Hahn Brett A, Richir Milan C, Witkamp Arjen J, de Jong Tim, Krijgh David D
Department of Plastic and Reconstructive Surgery University Medical Center Utrecht Utrecht The Netherlands.
Department of Oncologic Surgery University Medical Center Utrecht Utrecht The Netherlands.
JPRAS Open. 2024 Nov 17;43:187-199. doi: 10.1016/j.jpra.2024.11.001. eCollection 2025 Mar.
Lower extremity lymphedema (LEL) can develop because of inguinal lymph node dissection in the treatment of gynecologic, genitourinary, and dermatological malignancies. To optimize patient counseling and patient selection for microsurgical interventions aimed at preventing or treating LEL, its prevalence and associated patient characteristics must be accurately documented. This systematic review and meta-analysis provides a comprehensive overview of literature on the reported prevalence of LEL in patients undergoing inguinal lymphadenectomy.
From Embase, PubMed, and Web of Science databases, 23 studies were identified that met the inclusion criteria. This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies-of Exposure tool.
Random-effects meta-analyses of proportions estimated a 24% (95% confidence interval [CI]: 17-31) pooled prevalence of LEL with a high degree of heterogeneity between the studies ( =96%, < 0.01). Subgroup analysis revealed significant differences in LEL prevalence based on the indications for inguinal lymphadenectomy. The pooled LEL prevalence was 25.75% (95% CI: 0.00-96.16) for patients who underwent lymphadenectomy for melanoma, 12.22% (95% CI: 1.03-23.40) for penile cancer, 30.96% (95% CI: 21.08-40.84) for vulvar cancer, and 13.62% (95% CI: 0.00-51.02) for miscellaneous indications.
The findings from this study emphasize the importance of considering malignancy etiology when assessing the risk of LEL following inguinal lymphadenectomy. This knowledge could aid physicians in informing patients about the risk of LEL, while also facilitating proper patient selection for microsurgical interventions.
在妇科、泌尿生殖系统和皮肤科恶性肿瘤的治疗中，腹股沟淋巴结清扫术可能会导致下肢淋巴水肿（LEL）。为了优化针对预防或治疗LEL的显微外科手术干预的患者咨询和患者选择，必须准确记录其患病率及相关患者特征。本系统评价和荟萃分析全面概述了有关腹股沟淋巴结清扫术患者中LEL报告患病率的文献。
从Embase、PubMed和Web of Science数据库中，识别出23项符合纳入标准的研究。本评价按照系统评价和荟萃分析的首选报告项目指南进行。使用非随机暴露研究中的偏倚风险工具评估偏倚风险。
比例的随机效应荟萃分析估计LEL的合并患病率为24%（95%置信区间[CI]：17 - 31），研究间存在高度异质性（I² = 96%，P < 0.01）。亚组分析显示，根据腹股沟淋巴结清扫术的指征，LEL患病率存在显著差异。因黑色素瘤接受淋巴结清扫术的患者中，LEL合并患病率为25.75%（95% CI：0.00 - 96.16），阴茎癌患者为12.22%（95% CI：1.03 - 23.40），外阴癌患者为30.96%（95% CI：21.08 - 40.84），其他指征患者为13.62%（95% CI：0.00 - 51.02）。
本研究结果强调了在评估腹股沟淋巴结清扫术后LEL风险时考虑恶性肿瘤病因的重要性。这些知识有助于医生告知患者LEL风险，同时也便于为显微外科手术干预进行恰当的患者选择。
