Identifying risk factors for occult lower extremity lymphedema using computed tomography in patients undergoing lymphadenectomy for gynecologic cancers

• Published in: Gynecologic oncology 2017-01, Vol.144 (1), p.153-158
• Main Authors: Kim, Miseon, Suh, Dong Hoon, Yang, Eun Joo, Lim, Myong Cheol, Choi, Jin Young, Kim, Kidong, No, Jae Hong, Kim, Yong-Beom
• Format: Article
• Language: English
• Subjects: Adult; Aorta; Computed tomography; Female; Genital Neoplasms, Female - radiotherapy; Genital Neoplasms, Female - surgery; Gynecologic cancer; Hematology, Oncology and Palliative Medicine; Humans; Lower Extremity; Lower extremity lymphedema; Lymph Node Excision - adverse effects; Lymphadenectomy; Lymphedema - etiology; Middle Aged; Obstetrics and Gynecology; Operative Time; Pelvis; Radiotherapy, Adjuvant - adverse effects; Retrospective Studies; Risk factor; Risk Factors; Subcutaneous Tissue - diagnostic imaging; Tomography, X-Ray Computed
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2016.10.037

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 ± 3.14 mm) 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 > 3.77 mm and ≤ 3.77 mm. 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 > 3.77 mm. 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.