title: Close relationship between removal of circumflex iliac nodes to distal external iliac nodes and postoperative lower-extremity lymphedema in uterine corpus malignant tumors.
abstract: OBJECTIVE
  The aim of this study was to confirm a causal relationship between removal of circumflex iliac nodes to the distal external iliac nodes (CINDEIN) and lower-extremity lymphedema after systematic lymphadenectomy in patients with uterine corpus malignancies.
  
  
  METHODS
  A retrospective chart review was carried out for all patients with uterine corpus malignant tumor managed at Hokkaido Cancer Center between 1991 and 2013. All 318 patients underwent CINDEIN dissection as a part of initial surgery and 217 patients did not. Patients had undergone hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy and their medical records were reviewed. The type of lymphadenectomy gradually shifted from pelvic lymphadenectomy with removal of CINDEIN to full lymphadenectomy without CINDEIN dissection during this period. We identified patients with postoperative lower-extremity lymphedema (POLEL). Logistic regression analysis was used to select the risk factors for POLEL.
  
  
  RESULTS
  Of 535 patients evaluated, POLEL was noted in the medical records of 126 patients (23.6%), with median follow-up of 71months. The occurrence of POLEL was significantly higher in the CINDEIN-dissection group than in the CINDEIN-sparing group (34.3% vs. 7.8%, P<0.0001). Multivariate analysis confirmed that adjuvant radiation therapy [odds ratio (OR)=6.3, 95% confidence interval (CI)=2.6-14.9], resection of more than 31 lymph nodes (OR=2.0, 95% CI=1.2-3.5), and removal of CINDEIN (OR=5.4, 95% CI=3.1-9.3) were independent risk factors for POLEL.
  
  
  CONCLUSIONS
  Elimination of CINDEIN dissection can be helpful in reducing the incidence of POLEL.
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan. Electronic address: yukiharu@sap-cc.go.jp.
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Todo
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamazaki
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Takeshita
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Ohba
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Sudo
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Minobe
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Kazuhira
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kato
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007866:Leg; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008198:Lymph Nodes / Q000601:surgery*; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000209:etiology*; D008875:Middle Aged; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Cancer survivor; Circumflex iliac node; Endometrial cancer; Leg edema; Lymphadenectomy