title: Prospective assessment of lymphedema incidence and lymphedema-associated symptoms following lymph node surgery for melanoma.
abstract: We aimed to prospectively assess limb volume change (LVC) and associated symptoms in patients with melanoma undergoing sentinel lymph node biopsy and/or therapeutic lymph node dissection. Limb volume was measured preoperatively and postoperatively at 6 and 12 months using a perometer (1000 mol/l). LVC was calculated and used to define three groups: less than 5%, 5-10%, and greater than 10%. A 19-item lymphedema symptom questionnaire was administered at baseline, 6, and 12 months. One hundred and eighty-two patients were enrolled. Twelve months after axillary surgery, 9% had LVC 5-10% and 13% had LVC greater than 10%. Twelve months after inguinofemoral surgery, 10% had LVC 5-10% and 13% had LVC greater than 10%. There was a significant seven- to nine-fold increase in symptoms for patients with LVC greater than 10% compared with those with LVC less than 5% (P<0.05). On multivariate analysis, therapeutic lymph node dissection versus sentinel lymph node biopsy (odds ratio=3.18; P<0.01) and borderline significance for lower-extremity versus upper-extremity procedures (odds ratio=1.72; P=0.07) were associated with LVC greater than 5%. LVC greater than 5% is common at 12 months following nodal surgery for melanoma and is associated with symptoms. Informed consent for melanoma patients undergoing lymph node surgery should include a discussion of the risks of postoperative lymphedema.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Hyngstrom
authors.forename: Yi-Ju
authors.initials: YJ
authors.lastname: Chiang
authors.forename: Kate D
authors.initials: KD
authors.lastname: Cromwell
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Yan
authors.initials: Y
authors.lastname: Xing
authors.forename: Kristi S
authors.initials: KS
authors.lastname: Mungovan
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Gershenwald
authors.forename: Richard E
authors.initials: RE
authors.lastname: Royal
authors.forename: Anthony
authors.initials: A
authors.lastname: Lucci
authors.forename: Jane M
authors.initials: JM
authors.lastname: Armer
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
mesh_terms: D015992:Body Mass Index; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013781:Texas / Q000453:epidemiology