Comparison of lymphedema incidence between 2 lymphadenectomy techniques in patients with uterine cancer undergoing robotic staging.
OBJECTIVE
This study aimed to compare the incidence of lower extremity lymphedema in patients with uterine cancer after robotic staging using the following 2 methods: standard and selective pelvic lymphadenectomy.


METHODS
Three hundred forty-four consecutive patients who presented with endometrial cancer from March 2007 to October 2012 underwent robotic staging. Surgeon A performed standard pelvic lymphadenectomy and surgeon B performed selective lymphadenectomy. Selective pelvic lymphadenectomy spared the lateral chain of the external iliac lymph nodes (LNs). The incidence of lymphedema and staging adequacy between the 2 groups were analyzed.


RESULTS
Standard pelvic lymphadenectomy was performed in 238/344 (69.2%) patients and selective pelvic lymphadenectomy was performed in 106/344 (30.8%) patients. Conversion to laparotomy occurred in 2/344 cases (0.6%). Mean age for 344 patients was 63.6 (10) years and body mass index was 34.8 (10.1) kg/m(2). The mean operative time was 162.3 (54.6) minutes. Postoperative hospitalization was 1.62 (1.93) days. Histology included 80.8% endometrioid adenocarcinomas and 19.2% clear cell, serous, and carcinosarcomas. Mean pelvic LN counts for the standard and selective pelvic lymphadenectomy groups were 16 (8.6) and 15.5 (7.1), respectively (P = 0.31). Mean numbers of para-aortic LNs retrieved for the standard and selective lymphadenectomy groups were 3.1 (4.1) and 4.9 (4.5), respectively (P < 0.01).Median follow-up was 29.3 months (interquartile range, 15.6-43.1 months). The difference in the incidence of lower extremity lymphedema was statistically significant: 4.6% (11/238 patients) in the standard lymphadenectomy group versus 0.9% (1/106 patients) in the selective lymphadenectomy group (P = 0.03).


CONCLUSIONS
When compared to the standard technique, selective pelvic lymphadenectomy with sparing of the lateral chain of the external iliac LNs is adequate and results in a lower incidence of lower extremity lymphedema.
Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT.
Gulden
G
Menderes
Masoud
M
Azodi
Peter
P
Schwartz
Dan-Arin
DA
Silasi
D018262:Adenocarcinoma, Clear Cell / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000556:secondary / Q000601:surgery; D002296:Carcinosarcoma / Q000556:secondary / Q000601:surgery; D003237:Connecticut / Q000453:epidemiology; D018284:Cystadenocarcinoma, Serous / Q000556:secondary / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D009367:Neoplasm Staging; D010220:Para-Aortic Bodies / Q000473:pathology; D010386:Pelvic Neoplasms / Q000556:secondary / Q000601:surgery; D011379:Prognosis; D012371:Robotics / Q000379:methods*; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*