Secondary lymphedema is associated with impaired lymph fluid drainage and remains incurable. Alternatively, cell-based therapy may pave the way for lymphedema treatment. We found 11 animal and seven human studies had been conducted from 2008 to 2018. Most studies showed great potential for this treatment modality. Emerging studies have focused on novel techniques, such as coupling cell therapy with lymph node transfer, or adding growth factors to cell therapy.
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Affiliation(s)
- Ching-En Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Jung Chiang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.,Department of Internal Medicine, Cheng Kung University Medical Center, Tainan, Taiwan
| | - Cherng-Kang Perng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsu Ma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Hsun Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Singh V, Chaudhary A, Modi KB, Singh LS, Roy L, Dougall P, Makkar G, Abrari A, Chaturvedi H. A Prospective Study of Role of Sentinel Lymph Node Biopsy in Low-Risk/Intermediate-Risk Early-Stage Endometrial Carcinoma Using Dual-Dye and Dual-Site and Injection Technique. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Baseline Lymphatic Dysfunction Amplifies the Negative Effects of Lymphatic Injury. Plast Reconstr Surg 2019; 143:77e-87e. [PMID: 30589786 DOI: 10.1097/prs.0000000000005091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Genetic mutations and obesity increase the risk of secondary lymphedema, suggesting that impaired lymphatic function before surgical injury may contribute to disease pathophysiology. Previous studies show that obesity not only decreases lymphatic function, but also markedly increases pathologic changes, such as swelling, fibroadipose deposition, and inflammation. However, although these reports provide circumstantial evidence supporting the hypothesis that baseline lymphatic defects amplify the effect of lymphatic injury, the mechanisms regulating this association remain unknown. METHODS Baseline lymphatic morphology, leakiness, pumping, immune cell trafficking, and local inflammation and fibroadipose deposition were assessed in wild-type and Prox1-haploinsufficient (Prox1) mice, which have previously been shown to have abnormal vasculature without overt evidence of lymphedema. In subsequent experiments, wild-type and Prox1 mice underwent popliteal lymph node dissection to evaluate the effect of lymphatic injury. Repeated testing of all variables was conducted 4 weeks postoperatively. RESULTS At baseline, Prox1 mice had dilated, leaky lymphatic vessels corresponding to low-grade inflammation and decreased pumping and transport function, compared with wild-type mice. Popliteal lymph node dissection resulted in evidence of lymphedema in both Prox1 and wild-type mice, but popliteal lymph node dissection-treated Prox1 mice had increased inflammation and decreased lymphatic pumping. CONCLUSIONS Subclinical lymphatic dysfunction exacerbates the pathologic changes of lymphatic injury, an effect that is multifactorial and related to increased lymphatic leakiness, perilymphatic accumulation of inflammatory cells, and impaired pumping and transport capacity. These findings suggest that preoperative testing of lymphatic function may enable clinicians to more accurately risk-stratify patients and design targeted preventative strategies.
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28
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A pilot study of lower extremity lymphedema, lower extremity function, and quality of life in women after minimally invasive endometrial cancer staging surgery. Gynecol Oncol 2019; 153:399-404. [PMID: 30879878 DOI: 10.1016/j.ygyno.2019.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The primary aim of this study was to pilot the use of an objective measurement technique to prospectively evaluate the incidence of lower extremity lymphedema (LEL) after minimally invasive staging surgery for endometrial cancer. Secondary objectives included observation of changes in lower extremity function and quality of life in this patient population. METHODS A prospective evaluation of LEL was performed in 97 women who underwent minimally invasive staging surgery for endometrial cancer using comparative circumferential volume measurements. Postoperative changes in lower extremity function and global quality of life were also assessed using patient-reported outcome measures. RESULTS Ninety-seven patients were included for lymphedema analysis. The rate of LEL was 25% at 4-6 weeks, 19% at 6-9 months, and 27% at 12-18 months postoperatively. The presence of LEL was associated with a significant worsening from baseline Lower Extremity Functional Scale (LEFS) scores at 4-6 weeks (-27.0% vs -3.7%, p = 0.02) and 6-9 months (-13.0% vs 0%, p = 0.01). LEL was not associated with a change in patient-reported global quality of life. CONCLUSIONS Up to one in four women experience lymphedema following surgical staging for endometrial cancer, and its presence is associated with diminished lower extremity function. Larger, prospective trials using the objective methodology piloted in this study should better clarify risk factors and long-term outcomes of this morbidity.
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Ly CL, Cuzzone DA, Kataru RP, Mehrara BJ. Small Numbers of CD4+ T Cells Can Induce Development of Lymphedema. Plast Reconstr Surg 2019; 143:518e-526e. [PMID: 30601329 PMCID: PMC6395505 DOI: 10.1097/prs.0000000000005322] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND CD4 T cells have been implicated in the pathology of lymphedema. Interestingly, however, there have been case reports of lymphedema development in patients with low levels of CD4 T cells because of immunosuppression. In this study, the authors sought to delineate the effect of relative CD4 T-cell deficiency on the development of lymphedema in a mouse model. METHODS A mouse model of relative CD4 T-cell deficiency was created through lethal total body irradiation of wild-type mice that then underwent bone marrow transplantation with progenitors harvested from CD4 knockout mice (wild-type/CD4 knockout). Irradiated CD4 knockout mice reconstituted with wild-type mouse-derived progenitors (CD4 knockout/wild-type), and unirradiated CD4 knockout and wild-type mice were used as controls. All mice underwent tail skin and lymphatic excision to induce lymphedema, and analysis was performed 6 weeks later. RESULTS Wild-type/CD4 knockout chimeras were not protected from developing lymphedema. Despite a global deficit in CD4 T cells, these mice had swelling, fibrosis, inflammation, and impaired lymphatic transport function indistinguishable from that in wild-type and CD4 knockout/wild-type mice. In contrast, unirradiated CD4 knockout mice had no features of lymphedema after lymphatic injury. CONCLUSIONS Relatively small numbers of bone marrow and peripheral CD4 T cells are sufficient to induce the development of lymphedema. These findings suggest that lymphatic injury results in expansion of CD4 T-cell populations in lymphedematous tissues.
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Affiliation(s)
- Catherine L. Ly
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Daniel A. Cuzzone
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Raghu P. Kataru
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York 10065
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Volpi L, Sozzi G, Capozzi VA, Ricco' M, Merisio C, Di Serio M, Chiantera V, Berretta R. Long term complications following pelvic and para-aortic lymphadenectomy for endometrial cancer, incidence and potential risk factors: a single institution experience. Int J Gynecol Cancer 2019; 29:312-319. [PMID: 30718312 DOI: 10.1136/ijgc-2018-000084] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 11/23/2018] [Accepted: 11/29/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the incidence of long term lymphadenectomy complications in primary surgery for endometrial cancer and to elucidate risk factors for these complications. METHODS A retrospective chart review was carried out for all patients with endometrial cancer managed at Parma University Hospital Unit of Gynecology and Obstetrics between 2010 and 2016. Inclusion criteria were surgical procedure including hysterectomy and lymphadenectomy (pelvic or pelvic and aortic). We identified patients with postoperative lymphocele and lower extremity lymphedema. Logistic regression analysis was used to identify predictive factors for postoperative complications. RESULTS Of the 249 patients tested, 198 underwent pelvic lymphadenectomy (79.5%), and 51 (20.5%) of those underwent both pelvic and para-aortic lymphadenectomy. Among the 249 patients, 92 (36.9 %) developed lymphedema while 43 (17.3%) developed lymphocele. Multivariate analysis showed that addition of para-artic lymphadenectomy was an independent predictor for both lymphedema (odds ratio (OR) 2.764, 95% confidence interval (CI) 1.023 to 7.470) and lymphocele (OR 5.066, 95% CI 1.605 to 15.989). Moreover, postoperative adjuvant radiotherapy (OR 2.733, 95% CI 1.149 to 6.505) and identification of any positive lymph node (OR 19.391, 95% CI 1.486 to 253.0) were significantly correlated with lymphedema, while removal of circumflex iliac nodes (OR 8.596, 95% CI 1.144 to 65.591) was associated with lymphoceles occurrence. CONCLUSION Although sentinel lymph node navigation is a promising option, lymphadenectomy represents the primary treatment in many patients with endometrial cancer. However, comprehensive nodal dissection remains associated with a high rate of long term complications, such as lymphedema and lymphocele. Avoiding risk factors that are related to the development of these postoperative complications is often difficult and, therefore, the strategy to assess lymph nodal status in these women must be tailored to obtain the maximum results in terms of oncological and functional outcome.
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Affiliation(s)
- Lavinia Volpi
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, ARNAS Civico Hospital of Palermo, Palermo, Italy
| | | | - Matteo Ricco'
- Local Health Unit of Reggio Emilia, Department of Public Health, Reggio Emilia, Reggio Emilia, Italy
| | - Carla Merisio
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
| | - Maurizio Di Serio
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Civico Hospital of Palermo, University of Palermo, Palermo, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
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Salehi S, Åvall-Lundqvist E, Brandberg Y, Johansson H, Suzuki C, Falconer H. Lymphedema, serious adverse events, and imaging 1 year after comprehensive staging for endometrial cancer: results from the RASHEC trial. Int J Gynecol Cancer 2019; 29:86-93. [DOI: 10.1136/ijgc-2018-000019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/06/2018] [Accepted: 09/14/2018] [Indexed: 11/12/2022] Open
Abstract
Background and ObjectivesIn the Robot Assisted Surgery for High Risk Endometrial Cancer (RASHEC) trial, patients with high-risk endometrial cancer were randomly assigned to robot-assisted laparoscopic surgery (RALS) or laparotomy for pelvic and infrarenal para-aortic lymph node dissection. We here report on self-reported lower limb lymphedema (LLL), lymphocyst formation, ascites, and long-term serious adverse events 12 months after surgery.Patients and methodsPatients were enrolled between 2013 and 2016, and 96 patients were included in the per protocol analysis, evenly distributed between RALS and laparotomy. Self-reported LLL was recorded using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for endometrial cancer—EN24, assessed before and 12 months after surgery. Computed tomography was assessed at baseline, 3, and 12 months. Medical charts were reviewed for serious adverse events and hospital admissions 31 to 365 days after surgery.ResultsAt 12 months after laparotomy and RALS, 61% and 50% patients, respectively, reported LLL (p = 0.31). In univariate analysis, the mean score of LLL at 12 months was significantly higher for laparotomy than for RALS (p < 0.05) and for those without abdominal drainage (p = 0.02), but was not independently associated with LLL in the multivariate analysis. Imaging showed no significant difference in lymphocyst formation or ascites between surgical modalities. No difference was found in serious adverse events and admissions to hospital for any reason. There was no agreement between lymphocyst formation or ascites and self-reported LLL.ConclusionFollow-up 1 year after comprehensive surgical staging for high-risk endometrial cancer showed no differences in self-reported LLL, findings on imaging, or SAE between laparotomy and robot-assisted surgery.
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Wang MC, Lee SY, Hsu KF, Lin CF, Ma MC, Hsu YY. Psychometric evaluation of a Chinese version of Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema in women with gynaecological cancer surgery. Eur J Cancer Care (Engl) 2018; 27:e12940. [DOI: 10.1111/ecc.12940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/28/2018] [Accepted: 09/01/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Mei-Chin Wang
- Department of Nursing, College of Medicine; National Cheng Kung University; Tainan Taiwan
| | - Shih-Yu Lee
- College of Nursing and Health Sciences; University of Texas at Tyler; Tyler Texas
| | - Keng-Fu Hsu
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital; College of Medicine, National Cheng Kung University; Tainan Taiwan
| | - Cheng-Feng Lin
- Department of Physical Therapy, College of Medicine; National Cheng Kung University; Tainan Taiwan
| | - Mi-Chia Ma
- Department of Statistics, College of Management; National Cheng Kung University; Tainan Taiwan
| | - Yu-Yun Hsu
- Department of Nursing, College of Medicine; National Cheng Kung University; Tainan Taiwan
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McGee P, Munnoch DA. Treatment of gynaecological cancer related lower limb lymphoedema with liposuction. Gynecol Oncol 2018; 151:460-465. [PMID: 30293713 DOI: 10.1016/j.ygyno.2018.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/22/2018] [Accepted: 09/25/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate outcomes in patients with gynaecological cancer related lymphoedema treated with liposuction. METHODS A prospective analysis of 21 patients who underwent liposuction followed by compression therapy for chronic unilateral lower limb lymphoedema with up to 8 years follow up was performed. RESULTS Duration of lymphoedema prior to liposuction ranged from 4 to 28 years (mean 15.2 years). The mean age at time of liposuction was 52 years (range 37-67). Estimated volume excess in the affected limb ranged from 1.6 to 12 l (mean 4.7 l). The mean percentage reduction was 92.6% at 6 months (range 59.4-159.9) and 88.9% (range 60.9-127.5) at 1 year. Longer term follow-up of 6 patients at 5 years post-liposuction revealed a mean percentage reduction of 113.6% (range 83.5-155.5). CONCLUSION Our experience of liposuction combined with compression garments has demonstrated significant and sustainable reduction in limb volume in patients with lower limb lymphoedema secondary to gynaecological malignancy.
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Affiliation(s)
- Pauline McGee
- Department of Plastic Surgery, Ninewells Hospital, James Arrott Drive, Dundee DD1 9SY, United Kingdom.
| | - David Alex Munnoch
- Consultant Plastic Surgeon, Department of Plastic Surgery, Ninewells Hospital, James Arrott Drive, Dundee DD2 9SY, United Kingdom.
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Dai YF, Xu M, Zhong LY, Xie XY, Liu ZD, Yan MX, Yi H, Lin DM. Prognostic significance of solitary lymph node metastasis in patients with stages IA2 to IIA cervical carcinoma. J Int Med Res 2018; 46:4082-4091. [PMID: 29963935 PMCID: PMC6166324 DOI: 10.1177/0300060518785827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the prognostic significance of and risk factors for solitary lymph node metastasis (SLNM) of patients with cervical carcinoma. Methods Clinical data from patients with International Federation of Gynecology and Obstetrics (FIGO) stages IA2 to IIA cervical carcinoma who underwent radical hysterectomy and pelvic lymphadenectomy between January 2003 and December 2010 were analysed retrospectively. Histopathological analysis was used to identify SLNM. Long-term survival and risk factors associated with SLNM were analysed. Results The study enrolled 302 patients with cervical cancer: 48 with SLNM (SLNM group) and 254 patients with no lymph node metastases (nLNM group). FIGO stage, tumour grade, depth of tumour invasion, uterine body involvement, parametrial involvement and lymphovascular invasion differed significantly between the two groups. Logistic regression analysis revealed that FIGO stage, depth of tumour invasion and lymphovascular invasion were independent factors associated with SLNM. The 5-year survival rates of the SLNM and nLNM groups were 54.2% and 87.8%, respectively. Multivariate analysis identified SLNM as an independent factor affecting survival. Conclusions The occurrence of just one solitary lymph node metastasis significantly worsened the prognosis in patients with cervical carcinoma compared with patients without lymph node metastases.
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Affiliation(s)
- Yi-Fang Dai
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Mu Xu
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Li-Ying Zhong
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Xiao-Yan Xie
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Zhao-Dong Liu
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Ming-Xing Yan
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Huan Yi
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Dan-Mei Lin
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
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Roman MM, Barbieux R, Nogaret JM, Bourgeois P. Use of lymphoscintigraphy to differentiate primary versus secondary lower extremity lymphedema after surgical lymphadenectomy: a retrospective analysis. World J Surg Oncol 2018; 16:75. [PMID: 29631609 PMCID: PMC5891959 DOI: 10.1186/s12957-018-1379-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background When managing patients with cancer, lymphedema of the lower limbs (LLL) is commonly reported as secondary to the surgical excision and/or irradiation of lymph nodes (LNs). In the framework of lymphoscintigraphic imaging performed to evaluate secondary LLL, some lympho-nodal presentations have been observed that could not be explained by the applied treatments, suggesting that these LLL might be primary. Therefore, all our lymphoscintigraphic examinations that were performed in patients for LLL after surgery for gynecological or urological cancer were retrospectively analyzed in order to evaluate the frequency in which these LLL might not be secondary (either completely or partially) but primary in origin. Methods Lymphoscintigraphies performed in 33 patients who underwent LN dissection (limited to the intra-abdominal LN) with or without radiotherapy for histologically confirmed ovarian cancer (n = 6), uterine cancer (n = 14 with cervical cancer and n = 7 with endometrial cancer), or prostate cancer (n = 6) were compared to lymphoscintigraphies obtained in primary LLL. Results In 12 (33% of the) patients (3 men plus 9 women, 4 with cervical cancer and 5 with endometrial cancer), scintigraphy of the lower limbs revealed lympho-nodal presentation that did not match with the expected consequences of the surgical and/or radiological treatments and were either suggestive or typical of primary lymphedema. Conclusions This retrospective analysis of a limited but well-defined series of patients suggests that the appearance of LLL might not be related to cancer treatment(s) but that these LLL may represent the development of a primary lymphatic disease latent prior to the therapeutic interventions.
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Affiliation(s)
- Mirela Mariana Roman
- Department of Mammo-Pelvic Surgery, Jules Bordet Institute, 121, Bd. de Waterloo, 1000, Brussels, Belgium. .,Multidisciplinary Clinic of Lymphology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.
| | - Romain Barbieux
- Service of Kinesitherapy, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.,Service of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.,Multidisciplinary Clinic of Lymphology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Marie Nogaret
- Department of Mammo-Pelvic Surgery, Jules Bordet Institute, 121, Bd. de Waterloo, 1000, Brussels, Belgium
| | - Pierre Bourgeois
- Service of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.,Multidisciplinary Clinic of Lymphology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
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The Combination of Preoperative Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Sentinel Lymph Node Mapping in the Surgical Management of Endometrioid Endometrial Cancer. Int J Gynecol Cancer 2018; 26:1228-38. [PMID: 27643647 DOI: 10.1097/igc.0000000000000773] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The goal of this study was to evaluate the combination of sentinel lymph node (SLN) mapping and F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) scan in detection of lymph node involvement in patients with endometrioid endometrial cancer (EEC). METHODS/MATERIALS Ninety-five patients with EEC who had preoperative PET/CT imaging and underwent SLN mapping were retrospectively analyzed. Methylene blue dye was used and injected to the cervix at 3- and 9-o'clock positions (a total of 4 mL). Pelvic lymphadenectomy was performed on all of the patients after SLN mapping. If the SLN was negative in the initial hematoxylin and eosin staining, an ultrastaging study was performed for the SLNs. RESULTS Sentinel lymph nodes were detected in 77 (81.1%) of 95 patients, with a mean of 2.95 SLNs. There was only 1 case (1.4%) with a positive SLN in the intraoperative frozen section examination in those patients with negative PET/CT findings and in whom SLNs were detected (n = 70). Among the remaining 69 patients with negative preoperative PET/CT findings and negative frozen section results for the SLNs, there were 2 patients with SLN involvement in the final ultrastaging pathology. In the patient-based analyses, the sensitivity, specificity, and positive and negative predictive values of the PET/CT and SLN frozen section were 33%, 100%, 100%, and 97.1%, respectively. CONCLUSIONS As no metastases in the nonsentinel pelvic lymph nodes were found in patients with EEC who had both negative PET/CT findings and frozen section results of the SLNs in both hemipelvises, we suggest using both methods to reduce the incidence of unnecessary systematic lymphadenectomy.
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Incidence and Risk Factors of Lower Extremity Lymphedema After Gynecologic Surgery in Ovarian Cancer. Int J Gynecol Cancer 2018; 26:1327-32. [PMID: 27400319 DOI: 10.1097/igc.0000000000000757] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE There is no standard method to establish an early diagnosis of lower extremity lymphedema (LEL). Lower extremity lymphedema can be diagnosed by physical examination and laboratory tests when patients complain of typical clinical symptoms. The objective of this study was to investigate the incidence and risk factors of LEL in patients with ovarian cancer. METHODS The medical records were reviewed retrospectively in patients with ovarian cancer treated at Seoul St. Mary's Hospital from January 2000 to July 2014. RESULTS A total of 413 patients with epithelial ovarian cancer were analyzed. Forty-six patients (11.1%) developed LEL, and 67.4% of these patients had LEL within 1 year after surgery. The mean number of resected lymph nodes (LNs) was larger in patients with LEL (43.1 ± 16.7; range, 12-80) than in those without (32.3 ± 19.8; range, 0-99) (P < 0.0001). The number of resected LNs was significantly associated with the occurrence of LEL (odds ratio, 1.025; 95% confidence interval, 1.005-1.045; P < 0.05). CONCLUSION A significant proportion of patients with ovarian cancer could develop LEL after surgery. This study suggests that the occurrence of LEL is associated with the number of resected LNs.
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Urner S, Kelly-Goss M, Peirce SM, Lammert E. Mechanotransduction in Blood and Lymphatic Vascular Development and Disease. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2017; 81:155-208. [PMID: 29310798 DOI: 10.1016/bs.apha.2017.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The blood and lymphatic vasculatures are hierarchical networks of vessels, which constantly transport fluids and, therefore, are exposed to a variety of mechanical forces. Considering the role of mechanotransduction is key for fully understanding how these vascular systems develop, function, and how vascular pathologies evolve. During embryonic development, for example, initiation of blood flow is essential for early vascular remodeling, and increased interstitial fluid pressure as well as initiation of lymph flow is needed for proper development and maturation of the lymphatic vasculature. In this review, we introduce specific mechanical forces that affect both the blood and lymphatic vasculatures, including longitudinal and circumferential stretch, as well as shear stress. In addition, we provide an overview of the role of mechanotransduction during atherosclerosis and secondary lymphedema, which both trigger tissue fibrosis.
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Affiliation(s)
- Sofia Urner
- Institute of Metabolic Physiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Molly Kelly-Goss
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Shayn M Peirce
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Eckhard Lammert
- Institute of Metabolic Physiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute for Beta Cell Biology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.
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Rodríguez-Trujillo A, Martínez-Serrano MJ, Martínez-Román S, Martí C, Buñesch L, Nicolau C, Pahisa J. Preoperative Assessment of Myometrial Invasion in Endometrial Cancer by 3D Ultrasound and Diffusion-Weighted Magnetic Resonance Imaging: A Comparative Study. Int J Gynecol Cancer 2017; 26:1105-10. [PMID: 27177278 DOI: 10.1097/igc.0000000000000724] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The prognosis of endometrial cancer depends on the correct surgical staging. In early stages, 18% to 30% rate of positive lymph nodes is reported with a myometrial invasion of 50% or more. According to this, patients with International Federation of Gynecology and Obstetrics stage Ib would benefit from staging lymphadenectomy. Therefore, it is important to classify these patients preoperatively to plan the surgery. In the recent years, 3-dimensional (3D) ultrasound and diffusion-weighted magnetic resonance imaging (DW-MRI) have been incorporated in the preoperative management of these patients. The aim of this study was to assess the usefulness of 3D ultrasound and DW-MRI as predictor of myometrial invasion in endometrial cancer. MATERIAL AND METHODS We retrospectively compared the assessment of myometrial invasion by 3D ultrasound and DW-MRI with final pathologic evaluation on hysterectomy specimens, in 98 patients diagnosed of early-stage endometrial cancer, who underwent surgery at the Hospital Clinic of Barcelona between 2012 and 2015. RESULTS Evaluation of the depth of myometrial invasion with 3D ultrasound had a sensitivity, specificity, and accuracy of 77%, 83% and 81%, respectively. Evaluation of the depth of myometrial invasion with DW-MRI had a sensitivity, specificity, and accuracy of 69%, 86%, and 81%, respectively. Association of both techniques improved all the values, showing a sensitivity, specificity, and accuracy of 87%, 93%, and 91%, respectively. In both 3D ultrasound and DW-MRI, the presence of leiomyomas was the first detectable cause of false negative (3% and 4%, respectively) and false-positive (3% and 1%, respectively). CONCLUSIONS We conclude that the implementation of the 2 studies in early-stage endometrial cancer provides low false-negatives and false-positives rates. In cases of patients with leiomyomas, adenomiosis, or intrauterine fluid collection, definitive evaluation of myometrial invasion could be better deferred to intraoperative biopsy in an attempt to reduce false-negatives and false-positives rates.
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Affiliation(s)
- Adriano Rodríguez-Trujillo
- *Department of Gynecology and Obstetrics, Hospital Clìnic i Provincial, University of Barcelona, Spain; and †Department of Radiology, Hospital Clínic i Provincial, University of Barcelona, Barcelona, Spain
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The Influence of Adverse Effects on Quality of Life of Survivors of Gynecologic Cancer. Int J Gynecol Cancer 2017; 27:2014-2019. [DOI: 10.1097/igc.0000000000001125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe objective of this observational study was to investigate correlations between adverse effects (lower-extremity lymphedema [LEL], dysuria, and severe gastrointestinal symptoms) and quality of life (QOL) (physical well-being [PWB], social well-being, emotional well-being [EWB], and functional well-being) before treatment, at least 6 weeks after treatment (posttreatment1), and 3 or 6 months after treatment (posttreatment2) of patients with gynecologic cancer (GC).MethodsFrom August 2012 to October 2016, questionnaire responses and clinical data of 75 patients with GC were collected and assessed by treatment received. The χ2 test was used to determine the significance of correlations.ResultsParticipants with LEL had significantly poorer QOL than did those without it in the domains of PWB at posttreatment1 (P = 0.026) and EWB at posttreatment2 (P = 0.020). Moreover, patients with 2 adverse effects (LEL plus dysuria or severe gastrointestinal symptoms) had significantly poorer QOL than did those with no or single adverse effect in the domains of PWB at posttreatment1 and posttreatment2 (posttreatment1: P = 0.049, P = 0.001; posttreatment2: P = 0.002, P = 0.028) and poorer QOL compared with those with no adverse effect in the domain of EWB at posttreatment1 (P = 0.017).ConclusionsPoorer QOL in emotional and physical domains is associated with adverse effects of treatment in patients with GC. It is important to consider the effects of radical therapy not only on survival but also on the QOL of survivors.
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Hayes SC, Janda M, Ward LC, Reul-Hirche H, Steele ML, Carter J, Quinn M, Cornish B, Obermair A. Lymphedema following gynecological cancer: Results from a prospective, longitudinal cohort study on prevalence, incidence and risk factors. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.06.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yamamoto T, Yamamoto N, Yoshimatsu H, Narushima M, Koshima I. Factors Associated with Lower Extremity Dysmorphia Caused by Lower Extremity Lymphoedema. Eur J Vasc Endovasc Surg 2017; 54:69-77. [PMID: 28392114 DOI: 10.1016/j.ejvs.2017.02.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Indocyanine green (ICG) lymphography has been reported to be useful for the early diagnosis of lymphoedema. However, no study has reported the usefulness of ICG lymphography for evaluation of lymphoedema with lower extremity dysmorphia (LED). This study aimed to elucidate independent factors associated with LED in secondary lower extremity lymphoedema (LEL) patients. METHODS This was a retrospective observational study of 268 legs of 134 secondary LEL patients. The medical charts were reviewed to obtain data of clinical demographics and ICG lymphography based severity stage (leg dermal backflow [LDB] stage). LED was defined as a leg with a LEL index of 250 or higher. Logistic regression analysis was used to identify independent factors associated with LED. RESULTS LED was observed in 106 legs (39.6%). Multivariate analysis revealed that independent factors associated with LED were higher LDB stages compared with LDB stage 0 (LDB stage III; OR 17.586; 95% CI 2.055-150.482; p = .009) (LDB stage IV; OR 76.794; 95% CI 8.132-725.199; p < .001) (LDB stage V; OR 47.423; 95% CI 3.704-607.192; p = .003). On the other hand, inverse associations were observed in higher age (65 years or older; OR 0.409; 95% CI 0.190-0.881; p = .022) and higher body mass index (25 kg/m2 or higher; OR 0.408; 95% CI 0.176-0.946; p = .037). CONCLUSIONS Independent factors associated with LED were elucidated. ICG lymphography based severity stage showed the strongest association with LED, and was useful for evaluation of progressed LEL with LED.
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Affiliation(s)
- T Yamamoto
- Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
| | - N Yamamoto
- Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - H Yoshimatsu
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - M Narushima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - I Koshima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
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Fukushima T, Tsuji T, Sano Y, Miyata C, Kamisako M, Hohri H, Yoshimura C, Asakura M, Okitsu T, Muraoka K, Liu M. Immediate effects of active exercise with compression therapy on lower-limb lymphedema. Support Care Cancer 2017; 25:2603-2610. [PMID: 28386788 PMCID: PMC5486768 DOI: 10.1007/s00520-017-3671-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/14/2017] [Indexed: 11/28/2022]
Abstract
Purpose Active exercise with compression therapy (AECT) is a standard treatment for gynecological cancer-related lower-limb lymphedema (LLL) in clinical situations. However, there is insufficient evidence regarding the immediate effects of the use of AECT on LLL. The purpose of this study was to evaluate the immediate effects of AECT on LLL. Methods Participants in this randomized controlled crossover trial comprised 23 women with LLL who completed high-load AECT, low-load AECT, and compression-only therapy (CT). AECT was performed on a bicycle ergometer with short stretch bandages. Each intervention was performed for 15 min, with successive interventions separated by a 1-week washout period. Lower-limb volume was assessed using a Perometer™ sensor (Pero-system, Wuppertal, Germany). General symptoms (pain and heaviness) and skin symptoms (pitting and stiffness) were assessed using a visual analog scale and palpation, respectively. Measurements were taken before and after each intervention. Analysis of variance using linear mixed-effect modeling was used for statistical analyses. Results Volume decrement differed significantly between all three interventions (P < 0.05). Lower-limb volume was significantly reduced after high-load AECT compared to that after CT. General symptoms and skin symptoms were similar across the three interventions, but severity of pre-intervention skin symptoms correlated significantly with volume decrement after high- and low-load AECT. High-load AECT using the bicycle ergometer was more effective than CT for decreasing lower-limb volume. Conclusions These results suggest that high-load AECT has marked effects on severe LLL.
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Affiliation(s)
- Takuya Fukushima
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Locomotive Rehabilitation Science, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Yufuko Sano
- Department of Rehabilitation Medicine, Keio University Hospital, Tokyo, Japan
| | - Chieko Miyata
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Michiyo Kamisako
- Department of Rehabilitation Medicine, Keio University Hospital, Tokyo, Japan
| | - Hiroka Hohri
- Department of Rehabilitation Medicine, Keio University Hospital, Tokyo, Japan
| | - Chikako Yoshimura
- Department of Rehabilitation Medicine, Keio University Hospital, Tokyo, Japan
| | - Megumi Asakura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Taro Okitsu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Muraoka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Lindqvist E, Wedin M, Fredrikson M, Kjølhede P. Lymphedema after treatment for endometrial cancer − A review of prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol 2017; 211:112-121. [DOI: 10.1016/j.ejogrb.2017.02.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/19/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
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Li J, Chen Y, Zhang L, Xing L, Xu H, Wang Y, Shi Q, Liang Q. Total saponins of panaxnotoginseng promotes lymphangiogenesis by activation VEGF-C expression of lymphatic endothelial cells. JOURNAL OF ETHNOPHARMACOLOGY 2016; 193:293-302. [PMID: 27553977 PMCID: PMC5108701 DOI: 10.1016/j.jep.2016.08.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 08/14/2016] [Accepted: 08/20/2016] [Indexed: 05/31/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Lymphatic system plays an important role in maintaining the fluid homeostasis and normal immune responses, anatomic or functional obstruction of which leads to lymphedema, and treatments for therapeutic lymphangiogenesis are efficiency for secondary lymphedema. Total saponins of panaxnotoginseng (PNS) are a mixture isolated from Panaxnotoginseng (Burkill) F.H.Chen, which has been used as traditional Chinese medicine in China for treatment of cardio- and cerebro-vascular diseases. The aim of this study was to determine the effect and mechanism of PNS on lymphangiogenesis. METHODS The Tg (fli1: egfp; gata1: dsred) transgenic zebrafish embryos were treated with different concentrations of PNS (10, 50, 100μM) for 48h with or without the 6h pretreatment of the 30μM Vascular endothelial growth factors receptor (VEGFR)-3 kinase inhibitor, followed with morphological observation and lympangiogenesis of thoracic duct assessment. The effect of PNS on cell viability, migration, tube formation and Vascular endothelial growth factors (VEGF)-C mRNA and protein expression of lymphatic endothelial cells (LECs) were determined. The role of phosphatidylinositol-3 (PI-3)-kinase (PI3K), extracellular signal-regulated kinase (ERK)1/2 pathways, c-Jun N-terminal kinase (JNK) and P38 mitogen activated protein kinases (MAPK) signaling in PNS-induced VEGF-C expression of LECs by using pharmacological agents to block each signal. RESULTS PNS promotes lymphangiogenesis of thoracic duct in zebrafish with or without VEGFR3 Kinase inhibitor pre-impairment. PNS promotes proliferation, migration and tube formation of LECs. The tube formation induced by PNS could be blocked by VEGFR3 Kinase inhibitor. PNS induce VEGF-C expression of LEC, which could be blocked by ERK1/2, PI3K and P38MAPK signaling inhibitors. CONCLUSION PNS activates lymphangiogenesis both in vivo and in vitro by up-regulating VEGF-C expression and activation of ERK1/2, PI3K and P38MAPK signaling. These findings provide a novel insight into the role of PNS in lymphangiogenesis and suggest that it might be an attractive and suitable therapeutic agent for treating secondary lymphedema or other lymphatic system impairment related disease.
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Affiliation(s)
- Jinlong Li
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
| | - Yan Chen
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
| | - Li Zhang
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
| | - Lianping Xing
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA; Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | - Hao Xu
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
| | - Yongjun Wang
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
| | - Qi Shi
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
| | - Qianqian Liang
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
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Relationship Between Lymphedema and Arteriosclerosis: Higher Cardio-Ankle Vascular Index (CAVI) in Lymphedematous Limbs. Ann Plast Surg 2016; 76:336-9. [PMID: 25695448 DOI: 10.1097/sap.0000000000000481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Arteriosclerosis is one of the most important public health issues because it is very common in developed countries and its sequelae are lethal. Lymphatic vessel insufficiency has been reported to be associated with atherogenesis. Lymphedema seems to affect progression of arteriosclerosis, but no clinical study has been reported. METHODS Forty-eight limbs of 24 female patients with pelvic cancer-related lower extremity lymphedema (LEL) were evaluated. Cardio-ankle vascular index (CAVI), an indirect estimate of the arterial stiffness, was measured in each limb. Cardio-ankle vascular index was compared according to known arteriosclerosis risk factors including age (younger than 65 years vs 65 years), body mass index (BMI; <25 vs 25 kg/m), hypertension (HT), diabetes mellitus, hyperlipidemia (HL), and smoking, as well as according to LEL-related factors including duration of LEL (<5 years vs 5 years), pelvic irradiation, leg cellulitis, LEL index (<250 vs 250), and leg dermal backflow (LDB) stage (LDB stage 0/I vs LDB stage II/III/IV/V) using univariable analyses and multivariable analysis. RESULTS Univariable analyses revealed statistically significant differences in CAVI between lower BMI and higher BMI [7.19 (0.75) vs 8.36 (1.24), P < 0.01], HT (-) and HT (+) [7.25 (0.81) vs 8.17 (1.29), P < 0.01], HL (-) and HL (+) [7.19 (0.74) vs 8.06 (1.27), P < 0.01], and lower LDB stage and higher LDB stage [6.87 (0.65) vs 7.76 (1.05), P < 0.01]. Multivariable analysis revealed statistically significant differences in CAVI between lower BMI and higher BMI (P < 0.01), shorter duration of LEL and longer duration of LEL [7.21 (1.04) vs 7.71 (0.97), P = 0.04], and lower LDB stage and higher LDB stage (P = 0.04) CONCLUSIONS: Higher BMI, longer duration of LEL, and higher LDB stage were independent factors associated with higher CAVI in pelvic cancer-related LEL.
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Lamprou DAA, Voesten HGJ, Damstra RJ, Wikkeling ORM. Circumferential suction-assisted lipectomy in the treatment of primary and secondary end-stage lymphoedema of the leg. Br J Surg 2016; 104:84-89. [DOI: 10.1002/bjs.10325] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/25/2016] [Accepted: 08/23/2016] [Indexed: 01/15/2023]
Abstract
Abstract
Background
The treatment of end-stage lymphoedema of the leg is challenging, especially when conservative treatment fails and there is a large volume difference between the affected and unaffected legs. Circumferential suction-assisted lipectomy (CSAL) has been described as a treatment option for end-stage lymphoedema of the leg. Here, the long-term results of CSAL in end-stage primary and secondary lymphoedema of the leg were analysed.
Methods
This was a descriptive study of patients treated with CSAL for unilateral chronic irreversible lymphoedema of the leg. Compression therapy was resumed after surgery. Leg volumes were measured before surgery, and at 1, 6, 12 and 24 months after the procedure.
Results
A total of 47 patients with primary lymphoedema had a median preoperative volume difference between affected and unaffected legs of 3686 (i.q.r. 2851–5121) ml. Two years after surgery, this volume difference was reduced to 761 ml, a 79 per cent reduction. In the 41 patients treated for secondary lymphoedema, the median preoperative volume difference was 3320 (i.q.r. 2533–4783) ml, decreasing after 2 years to −38 ml (101 per cent reduction). The preoperative volume difference and the sex of the patient significantly influenced the final outcome after 2 years. The outcome was not related to BMI or other patient characteristics.
Conclusion
CSAL is an effective method for treating both primary and secondary lymphoedema of the leg.
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Affiliation(s)
- D-A A Lamprou
- Expert Centre of Lympho-Vascular Medicine, Departments of Vascular Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - H G J Voesten
- Expert Centre of Lympho-Vascular Medicine, Departments of Vascular Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - R J Damstra
- Departments of Dermatology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - O R M Wikkeling
- Expert Centre of Lympho-Vascular Medicine, Departments of Vascular Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands
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Kim M, Suh DH, Yang EJ, Lim MC, Choi JY, Kim K, No JH, Kim YB. Identifying risk factors for occult lower extremity lymphedema using computed tomography in patients undergoing lymphadenectomy for gynecologic cancers. Gynecol Oncol 2016; 144:153-158. [PMID: 28094037 DOI: 10.1016/j.ygyno.2016.10.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/18/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify risk factors for lower extremity lymphedema (LEL) using computed tomographic (CT) scan in patients undergoing lymphadenectomy for gynecologic cancers. METHODS We retrospectively reviewed 511 consecutive gynecologic cancer patients undergoing lymphadenectomy. Mean difference (3.77±3.14mm) of subcutaneous layer thicknesses between preoperative and postoperative 1-year CT scans of 106 patients with clinical LEL was used as an objective criterion for regrouping all the patients into those with mean difference >3.77mm and ≤3.77mm. Risk factors for clinical LEL and significant increase of subcutaneous layer thickness on CT were evaluated using a logistic regression model. RESULTS A total of 106 (20.7%) patients were clinically diagnosed with LEL by a physician. Total number of lymph nodes (LNs) retrieved >30 (Odds ratio [OR] 3.2; 95% Confidence interval [CI] 1.94-5.32; p<0.001) and adjuvant pelvic radiotherapy (OR 3.1; 95% CI 1.75-5.52; p<0.001) were risk factors for clinical LEL. One hundred-nineteen (23.3%) had subcutaneous layer thickness increase of >3.77mm. In addition to number of LNs retrieved >30 (OR 2.3; 95% CI 1.40-3.74; p=0.001) and adjuvant pelvic radiotherapy (OR 1.7; 95% CI 1.01-2.74; p=0.046), open surgery (OR 1.8; 95% CI 1.01-3.11; p=0.045), long operation time (OR 1.7; 95% CI 1.05-2.83; p=0.032), and no use of intermittent pneumatic compression (IPC) (OR 2.1; 95% CI 1.06-4.16; p=0.034) were risk factors for thick subcutaneous layer on postoperative CT. CONCLUSIONS In addition to high LN retrieval and adjuvant pelvic radiotherapy, open surgery, long operation time, and no IPC use could be risk factors for occult LEL after lymphadenectomy in gynecologic cancers.
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Affiliation(s)
- Miseon Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myong Cheol Lim
- Gynecologic Cancer Branch and Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Jin Young Choi
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong-Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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50
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Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016; 66:271-89. [PMID: 27253694 DOI: 10.3322/caac.21349] [Citation(s) in RCA: 3404] [Impact Index Per Article: 425.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The number of cancer survivors continues to increase because of both advances in early detection and treatment and the aging and growth of the population. For the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborate to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results cancer registries. In addition, current treatment patterns for the most prevalent cancer types are presented based on information in the National Cancer Data Base and treatment-related side effects are briefly described. More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, and this number is projected to reach more than 20 million by January 1, 2026. The 3 most prevalent cancers are prostate (3,306,760), colon and rectum (724,690), and melanoma (614,460) among males and breast (3,560,570), uterine corpus (757,190), and colon and rectum (727,350) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost one-half (47%) are aged 70 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by primary care providers. Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care. CA Cancer J Clin 2016;66:271-289. © 2016 American Cancer Society.
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Affiliation(s)
- Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Strategic Director, Surveillance Information, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Chun Chieh Lin
- Director, Health Services Research, Intramural Research Department, American Cancer Society, Atlanta, GA
| | - Angela B Mariotto
- Branch Chief, Surveillance Research Program, National Cancer Institute, Bethesda, MD
| | - Joan L Kramer
- Assistant Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Julia H Rowland
- Director, Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD
| | - Kevin D Stein
- Vice President, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Rick Alteri
- Medical Editor, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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