Hopp et.

al 2016:
Acquired lower-extremity lymphedema occurs after external interruption to the lymphatic system in
some gynecologic cancer patients. Endolymphatic pressure increases in the lymphatic vessels and
histological changes of the vessels ensue which causes protein-rich fluid to accumulate in the interstitial
spaces of the lower-extremity (Mihara et al., 2012)

Wefoundtheincidence of lymphedema inthis prospective study of womenwith endometrial cancer to be

12.8% (5 of 39 patients) over a two-year post-operative interval.

Multiple studies have shown that preservation of the circumflex iliac lymph nodes decreases the
incidence of lower-extremity lymphedema (Hareyama et al., 2012; Todo et al., 2010).

Theincidence of lymphedema in gynecologic malignancies has been reported as 20% in one systematic
review and reported as a range of 6–37% in a retrospective chart review (Cormier et al., 2010; Hareyama
et al., 2012). Specifically, patients undergoinglymphadenectomysecondarytoendometrial cancer develop
lower-extremity edema in 1.2 to 37.8% of cases (Tada et al., 2009; Abu-Rustum et al., 2006; Todo et al.,
2010; Pereira de Godoy et al., 2002).

Our study demonstrates that in a single institution by usingastandardized,prospective

approach,theincidenceof
lymphedemainwomenwithendometrialcancerwhohaveundergoneacomprehensivestagingprocedurewith
lymphnodedissectionis12.8%andmay evolve over the course of up to two years post surgery. The
majority of womendidnotexperienceasignificantnegativeimpactontheirquality of life with regards to
change in weight, leg discomfort, or pain. The developmentof lymphedemainoursubjects
appearedtobeaprocessnot influenced bythenumberorlocationof lymphnodesremoved,surgical approach,
or medical comorbidities.

Barros 2017

According to literature, the risk increases with the number and positivity of the lymph nodes
dissected.3,4 These patients may also have comorbid conditions such as obesity and diabetes that
further increase the risk. Once present, the symptoms and local effects of lymphedema cannot be cured,
only managed.3,5 Some suggested strategies to prevent lymphedema formation include omission of
lymphadenectomy in low risk patients; sentinel lymph node mapping -although long-term assessments
are needed to demonstrate reduction of lymphedema in these patients -, and preservation of the distal
most external iliac lymph node at the circumflex vein.

Becker 2012

Incidence of lymphedema after the treatment of gynecologic cancers is 20%. Risk factors for developing
lymphedema after cancer treatment are obesity, infection, and trauma.

McGuineess 2009
Lymphedema is subdivided into primary and secondary lymphedema, the latter being the most
common.
Any malignant process that spreads to the lymph nodes can cause secondary lymphedema, but it
is more common after surgical resection or radiotherapy directed at nodal deposits of tumor

Lymphedema can be primary, when it appears to be caused by genetic abnormalities, or secondary,

when the lymphatic drainage has been disrupted as a result of some recognized pathological process.
Secondary lymphedema can be attributed to various factors including radiotherapy, infection, trauma or
malignancy.

Acquired lower-extremity lymphedema occurs after external interruption to the lymphatic system in
some gynecologic cancer patients. The incidence of lymphedema in gynecologic malignancies has been
reported as 20%. Specifically, according to Hopp, et. Al (2016), patients undergoing lymphadenectomy
secondary to endometrial cancer develop lower-extremity edema in 1.2 to 37.8% of cases. Moreover,
lymphedema in women with endometrial cancer who have undergone a comprehensive staging
procedure with lymph node dissection is 12.8% and may evolve over the course of up to two years post
surgery.

According to Barros (2017), the risk increases with the number and positivity of the lymph nodes
dissected. Other factors that increase the risk of lymphedema are trauma, infection, obesity and
diabetes. Preservation of the distal most external iliac lymph node at the circumflex vein may prevent
occurrence of lymphedema. Barros (2017) also suggested strategies to prevent lymphedema formation
including omission of lymphadenectomy in low risk patients; sentinel lymph node mapping -although
long-term assessments are needed to demonstrate reduction of lymphedema.