Reduced lymphedema after sentinel lymph node biopsy versus lymphadenectomy for endometrial cancer.
Gretchen Glaser, Giorgia Dinoi, Francesco Multinu, Kathleen Yost, Mariam Al Hilli, Alyssa Larish, Amanika Kumar, Michaela McGree, Amy L Weaver, Andrea Cheville, Sean Dowdy, Andrea Mariani
Author Information
Gretchen Glaser: Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA glaser.gretchen@mayo.edu. ORCID
Giorgia Dinoi: Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
Francesco Multinu: Gynecologic Oncology, Istituto Europeo di Oncologia, Milan, Italy. ORCID
Kathleen Yost: Health Sciences Research, Mayo Clinic Rochester, Rochester, Minnesota, USA.
Mariam Al Hilli: Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, USA.
Alyssa Larish: Obstetrics and Gynecology, Mayo Clinic Health System, Austin, Minnesota, USA.
Amanika Kumar: Mayo Clinic Minnesota, Rochester, New York, USA.
Michaela McGree: Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.
Amy L Weaver: Mayo Clinic Rochester, Rochester, Minnesota, USA.
Andrea Cheville: Physical Medicine and Rehabilitation, Mayo Clinic Rochester, Rochester, Minnesota, USA.
Sean Dowdy: Gynecologic Surgery, Mayo Clinic, Rochester, New York, USA.
Andrea Mariani: Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA.
OBJECTIVE: Endometrial cancer surgical staging includes lymph node assessment which can lead to lower extremity lymphedema. The aim of this study was to estimate prevalence after sentinel lymph node biopsy versus lymphadenectomy. METHODS: Consecutive patients who underwent minimally invasive surgery at the Mayo Clinic, Rochester, Minnesota, USA, between January 2009 and June 2016 for newly diagnosed endometrial cancer were mailed our validated 13 item lower extremity lymphedema screening questionnaire. We also ascertained via questionnaire whether the patient was ever diagnosed with lower extremity lymphedema. RESULTS: Among 378 patients included in the analysis, 127 (33.5%) had sentinel lymph node biopsy with or without side specific lymphadenectomy (sentinel lymph node cohort) and 251 (66.4%) underwent bilateral lymphadenectomy prior to sentinel lymph node biopsy implementation at our institution or as 'backup' after sentinel lymph node mapping (lymphadenectomy cohort). The prevalence of lower extremity lymphedema was 41.5% (157/378), with 69 patients (18.3%) self-reporting a lower extremity lymphedema diagnosis after their endometrial cancer surgery at a median of 54.3 months (interquartile range 31.2-70.1 months), and an additional 88 patients (23.3%) identified by the screening questionnaire. The prevalence of lower extremity lymphedema was significantly higher in the lymphadenectomy cohort compared with the sentinel lymph node group (49.4% (124/251) vs 26.0% (33/127); p<0.001). When the cohorts were restricted to patients surgically managed after the introduction of sentinel lymph node, the prevalence of lower extremity lymphedema was still significantly higher in the lymphadenectomy cohort compared with the sentinel lymph node cohort (39.0% (41/105) vs 26.0% (33/127); p=0.03). In a multivariable analysis adjusted for body mass index, receipt of adjuvant external beam radiation, diabetes, congestive heart failure, and International Federation of Gynecology and Obstetrics grade, the adjusted odds ratio for the association between type of nodal sampling (lymphadenectomy cohort vs sentinel lymph node cohort) and lower extremity lymphedema was 2.75 (95% confidence interval 1.69 to 4.47, p<0.001). CONCLUSIONS: Sentinel lymph node biopsy was associated with a decreased risk of post-treatment lymphedema compared with lymphadenectomy in patients who underwent surgical staging for endometrial carcinoma.
