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Reduction/Prevention of Lower Extremity Lymphedema after Pelvic and Para-aortic Lymphadenectomy for Patients with Gynecologic Malignancies

Annals of Surgical Oncology volume 19, pages 268–273 (2012)Cite this article

Abstract

Background

Lower extremity lymphedema (LEL) is a serious complication caused by lymphadenectomy in patients with gynecologic malignancies. In this study, we evaluated the effect of preserving the circumflex iliac lymph nodes (CILNs), i.e., the most caudal external iliac lymph nodes, for the prevention and reduction of LEL by comparing two groups of patients, one in which CILN were removed and the other in which CILNs were preserved.

Methods

We retrospectively reviewed 329 patients with gynecologic malignancies who had undergone abdominal complete systematic pelvic and para-aortic lymphadenectomy. The patients were divided into nonpreserved (n = 189) and preserved (n = 140) groups, depending on whether CILNs were removed. Primary outcome measures included the incidence and severity of LEL.

Results

The incidence of LEL was significantly lower in the preserved group than in the nonpreserved group (P < 0.0001). The frequency of LEL was also significantly lower in the preserved group than in the nonpreserved group regardless of the range of pelvic and para-aortic lymphadenectomy (P < 0.0001). LEL in the overwhelming majority of cases in the preserved group was mild, and no patients experienced severe LEL. Further, the incidence of cellulitis was 0% in the preserved group, while it was 12.7% in the nonpreserved group (P < 0.0001). Lymphoscintigraphy revealed collateral pathways from the preserved CILN along the iliac and large abdominal vessels.

Conclusions

This method of lymph node preservation is a simple and extremely effective approach for preventing/reducing LEL after pelvic and para-aortic lymphadenectomy for patients with gynecologic malignancies.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Sapporo City General Hospital, Sapporo, Japan

    Hitoshi Hareyama MD, Kumiko Ito MD, Akiko Uchida MD, Yukitoki Hayakashi MD, Emi Hirayama MD, Mamoru Oikawa MD & Kazuhiko Okuyama MD

  2. Sanatorio La Paz, Itapua, Paraguay

    Kenichi Hada MD

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  1. Hitoshi Hareyama MD
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  2. Kumiko Ito MD
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  3. Kenichi Hada MD
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  4. Akiko Uchida MD
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  5. Yukitoki Hayakashi MD
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Correspondence to Hitoshi Hareyama MD.

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Hareyama, H., Ito, K., Hada, K. et al. Reduction/Prevention of Lower Extremity Lymphedema after Pelvic and Para-aortic Lymphadenectomy for Patients with Gynecologic Malignancies. Ann Surg Oncol 19, 268–273 (2012). https://doi.org/10.1245/s10434-011-1863-4

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