Lower Leg Lymphedema Common after Gyn Surgery

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NEW ORLEANS — Approximately 20-40% of women have significant lower-extremity lymphedema after surgery for gynecologic cancer, according to data from the most comprehensive study of the issue to date.

The incidence of lymphedema ranged from 18% after surgery for endometrial cancer to 40% in women who had surgery for vulvar cancer. Lymphedema appeared within 6 to 12 weeks after surgery in a majority of cases but had delayed onset of up to 18 months in some cases.

Use of a multifactor definition helped distinguish true lower-extremity lymphedema from an increase in leg volume, Jay Carlson, DO, of Cancer Research of the Ozarks, in Springfield, MO, reported here at the Society of Gynecologic Oncology annual meeting.

“The incidence of lymphedema of the lower extremity (LLE) is underrecognized,” he said. “This study helps distinguish between an increase in leg volume and lymphedema. It is the most extensive attempt to prospectively identify the true incidence of LLE and the associated risks. The data challenge some common tenets associated with lymphedema, such as lymph node count and adjuvant radiation, neither of which was associated.”

Carlson reported initial findings from the Lymphedema and Gynecologic Cancer (LeG) trial, sponsored by the Gynecologic Oncology Group (GOG 244). To date most research into postoperative lymphedema has focused on the upper extremities of women with breast cancer, he noted.

“In fact, many cancer survivors are living with disfigurement, discomfort, and disruption of activities due to lymphedema of the lower extremity. There is limited, prospectively collected data on gynecologic cancers as to the incidence, risk factors, and physical and emotional impact of lymphedema of the lower extremity.”

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The primary objective of GOG 244 was to determine the incidence of and identify potential risk factors for LLE. The investigators also examined the effect of LLE on quality of life and evaluated the relationship between LLE and self-reported symptoms, as assessed by the Gynecologic Cancer Lymphedema Questionnaire (GCLQ).

The GOG investigators enrolled patients from June 2012 through November 2014. Each patient had a baseline assessment within 14 days of surgery and then periodic follow-up assessments for 2 years after surgery.

Eligible patients had a baseline assessment of leg volume and at least one follow-up assessment. Clinicians at participating centers received training in measurement technique to ensure a standardized approach. Leg volume was measured in 10-cm increments from the ankle to the inguinal crease.

A total of 1,054 patients were enrolled, of whom 914 were included in the initial analysis of change in leg volume: 138 patients with cervical cancer, 734 with endometrial cancer, and 42 with vulvar cancer.

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