Lymphedema after vulvar cancer surgery. A prospective study

Česká verzia

Authors: M. Nováčková ¹; Michael Jiří Halaška ¹ ; I. Malá ²; H. Robová ¹ ; M. Pluta ¹; R. Chmel ¹ ; Lukáš Rob ¹
Authors place of work: Gynekologicko-porodnická klinika 2. LF UK a FN Motol, Praha, přednosta prof. MUDr. L. Rob, CSc. ¹; Vysoká škola ekonomická, Praha, vedoucí katedry doc. RNDr. L. Marek, CSc. ²
Published in the journal: Ceska Gynekol 2013; 78(5): 473-480
Category: Original Article

Summary

Introduction:
Prospective detection of postoperative lymphedema of the lower limbs (LLL) in patients after surgery for vulvar cancer using different examination methods and their comparison.

Design:
Prospective clinical study.

Setting:
Department of Obstetrics and Gynecology, 2nd Medical Faculty of the Charles University and University Hospital Motol, Prague.

Methods:
Totally 36 women were followed after surgery for vulvar cancer. Due to the radicality of surgery the patients were divided into conservative (sentinel lymph node biopsy) and radical (inguinofemoral lymphadenectomy) group. Lower limbs were preoperatively and 3, 6 and 12 months after surgery assessed for the presence of lymphedema by measuring of circumferences, multifrequency bioelectrical impedance analysis (MFBIA) and subjective evaluation of patients.

Results:
The prevalence of lower limb lymphedema 12 months after surgery diagnosed by subjective evaluation reached 19,44%, by circumference measurement 38,89% and with MFBIA 66,67%. The prevalence of lymphedema after inguinofemoral lymphadenectomy diagnosed by circumference measurement was in 12 months after surgery higher (45.83%) than after the conservative surgery (25%). Risk factors were evaluated 12 months after surgery (age, BMI, adjuvant radiotherapy, type of surgery) and none of them were found to be statistically significant for the development of the lower limbs lymphedema.

Conclusion:
The prevalence of lymphedema significantly depends on the diagnostic method, because they capture lymphedema in its various stages. Due to the high sensitivity MFBIA can be used for the detection of early stages of lymphedema. Preoperative measurement of the lower limbs is important for early detection of postoperative lymphedema.

Keywords:
vulvar cancer – lymphedema – multifrequency bioelectrical impedance analysis – MFBIA – circumference measurement

Zdroje

1. Beesley, VL., Janda, M., Eakin, EG., et al. Lymphedema after gynaecological cancer treatment: prevalence, correlates, and supportive care needs. Cancer, 2007, 109(12), p. 2607–2614.

2. Benda, K. Lymfedém končetin v ordinaci praktického lékaře. Med pro Praxi, 2006, 6, s. 276–279.

3. Brouns, E., Donceel, P., Stas, M. Quality of life and disability after ilio-inguinal lymphadenectomy. Acta Chir Belg, 2008, 108(6), p. 685–690.

4. Cormier, JN., Askew, RL., Mungovan, KS., et al. Lymphedema beyond breast cancer: a systematic review and metaanalysis of cancer-related secondary lymphedema. Cancer, 2010, 116(22), p. 5138–5149.

5. Cornish, BH., Thomas, BJ., Ward, LC., et al. A new technique for the quantification of peripheral edema with application in both unilateral and bilateral cases. Angiology, 2002, 53(1), p. 41–47.

6. Cornish, BH., Chapman, M., Hirst, C., et al. Early diagnosis of lymphoedema using multiple frequency bioimpedance. Lymphology, 2001, 34, p. 2–11.

7. Gaarenstroom, KN., Kenter, GG., Trimbos, JB., et al. Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions. Int J Gynecol Cancer, 2003, 13(4), p. 522–527.

8. Halaska, MJ., Novackova, M., Mala, I., et al. A prospective study of postoperative lymphedema after surgery for cervical cancer. Int J Gynecol Cancer, 2010, 20(5), p. 900–904.

9. Halaška, M., Strnad, P., Chod, J., et al. Detekce pooperačního lymfedému u pacientek s karcinomem prsu. Čes Gynek, 2007, 72(4), s. 299–304.

10. Halaska, MG., Komarek, V., Bunc, V., et al. A method for detection of postoperative lymphoedema after operation for breast cancer: Multifrequency Bioelectrical Impedance Analysis.J Applied Biomedicine, 2006, 4, p. 105–111.

11. Hinten, F., Van den Einden, LC., Hendriks, JC., et al. Risk factors for short- and long-term complications after groin surgery in vulvar cancer. Br J Cancer, 2011, 105(9), p. 1279–1287.

12. Johann, S., Klaeser, B., Krause, T., Mueller, MD. Comparision of outcome and recurrence-free survival after sentinel lymph node biopsy and lymphadenectomy in vulvar cancer. Gynecol Oncol, 2008, 110(3), p. 324–328.

13. Kunos, C., Simpkins, F., Gibbons, H., et al. Radiation therapy compared with pelvic node resection for node-positive vulvar cancer. Obstet Gynecol, 2009, 114(3), p. 537–546.

14. Levenback, CF., Van der Zee, AG., Rob, L., et al. Sentinellymph node biopsy in patients with gynecologic cancers Expert panel statement from the International Sentinel Node Society Meeting, February 21, 2008. Gynecol Oncol, 2009, 114(2), p. 151–156.

15. Novackova, M., Halaska, MJ., Robova, H., et al. A prospective study in detection of lower limb lymphoedema and evaluation of quality of life after vulvar cancer surgery. Int J Gynecol Cancer, 2012, 22(6), p. 1081–1088.

16. Nováčková, M., Halaška MJ., Chmel R., Rob L. Lymfedémy dolních končetin po chirurgické léčbě gynekologických nádorů. Gynekolog, 2009, 18(6), s. 211–213.

17. Rob, L., Robova, H., Pluta, M., et al. Further data on sentinel lymph node mapping in vulvar cancer by blue dye and radiocolloid Tc99. Int J Gynecol Cancer, 2007, 17(1), p. 147–153.

18. Rob, L., Svoboda, B., Robova, H., et al. Guideline gynekologických zhoubných nádorů 2004 – Primární komplexní léčba operabilních stadií zhoubných nádorů děložního hrdla. Čes Gynek, 2004, 69(5), s. 376–383.

19. Ryan, M., Stainton, MC., Slaytor, EK., et al. Aetiology and prevalence of lower limb lymphoedema following treatment for gynaecological cancer. Aust N Z J Obstet Gynaecol, 2003, 43(2), p. 148–151.

20. Tada, H., Teramukai, S., Fukushima, M., Sasaki, H. Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma. BMC Cancer, 2009, 9:47. Doi: 10.1186/1471-2407-9-47.

21. ÚZIS. Novotvary 2009 – Česká republika. Zdravotnická statistika ÚZIS ČR a NOR ČR, 2013.

22. Van der Velden, J., Fons, G., Lawrite, TA. Primary groin irradiation versus primary groin surgery for early vulvar cancer. Cochrane Database Syst Rev, 2011, 11(5), CD002224.

23. Van der Zee, AG., Oonk, MH., De Hullu, JA., et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol, 2008, 26(6), p. 884–889.

24. Ward, LC., Bunce, IH., Cornish, BH., et al. Multifrequency bio-electrical impedance augments the diagnosis and management of lymphoedema in post-mastectomy patients. Eur J Clin Invest, 1992, 22(11), p. 751–754.

25. Watanabe, R., Miura, A., Inoue, K., et al. Evaluation of leg edema using a multifrequency impedance meter in patients with lymphatic obstruction. Lymphology, 1989, 22(2), p. 85–92.