title: Relationship between removal of circumflex iliac nodes distal to the external iliac nodes and postoperative lower-extremity lymphedema in uterine cervical cancer.
abstract: OBJECTIVE
  This study aimed to determine if there is a causal relationship between removal of the circumflex iliac nodes distal to the external iliac nodes (CINDEIN) and postoperative lower-extremity lymphedema (POLEL) after systematic lymphadenectomy in patients with cervical cancer.
  
  
  METHODS
  A retrospective chart review was performed for all living cervical cancer patients who underwent lymphadenectomy and were managed at Hokkaido Cancer Center between 1993 and 2013. The type of lymphadenectomy gradually shifted from lymphadenectomy with removal of CINDEIN to without CINDEIN dissection during this period. The study period was divided into two phases: from 1993-2007 (first phase) and from 2008-2013 (second phase). We identified patients with POLEL. Logistic regression analysis was used to select the risk factors for POLEL.
  
  
  RESULTS
  Implementation of CINDEIN-dissection lymphadenectomy (94.0% vs. 20.6%, p<0.0001) and adjuvant radiotherapy (26.1% vs. 4.5%, p<0.0001) was significantly higher in the first phase than in the second phase. Of 398 patients evaluated, POLEL was noted in medical records of 80 (20.1%) patients with a median follow-up period of 78.0months. The occurrence rate of POLEL was significantly higher in the first phase than in the second phase (32.2% vs. 8.0%, p<0.0001), despite no change in the number of dissected lymph nodes between the two phases. Multivariate analysis showed that adjuvant radiation therapy (odds ratio=2.6, 95% confidence interval=1.4-4.8) and removal of CINDEIN (odds ratio=4.6, 95% confidence interval=2.4-9.0) were independent risk factors for POLEL.
  
  
  CONCLUSIONS
  Elimination of CINDEIN dissection is helpful for reducing the incidence of POLEL.
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamazaki
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, 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, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Takeshita
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Ohba
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Sudo
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Minobe
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan.
authors.forename: Kazuhira
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Division of Pathology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan.
authors.forename: Katsushige
authors.initials: K
authors.lastname: Yamashiro
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kato
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D015984:Causality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007083:Iliac Artery; D016015:Logistic Models; D035002:Lower Extremity; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000601:surgery*; D008209:Lymphedema / Q000453:epidemiology*; D008875:Middle Aged; D010388:Pelvis; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D055815:Young Adult
keywords: Cancer survivor; Cervical cancer; Circumflex iliac node; Leg edema; Lymphadenectomy