Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy; Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy.
Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy; Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy.
Taiwan J Obstet Gynecol. 2024 Jul;63(4):500-505. doi: 10.1016/j.tjog.2024.04.008.
Lower extremity lymphedema (LEL) is a common complication following surgical staging of endometrial cancer. LEL is a chronic condition associated with significant impact on patient morbidity and quality of life (QoL). This review aimed to report the current evidence in the literature on secondary LEL after surgical staging for endometrial cancer, focusing on the incidence based on different approaches to lymph node staging, diagnosis, risk factors, and the impact on QoL. Due to the absence of a standardized agreement regarding the methodology for evaluating LEL, the documented frequency of occurrence fluctuates across different studies, ranging from 0% to 50%. Systematic pelvic lymphadenectomy appears to be the primary determinant associated with the emergence of LEL, whereas the implementation of sentinel lymph node biopsy has notably diminished the occurrence of this lymphatic complication after endometrial cancer staging. LEL is strongly associated with decreased QoL, lower limb function, and negative body image, and has a detrimental impact on cancer-related distress reported by survivors. Standardization of lymphedema assessment is needed, along with cross-cultural adaptation of subjective outcome measures for self-reported LEL. The advent of sentinel lymph node mapping represents the ideal approach for accurate nodal assessment with less short- and long-term morbidity. Further research is needed to definitively assess the prevalence and risk factors of LEL and to identify strategies to improve limb function and QoL in cancer survivors with this chronic condition.
下肢淋巴水肿（LEL）是子宫内膜癌手术分期后的常见并发症。LEL 是一种慢性疾病，会对患者的发病率和生活质量（QoL）产生重大影响。本综述旨在报告关于子宫内膜癌手术分期后继发性 LEL 的文献中的现有证据，重点关注基于不同淋巴结分期方法、诊断、危险因素的发病率，以及对 QoL 的影响。由于缺乏评估 LEL 的标准化协议，不同研究中记录的发病频率存在波动，从 0%到 50%不等。系统盆腔淋巴结清扫术似乎是与 LEL 出现相关的主要决定因素，而前哨淋巴结活检的实施显著降低了子宫内膜癌分期后这种淋巴并发症的发生。LEL 与生活质量下降、下肢功能降低和负面身体形象密切相关，并对幸存者报告的癌症相关困扰产生不利影响。需要对淋巴水肿评估进行标准化，并对自我报告的 LEL 的主观结局测量进行跨文化适应性调整。前哨淋巴结绘图的出现代表了具有较少短期和长期发病率的准确淋巴结评估的理想方法。需要进一步研究来明确评估 LEL 的患病率和危险因素，并确定改善患有这种慢性疾病的癌症幸存者的肢体功能和生活质量的策略。
