title: Reduction/prevention of lower extremity lymphedema after pelvic and para-aortic lymphadenectomy for patients with gynecologic malignancies.
abstract: BACKGROUND
  Lower extremity lymphedema (LEL) is a serious complication caused by lymphadenectomy in patients with gynecologic malignancies. In this study, we evaluated the effect of preserving the circumflex iliac lymph nodes (CILNs), i.e., the most caudal external iliac lymph nodes, for the prevention and reduction of LEL by comparing two groups of patients, one in which CILN were removed and the other in which CILNs were preserved.
  
  
  METHODS
  We retrospectively reviewed 329 patients with gynecologic malignancies who had undergone abdominal complete systematic pelvic and para-aortic lymphadenectomy. The patients were divided into nonpreserved (n = 189) and preserved (n = 140) groups, depending on whether CILNs were removed. Primary outcome measures included the incidence and severity of LEL.
  
  
  RESULTS
  The incidence of LEL was significantly lower in the preserved group than in the nonpreserved group (P < 0.0001). The frequency of LEL was also significantly lower in the preserved group than in the nonpreserved group regardless of the range of pelvic and para-aortic lymphadenectomy (P < 0.0001). LEL in the overwhelming majority of cases in the preserved group was mild, and no patients experienced severe LEL. Further, the incidence of cellulitis was 0% in the preserved group, while it was 12.7% in the nonpreserved group (P < 0.0001). Lymphoscintigraphy revealed collateral pathways from the preserved CILN along the iliac and large abdominal vessels.
  
  
  CONCLUSIONS
  This method of lymph node preservation is a simple and extremely effective approach for preventing/reducing LEL after pelvic and para-aortic lymphadenectomy for patients with gynecologic malignancies.
authors: Department of Obstetrics and Gynecology, Sapporo City General Hospital, Sapporo, Japan. hitoshi.hareyama@doc.city.sapporo.jp
authors: Hitoshi
authors: H
authors: Hareyama
authors: Kumiko
authors: K
authors: Ito
authors: Kenichi
authors: K
authors: Hada
authors: Akiko
authors: A
authors: Uchida
authors: Yukitoki
authors: Y
authors: Hayakashi
authors: Emi
authors: E
authors: Hirayama
authors: Mamoru
authors: M
authors: Oikawa
authors: Kazuhiko
authors: K
authors: Okuyama
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000601:surgery*; D006801:Humans; D035002:Lower Extremity; D008197:Lymph Node Excision; D008209:Lymphedema / Q000517:prevention & control*; D061305:Lymphoscintigraphy; D008875:Middle Aged; D010388:Pelvis / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult