Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma

A total of 694 patients with histologically confirmed ovarian (135 patients) or uterine cancer (258 with cervical cancer, 301 with endometrial cancer) who underwent lymph node dissection were studied retrospectively. Logistic regression analyses were used to identify the risk factors associated with occurrence of lymphedema.Among ovarian and uterine cancer patients who underwent pelvic lymph node dissection, post-operative radiotherapy (odds ratio: 1.79; 95% confidence interval: 1.20–2.67; p = 0.006) was statistically significantly associated with occurrence of lymphedema.There was no relationship between any surgical procedure and occurrence of lymphedema among patients undergoing pelvic lymphadenectomy. Our findings are supported by a sound biological rationale because they suggest that limb lymphedema is caused by pelvic lymph node dissection.After breast cancer, ovarian and uterine carcinomas are the next most-common gynecological malignancies in Japan [1]. Owing to the recent development of effective chemotherapeutic agents and regimens, some cases of ovarian cancer are now curable with a combination of surgery and chemotherapy, and the survival of patients has continued to improve [2]. For early-stage ovarian cancer, the standard therapy is complete surgical staging followed by abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy and selective lymphadenectomy. Uterine cancer is also potentially curable using the following therapeutic approaches: (i) radiation, (ii) surgery, and (iii) chemotherapy [1]. As more effective modes of treatment, such as extended surgical removal and lymph node dissection are implemented, many patients with ovarian or uterine carcinoma have been cured and survivorship has continued to increase [3].However, an important but sometimes overlooked sequel to these treatments is lymphedema of the lower limbs [4]. This is a chronic, incurable condition, the effects of which include limb swelling and feelings of heavine