Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2018

Open Access 01-12-2018 | Research

Use of lymphoscintigraphy to differentiate primary versus secondary lower extremity lymphedema after surgical lymphadenectomy: a retrospective analysis

Authors: Mirela Mariana Roman, Romain Barbieux, Jean-Marie Nogaret, Pierre Bourgeois

Published in: World Journal of Surgical Oncology | Issue 1/2018

Login to get access

Abstract

Background

When managing patients with cancer, lymphedema of the lower limbs (LLL) is commonly reported as secondary to the surgical excision and/or irradiation of lymph nodes (LNs). In the framework of lymphoscintigraphic imaging performed to evaluate secondary LLL, some lympho-nodal presentations have been observed that could not be explained by the applied treatments, suggesting that these LLL might be primary. Therefore, all our lymphoscintigraphic examinations that were performed in patients for LLL after surgery for gynecological or urological cancer were retrospectively analyzed in order to evaluate the frequency in which these LLL might not be secondary (either completely or partially) but primary in origin.

Methods

Lymphoscintigraphies performed in 33 patients who underwent LN dissection (limited to the intra-abdominal LN) with or without radiotherapy for histologically confirmed ovarian cancer (n = 6), uterine cancer (n = 14 with cervical cancer and n = 7 with endometrial cancer), or prostate cancer (n = 6) were compared to lymphoscintigraphies obtained in primary LLL.

Results

In 12 (33% of the) patients (3 men plus 9 women, 4 with cervical cancer and 5 with endometrial cancer), scintigraphy of the lower limbs revealed lympho-nodal presentation that did not match with the expected consequences of the surgical and/or radiological treatments and were either suggestive or typical of primary lymphedema.

Conclusions

This retrospective analysis of a limited but well-defined series of patients suggests that the appearance of LLL might not be related to cancer treatment(s) but that these LLL may represent the development of a primary lymphatic disease latent prior to the therapeutic interventions.
Literature
1.
Soisson AP, Soper JT, Clarke-Pearson DL, Berchuck A, Montana G, Creasman WT. Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer. Gynecol Oncol. 1990;37:390–5.CrossRefPubMed
2.
Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi U, Nakatani M, Aoyagi Y, Ohba Y, Okamoto K, Kato H. Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy. Gynecol Oncol. 2010;119:60–4.CrossRefPubMed
3.
Briganti A, Chun KKH, Salonia A, Suardi N, Gallina A, Da Pozzo LF, Roscigno M, Zanni G, Valiquette L, Rigatti P, Montorsi F, Karakiewicz PI. Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer. Eur Urol. 2006;50:1006–13.CrossRefPubMed
4.
Abu-Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C, Chi DS, Barakat RR. The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center. Gynecol Oncol. 2006;103:714–8.CrossRefPubMed
5.
Clark T, Parekh DJ, Cookson MJ, Chang SS, Smith ER, Wells N, Smith J. Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. J Urol. 2003;169:145–7.CrossRefPubMed
6.
7.
Boris M, Weindorf S, Lasinski S. Persistance of lymphedema reduction after noninvasive complex lymphedema therapy. Oncol. 1997;11:99–109.
8.
Achouri A, Huchon C, Bats AS, Bensaid C, Nos C, Lecuru F. Complications of lymphadenectomy for gynecologic cancer. Eur J Surg Oncol. 2013;39:81–6.CrossRefPubMed
9.
Beesley V, Janda M, Eakin E, Obermair A, Battistutta D. Lymphedema after gynecological cancer treatment: prevalence, correlates, and supportive care needs. Cancer. 2007;109:2607–14.CrossRefPubMed
10.
Dunberger G, Lindquist H, Waldenstrom AC, Nyberg T, Steineck G, Avall-Lundqvist E. Lower limb lymphedema in gynecological cancer survivors–effect on daily life functioning. Support Care Cancer. 2013;21:3063–70.CrossRefPubMed
11.
Kondo E, Tabata T, Shiozaki T, Motohashi T, Tanida K, Okugawa T, Ikeda T. Large or persistent lymphocyst increases the risk of lymphedema, lymphangitis, and deep vein thrombosis after retroperitoneal lymphadenectomy for gynecologic malignancy. Arch Gynecol Obstet. 2013;288:587–93.CrossRefPubMed
12.
Obermair A, Ginbey P, AJ MC. Feasibility and safety of total laparoscopic radical hysterectomy. J Am Assoc Gynecol Laparosc. 2003;10:345–9.CrossRefPubMed
13.
Ryan M, Stainton MC, Slaytor EK, Jaconelli C, Watts S, Mackenzie P. Aetiology and prevalence of lower limb lymphoedema following treatment for gynaecological cancer. Aust N Z J Obstet Gynaecol. 2003;43:148–51.CrossRefPubMed
14.
15.
16.
Kuoppala T, Tomas E, Heinonen PK. Clinical outcome and complications of laparoscopic surgery compared with traditional surgery in women with endometrial cancer. Arch Gynecol Obstet. 2004;270:25–30.CrossRefPubMed
17.
18.
Bergmark K, Avall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G. Lymphedema and bladder-emptying difficulties after radical hysterectomy for early cervical cancer and among population controls. Int J Gynecol Cancer. 2006;16:1130–9.CrossRefPubMed
19.
20.
Hosaka M, Watari H, Takeda M, Moriwaki M, Hara Y, Todo Y, Ebina Y, Sakuragi N. Treatment of cervical cancer with adjuvant chemotherapy versus adjuvant radiotherapy after radical hysterectomy and systematic lymphadenectomy. J Obstet Gynaecol Res. 2008;34:552–6.CrossRefPubMed
21.
Kim JH, Choi JH, Ki EY, Lee SJ, Yoon JH, Lee KH, Park TC, Park JS, Bae SN, Hur SY. Incidence and risk factors of lower-extremity lymphedema after radical surgery with or without adjuvant radiotherapy in patients with FIGO stage I to stage IIA cervical cancer. Int J Gynecol Cancer. 2012;22:686–91.CrossRefPubMed
22.
Ohara K, Tsunoda H, Satoh T, Oki A, Sugahara S, Yoshikawa H. Use of the small pelvic field instead of the classic whole pelvic field in postoperative radiotherapy for cervical cancer: reduction of adverse events. Int J Radiat Oncol Biol Phys. 2004;60:258–64.CrossRefPubMed
23.
Ohba Y, Todo Y, Kobayashi N, Kaneuchi M, Watari H, Takeda M, Sudo S, Kudo M, Kato H, Sakuragi N. Risk factors for lower-limb lymphedema after surgery for cervical cancer. Int J Clin Oncol. 2011;16:238–43.CrossRefPubMed
24.
Hoogendam JP, Verheijen RH, Wegner I, Zweemer RP. Oncological outcome and long-term complications in robot-assisted radical surgery for early stage cervical cancer: an observational cohort study. BJOG. 2014;121:1538–45.CrossRefPubMed
25.
Carlson JW, Kauderer J, Walker JL, Gold MA, O'Malley D, Tuller E, Clarke-Pearson DL. A randomized phase III trial of VH fibrin sealant to reduce lymphedema after inguinal lymph node dissection: a gynecologic oncology group study. Gynecol Oncol. 2008;110:76–82.CrossRefPubMed
26.
Gaarenstroom KN, Kenter GG, Trimbos JB, Agous I, Amant F, Peters AA, Vergote I. Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions. Int J Gynecol Cancer. 2003;13:522–7.CrossRefPubMed
27.
Hinten F, Van den Einden LC, Hendriks JC, Van der Zee AG, Bulten J, Massuger LF, Van de Nieuwenhof HP, De Hullu JA. Risk factors for short- and long-term complications after groin surgery in vulvar cancer. Br J Cancer. 2011;105:1279–87.CrossRefPubMedPubMedCentral
28.
Novackova M, Halaska MJ, Robova H, Mala I, Pluta M, Chmel R, Rob L. A prospective study in detection of lower-limb lymphedema and evaluation of quality of life after vulvar cancer surgery. Int J Gynecol Cancer. 2012;22:1081–8.CrossRefPubMed
29.
Sawan S, Mugnai R, Lopes Ade B, Hughes A, Edmondson RJ. Lower-limb lymphedema and vulval cancer: feasibility of prophylactic compression garments and validation of leg volume measurement. Int J Gynecol Cancer. 2009;19:1649–54.CrossRefPubMed
30.
Walker KF, Day H, Abu J, Nunns D, Williamson K, Duncan T. Do surgical techniques used in groin lymphadenectomy for vulval cancer affect morbidity rates? Int J Gynecol Cancer. 2011;21:1495–9.CrossRefPubMed
31.
Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer. 2010;116:5138–49.CrossRefPubMed
32.
Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med. 2003;44:43–57.PubMed
33.
Lee BB, Andrade M, Antignani PL, Boccardo F, Bunke N, Campisi C, Damstra R, Flour M, Forner-Cordero I, Gloviczki P, Laredo J, Partsch H, Piller N, Michelini S, Mortimer P, Rabe E, Rockson S, Scuderi A, Szolnoky G, Villavicencio JL. Diagnosis and treatment of primary lymphedema. Consensus document of the international union of phlebology. Int Angiol. 2013;32:541–74.PubMed
34.
Bourgeois P, Dargent JL, Larsimont D, Munck D, Sales F, Boels M, De Valck C. Lymphoscintigraphy in angiomyomatous hamartomas and primary lower limb lymphedema. Clin Nucl Med. 2009;34:405–9.CrossRefPubMed
35.
Papendieck CM. Lymphatic dysplasia in paediatrics. A new classification. Int Angiol. 1999;18:6–9.PubMed
36.
Miaskowski C, Dodd M, Paul SM, West C, Hamolsky D, Abrams G, Cooper BA, Elboim C, Neuhaus J, Schmidt BL, Smoot B, Aouizerat BE. Lymphatic and angiogenic candidate genes predict the development of secondary lymphedema following breast cancer surgery. PLoS One. 2013;8:e60164.CrossRefPubMedPubMedCentral
37.
Newman B, Lose F, Kedda MA, Francois M, Ferguson K, Janda M, Yates P, Spurdle AB, Hayes SC. Possible genetic predisposition to lymphedema after breast cancer. Lymphat Res Biol. 2012;10:2–13.CrossRefPubMedPubMedCentral
38.
Bains SK, Peters AM, Zammit C, Ryan N, Ballinger J, Glass DM, Allen S, Stanton AW, Mortimer PS, Purushotham AD. Global abnormalities in lymphatic function following systemic therapy in patients with breast cancer. Br J Surg. 2015;102:534–40.CrossRefPubMed
39.
Boccardo F, De Cian F, Campisi CC, Molinari L, Spinaci S, Dessalvi S, Talamo G, Campisi C, Villa G, Bellini C, Parodi A, Santi PL, Campisi C. Surgical prevention and treatment of lymphedema after lymph node dissection in patients with cutaneous melanoma. Lymphology. 2013;46:20–6.PubMed
Metadata
Title
Use of lymphoscintigraphy to differentiate primary versus secondary lower extremity lymphedema after surgical lymphadenectomy: a retrospective analysis
Authors
Mirela Mariana Roman
Romain Barbieux
Jean-Marie Nogaret
Pierre Bourgeois
Publication date
01-12-2018
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2018
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-018-1379-5

Other articles of this Issue 1/2018

World Journal of Surgical Oncology 1/2018 Go to the issue

Research

Lower pole approach in retroperitoneal laparoscopic radical nephrectomy: a new approach for the management of renal vascular pedicle

Research

A study on the value of narrow-band imaging (NBI) for the general investigation of a high-risk population of nasopharyngeal carcinoma (NPC)

Research

Early decrease in postoperative serum albumin predicts severe complications in patients with colorectal cancer after curative laparoscopic surgery

Research

Safflower polysaccharide inhibits the development of tongue squamous cell carcinoma

Research

A pancreatic zone at higher risk of fistula after enucleation

Research

Completion pneumonectomy: a valuable option for lung cancer recurrence or new primaries