title: Lymphedema after surgery for endometrial cancer: prevalence, risk factors, and quality of life.
abstract: OBJECTIVE
  To estimate lower extremity lymphedema prevalence in patients surgically treated for endometrial cancer, identify predictors of lymphedema, and evaluate the effects of lymphedema on quality of life.
  
  
  METHODS
  One thousand forty-eight consecutive patients who were operated on between 1999 and 2008 at the Mayo Clinic were mailed a survey, which included our validated 13-item lymphedema screening questionnaire and two validated quality-of-life measures. Logistic regression models were fit to identify factors associated with prevalent lymphedema; a multivariable model was obtained using stepwise and backward variable selection methods. The relationship between lymphedema and obesity with each quality-of-life score was evaluated separate multivariable linear models.
  
  
  RESULTS
  There were 591 responders (56%) after exclusions. Our questionnaire revealed a previous self-reported lymphedema diagnosis in 103 (17%) patients and identified undiagnosed lymphedema in 175 (30%) (overall prevalence 47.0%, median 6.2 years follow-up). Lymphedema prevalence in patients treated with hysterectomy alone compared with lymphadenectomy was 36.1% and 52.3%, respectively (attributable risk 23%). Lymphedema risk was not associated with the number of nodes removed or the extent of lymphadenectomy after adjusting for other factors. On multivariable analysis, higher body mass index, congestive heart failure, performance of lymphadenectomy, and radiation therapy were associated with prevalent lymphedema. Multiple quality-of-life scores were worse in women with lymphedema.
  
  
  CONCLUSIONS
  The attributable risk of developing lower extremity lymphedema was 23% for patients with endometrial cancer who underwent lymphadenectomy compared with hysterectomy alone with an overall prevalence of 47%. Lymphedema was associated with reductions in multiple quality-of-life domains.
  
  
  METHODS
  II.
authors.affiliation: Departments of Gynecologic Surgery, Physical Medicine and Rehabilitation, Gynecology, Biomedical Statistics and Informatics, and Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Yost
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Cheville
authors.forename: Mariam M
authors.initials: MM
authors.lastname: Al-Hilli
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.forename: Brigitte A
authors.initials: BA
authors.lastname: Barrette
authors.forename: Michaela E
authors.initials: ME
authors.lastname: McGree
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016889:Endometrial Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D035002:Lower Extremity; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires