Deura Imari, Shimada Muneaki, Hirashita Keiko, Sugimura Maki, Sato Seiya, Sato Shinya, Oishi Tetsuro, Itamochi Hiroaki, Harada Tasuku, Kigawa Junzo
Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan,
Int J Clin Oncol. 2015 Jun;20(3):556-60. doi: 10.1007/s10147-014-0724-0. Epub 2014 Jul 4.
Lower limb lymphedema (LLL) is one of the most frequent postoperative complications of retroperitoneal lymphadenectomy for gynecologic cancer. LLL often impairs quality of life, activities of daily living, sleep, and sex in patients with gynecologic cancer. We conducted this study to evaluate the incidence and risk factors for LLL after gynecologic cancer surgery in patients who received assessment and periodic complex decongestive physiotherapy (CDP).
We retrospectively reviewed 126 cases of gynecologic cancer that underwent surgery involving retroperitoneal lymphadenectomy at Tottori University Hospital between 2009 and 2012. All patients received physical examinations to detect LLL and underwent CDP by nurse specialists within several months after surgery. The International Society of Lymphology staging of lymphedema severity was used as the diagnostic criteria.
Of 126 patients, 57 (45.2%) had LLL, comprising 45 and 12 patients with stage 1 and stage 2 LLL, respectively. No patient had stage 3 LLL. LLL was present in 37 (29.4%) patients at the initial physical examination. Multivariate analysis revealed that adjuvant concurrent chemoradiotherapy and age ≥ 55 years were independent risk factors for ≥ stage 2 LLL.
To minimize the incidence of ≥ stage 2 LLL, gynecologic oncologists should be vigilant for this condition in patients who are ≥ 55 years and in those who undergo adjuvant chemoradiotherapy. Patients should be advised to have a physical assessment for LLL and to receive education about CDP immediately after surgery involving retroperitoneal lymphadenectomy for gynecologic cancer.
下肢淋巴水肿（LLL）是妇科癌症腹膜后淋巴结清扫术后最常见的并发症之一。LLL常损害妇科癌症患者的生活质量、日常生活活动、睡眠和性功能。我们开展本研究以评估接受评估及定期综合消肿物理治疗（CDP）的妇科癌症手术后患者发生LLL的发生率及危险因素。
我们回顾性分析了2009年至2012年在鸟取大学医院接受涉及腹膜后淋巴结清扫术的126例妇科癌症病例。所有患者均接受体格检查以检测LLL，并在术后数月内由护士专家进行CDP治疗。采用国际淋巴学会的淋巴水肿严重程度分期作为诊断标准。
126例患者中，57例（45.2%）发生LLL，其中1期和2期LLL分别为45例和12例。无患者发生3期LLL。初次体格检查时，37例（29.4%）患者存在LLL。多因素分析显示，辅助同步放化疗及年龄≥55岁是≥2期LLL的独立危险因素。
为使≥2期LLL的发生率降至最低，妇科肿瘤学家应对≥55岁及接受辅助放化疗的患者警惕该情况。应建议患者在接受妇科癌症腹膜后淋巴结清扫术后立即进行LLL的体格评估并接受CDP相关教育。
