期刊
GYNECOLOGIC ONCOLOGY
卷 164, 期 1, 页码 76-84出版社
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.ygyno.2021.10.089
关键词
Lower limb lymphedema; Limb volume change; Transient edema; Assessment standardisation; Cervical cancer
资金
- Charles University in Prague [UNCE 204065, PROGRES Q28/LF1]
- Czech Health Research Council [NV19-03-00023]
This study aimed to investigate the assessment of lower limb lymphoedema (LLL) and suggested that the diagnostic threshold for LLL diagnosis based on limb volume change (LVC) should be increased to >15%. It also highlighted the importance of repeated measurements to distinguish transient oedema from persistent LLL and ensuring a sufficient follow-up duration. Patient-reported swelling correlated poorly with LVC and should only be used as an adjunct to objective LLL assessment.
Background. Lower limb lymphoedema (LLL) is the most disabling adverse effect of surgical staging of pelvic lymph nodes. However, the lack of standardisation of volumetric LLL assessment hinders direct comparison between the studies and makes LLL reporting unreliable. The aim of our study is to report outcomes from a prospective trial that have implications for LLL assessment standardisation. Methods. In the prospective international multicentre trial SENTIX, a group of 150 patients with stage IA1-IB2 cervical cancer treated by uterine surgery with bilateral sentinel lymph node biopsy was prospectively evaluated by objective LLL assessment, based on limb volume change (LVC) using circumferrential limb measurements and subjective patient-reported swelling. The assessments were conducted in six-month periods over 24 months post-surgery. Results. Patient LVC substantially fluctuated in both positive and negative directions, which were comparable in frequency up to +/- 14% change. Thirty-eight patients experienced persistent LVC increase >10% classified as LLL, with nine months median time to onset. Some 34.2% of cases experienced onset later than one year after the surgery. Thirty-three patients (22%) experienced transient oedema characterised as LVC >10%, which resolved without intervention between two consequent follow-up visits. No significant correlation between LVC >10% and a patient-reported swelling was observed. Conclusions. Given that we observed comparable fluctuations of the the lower-limb volumes after surgical treatment of cervical cancer in both positive and negative direction up to +/- 14%, the diagnostic threshold for LLL diagnosis based on LVC should be increased to >15% LVC. The distinction of transient oedema from persistent LLL requires repeated measurements. Also, as one-third of LLL cases are diagnosed >1-year post-surgery, a sufficient follow-up duration needs to be ensured. Patient-reported swelling correlated poorly with LVC and should only be used as an adjunct to objective LLL assessment. (C) 2021 Elsevier Inc. All rights reserved.
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