Lower-Limb Lymphedema after Sentinel Lymph Node Biopsy in Cervical Cancer Patients
by
, , , , , , , ,
David Cibula
1,*,†
,
Martina Borčinová
1,†,
Simone Marnitz
2,
Jiří Jarkovský
3,
Jaroslav Klát
4,†,
Radovan Pilka
5,†,
Aureli Torné
6,
Ignacio Zapardiel
7
,
Almerinda Petiz
8,
Laura Lay
9,
Borek Sehnal
10,†,
Jordi Ponce
11,
Michal Felsinger
12,†,
Octavio Arencibia-Sánchez
13,
Peter Kaščák
14,†,
Kamil Zalewski
15,†,
Jiri Presl
16,†,
Alicia Palop-Moscardó
17,
Solveig Tingulstad
18,
Ignace Vergote
19,‡,
Mikuláš Redecha
20,†,
Filip Frühauf
1,†,
Christhardt Köhler
2 and 
Roman Kocián
1,†add
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1
Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic
2
Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany
3
Data Analysis Department, Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
4
Department of Obstetrics and Gynecology, University Hospital Ostrava, 70800 Ostrava Poruba, Czech Republic
5
Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, 77900 Olomouc, Czech Republic
6
Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clinic-Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
7
Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain
8
Serviço de Ginecologia, Instituto Portugues de Oncologia do Porto, 1099-023 Porto, Portugal
9
Department of Gynaecology, Institute of Oncology Angel H Roffo University of Bueno s Aires, Buenos Aires C1417 DTB, Argentina
10
Department of Obstetrics and Gynecology, First Faculty of Medicine, University Hospital Bulovka, Charles University, 18081 Prague, Czech Republic
11
Department of Gynecology, Biomedical Research Institute of Bellvitge (IDIBELL), University Hospital of Bellvitge, University of Barcelona, 08908 Barcelona, Spain
12
Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, 60177 Brno, Czech Republic
13
Departments of Gynecologic Oncology, University Hospital of the Canary Islands, 35016 Las Palmas de Gran Canaria, Spain
14
Department of Obstetrics and Gynecology, Faculty Hospital Trencin, 911 71 Trencin, Slovakia
15
Department of Gynecologic Oncology, Holycross Cancer Center, 25-734 Kielce, Poland
16
Department of Obstetrics and Gynecology, Faculty of Medicine Pilsen, University Hospital in Pilsen and Charles University, 30460 Pilsen, Czech Republic
17
Gynecology Department, Instituto Valenciano de Oncologia (IVO), 46009 Valencia, Spain
18
Department of Obstetrics and Gynecology, Trondheim University Hospital, 7030 Trondheim, Norway
19
Department of Gynecology and Obstetrics, Leuven Cancer Institute, University Hospital Leuven, 3000 Leuven, Belgium
20
Department of Gynaecology and Obstetrics, University Hospital, Comenius University, 814 99 Bratislava, Slovakia
*
Author to whom correspondence should be addressed.
†
Central and Eastern European Gynecologic Oncology Group, CEEGOG.
‡
Belgium and Luxembourg Gynaecological Oncology Group, BGOG.
Cancers 2021, 13(10), 2360; https://doi.org/10.3390/cancers13102360
Submission received: 6 April 2021
/
Revised: 7 May 2021
/
Accepted: 11 May 2021
/
Published: 13 May 2021
(This article belongs to the Section Clinical Research of Cancer)
Simple Summary
Lower-limb lymphedema (LLL) is a well-recognized adverse outcome of the surgical management of cervical cancer. Recently, sentinel lymph node (SLN) biopsy has emerged as an alternative procedure to systematic pelvic lymphadenectomy (PLND) aiming to decrease the risk of complications, especially LLL development. Our study represents the first prospective analysis of LLL incidence in cervical cancer patients after a uterine procedure with SLN biopsy, without systematic PLND. In an international multicenter trial SENTIX, the group of 150 patients was prospectively evaluated using both objective and subjective LLL assessments in 6 months intervals for 2 years. Contrary to the expectations, our results showed that SLN biopsy does not eliminate the risk of LLL development which occurred in a mild or moderate stage in about 26% of patients with a median interval to the onset of 9 months.
Abstract
Background: To prospectively assess LLL incidence among cervical cancer patients treated by uterine surgery complemented by SLN biopsy, without PLND. Methods: A prospective study in 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy. Objective LLL assessments, based on limb volume increase (LVI) between pre- and postoperative measurements, and subjective patient-perceived swelling were conducted in six-month periods over 24-months post-surgery. Results: The cumulative incidence of LLL at 24 months was 17.3% for mild LLL (LVI 10–19%), 9.2% for moderate LLL (LVI 20–39%), while only one patient (0.7%) developed severe LLL (LVI > 40%). The median interval to LLL onset was nine months. Transient edema resolving without intervention within six months was reported in an additional 22% of patients. Subjective LLL was reported by 10.7% of patients, though only a weak and partial correlation between subjective-report and objective-LVI was found. No risk factor directly related to LLL development was identified. Conclusions: The replacement of standard PLND by bilateral SLN biopsy in the surgical treatment of cervical cancer does not eliminate the risk of mild to moderate LLL, which develops irrespective of the number of SLN removed.
