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  • br d Duke Cancer Institute Durham

    2019-11-06


    d Duke Cancer Institute, Durham, NC, United States of America
    e Department of Obstetrics and Gynecology Virginia Tech Carilion School of Medicine Roanoke, VA, United States of America
    • Lymphedema was present in 27% of endometrial cancer patients 12–18 months after surgical staging.
    • Lymphedema was associated with at least a short-term worsening of lower extremity function.
    • Lymphedema was not associated with a change in global quantity of life.
    Article history:
    Keywords:
    Endometrial cancer
    Minimally invasive surgery
    Lymphedema
    Quality of life 
    Objective. The primary aim of this Talaporfin sodium (ME2906) study was to pilot the use of an objective measurement technique to pro-spectively 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 stag-ing 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.
    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. © 2019 Elsevier Inc. All rights reserved.
    1. Introduction
    The incidence of endometrial cancer is steadily increasing in the United States, with an estimated 62,380 new cases diagnosed in 2018 [1]. Although endometrial cancer is a worsening healthcare burden, a
    Corresponding author at: Duke University, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 201 Trent Drive, 203 Baker House, Durham, NC 27710, United States of America.
    E-mail address: [email protected] (C.H. Watson).
    majority of women are diagnosed with the disease still confined to the uterus, and stage I disease has a N90% 5-year survival rate [2]. Given the excellent survival outcomes among surgically treated patients, it is imperative that providers recognize, address and potentially prevent the long-term adverse sequelae of surgical staging.
    Lower extremity lymphedema (LEL) resulting from lymph node dis-section is a recognized adverse outcome of the surgical management of endometrial cancer. This morbidity can limit a patient's mobility, com-promise her ability to perform daily activities, and have adverse effects on her psychological wellbeing [3–5]. However, the necessity of pelvic
    lymphadenectomy in the management of early stage endometrial can-cer has become a controversial subject. Given that two major random-ized trials have failed to demonstrate a survival benefit to pelvic lymphadenectomy (LND), some experts assert that it has a limited role in the treatment of early stage endometrial cancer [6,7]. Others con-tinue to recommend LND, believing that it provides useful prognostic information and guidance regarding adjuvant therapy [8]. More re-cently, sentinel lymph node biopsy (SLNB) has emerged as an alterna-tive to complete lymphadenectomy that has been hypothesized to lower the risk of LEL [9].
    Although mitigating the risk of LEL is one of the primary drivers of this debate, the true incidence of LEL after endometrial cancer stag-ing surgery is unknown. Published rates of LEL in patients who un-dergo lymphadenectomy for endometrial cancer range from 1% to 52% [10–13]. This wide range is likely secondary to inconsistencies in diagnosis and documentation, as well as the long period of follow-up required to adequately assess the morbidity. Salani et al. also found that patient-reported symptoms of lower limb swelling were significantly higher than patient-reported diagnoses of LEL, suggesting that this diagnosis is often under-recognized by both pa-tients and providers [14].