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Lower Extremity Cancers

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Lymphedema

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Abstract

Secondary lower limb lymphedema (LLL) is commonly associated with surgical excision of inguinofemoral lymph nodes and/or radiation of the respective node-bearing areas. The condition of LLL presents as progressive swelling of one leg or both, most typically within the first 12 months after the treatment for cancer. Once it develops, it is typically unremitting and often progressive. The incidence of, and risk factors for, LLL will vary depending on cancer type and treatment regimen. LLL is one of the important survivorship issues reported after cancer treatment, aggravating financial difficulties and impacting on quality of life.

  • Secondary lower limb lymphedema (LLL) is commonly associated with surgical excision of inguinofemoral lymph nodes and/or radiation of the respective node-bearing areas.

  • The incidence of, and risk factors for, LLL vary depending on cancer type and treatment regimen.

  • The most common timing of the onset of LLL is within the first year following treatment.

  • LLL is the most frequent problem impacting quality of life after cancer treatment of the relevant neoplasms.

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Highlighted References

  1. Tada H, Teramukai S, Fukushima M, Sasaki H. Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma. BMC Cancer. 2009;9:47.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hareyama H, Hada K, Goto K, Watanabe S, Hakoyama M, Oku K, et al. Prevalence, classification, and risk factors for postoperative lower extremity lymphedema in women with gynecologic malignancies: a retrospective study. Int J Gynecol Cancer. 2015;25(4):751–7.

    Article  PubMed  Google Scholar 

  3. Radhakrishnan K, Rockson SG. The clinical spectrum of lymphatic disease. Ann N Y Acad Sci. 2008;1131:155–84.

    Article  PubMed  Google Scholar 

  4. Stolldorf DP, Dietrich MS, Ridner SH. Symptom frequency, intensity, and distress in patients with lower limb lymphedema. Lymphat Res Biol. 2016;14(2):78–87.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Biglia N, Librino A, Ottino MC, Panuccio E, Daniele A, Chahin A. Lower limb lymphedema and neurological complications after lymphadenectomy for gynecological cancer. Int J Gynecol Cancer. 2015;25(3):521–5.

    Article  PubMed  Google Scholar 

References

  1. Kodama J, Seki N, Ojima Y, Nakamura K, Hongo A, Hiramatsu Y. Risk factors for early and late postoperative complications of patients with endometrial cancer. Eur J Obstet Gynecol Reprod Biol. 2006;124(2):222–6.

    Article  PubMed  Google Scholar 

  2. Konno Y, Todo Y, Minobe S, Kato H, Okamoto K, Sudo S, et al. A retrospective analysis of postoperative complications with or without para-aortic lymphadenectomy in endometrial cancer. Int J Gynecol Cancer. 2011;21(2):385–90.

    Article  PubMed  Google Scholar 

  3. Yamazaki H, Todo Y, Takeshita S, Ohba Y, Sudo S, Minobe S, et al. Relationship between removal of circumflex iliac nodes distal to the external iliac nodes and postoperative lower-extremity lymphedema in uterine cervical cancer. Gynecol Oncol. 2015;139(2):295–9.

    Article  PubMed  Google Scholar 

  4. Beesley V, Janda M, Eakin E, Obermair A, Battistutta D. Lymphedema after gynecological cancer treatment : prevalence, correlates, and supportive care needs. Cancer. 2007;109(12):2607–14.

    Article  PubMed  Google Scholar 

  5. Ryan M, Stainton MC, Jaconelli C, Watts S, MacKenzie P, Mansberg T. The experience of lower limb lymphedema for women after treatment for gynecologic cancer. Oncol Nurs Forum. 2003;30(3):417–23.

    Google Scholar 

  6. Rousseau B, Doucet L, Perrouin Verbe MA, Papin G, Erauso A, Joulin V, et al. Comparison of the morbidity between limited and extended pelvic lymphadenectomy during laparoscopic radical prostatectomy. Prog Urol. 2014;24(2):114–20.

    Article  CAS  PubMed  Google Scholar 

  7. Tanaka T, Ohki N, Kojima A, Maeno Y, Miyahara Y, Sudo T, et al. Radiotherapy negates the effect of retroperitoneal nonclosure for prevention of lymphedema of the legs following pelvic lymphadenectomy for gynecological malignancies: an analysis from a questionnaire survey. Int J Gynecol Cancer. 2007;17(2):460–4.

    Article  CAS  PubMed  Google Scholar 

  8. Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi U, Nakatani M, et al. Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy. Gynecol Oncol. 2010;119(1):60–4.

    Article  PubMed  Google Scholar 

  9. Graf N, Rufibach K, Schmidt AM, Fehr M, Fink D, Baege AC. Frequency and risk factors of lower limb lymphedema following lymphadenectomy in patients with gynecological malignancies. Eur J Gynaecol Oncol. 2013;34(1):23–7.

    CAS  PubMed  Google Scholar 

  10. Schirger A. Lymphedema. Cardiovasc Clin. 1983;13(2):293–305.

    CAS  PubMed  Google Scholar 

  11. Lewis JM, Wald ER. Lymphedema praecox. J Pediatr. 1984;104(5):641–8.

    Article  CAS  PubMed  Google Scholar 

  12. Harwood CA, Bull RH, Evans J, Mortimer PS. Lymphatic and venous function in lipoedema. Br J Dermatol. 1996;134(1):1–6.

    Article  CAS  PubMed  Google Scholar 

  13. Wolfe JH, Kinmonth JB. The prognosis of primary lymphedema of the lower limbs. Arch Surg. 1981;116(9):1157–60.

    Article  CAS  PubMed  Google Scholar 

  14. Mortimer PS. Swollen lower limb-2: lymphoedema. BMJ. 2000;320(7248):1527–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Langbecker D, Hayes SC, Newman B, Janda M. Treatment for upper-limb and lower-limb lymphedema by professionals specializing in lymphedema care. Eur J Cancer Care (Engl). 2008;17(6):557–64.

    CAS  Google Scholar 

  16. Yost KJ, Yount SE, Eton DT, Silberman C, Broughton-Heyes A, Cella D. Validation of the functional assessment of cancer therapy-breast symptom index (FBSI). Breast Cancer Res Treat. 2005;90(3):295–8.

    Article  PubMed  Google Scholar 

  17. Kim JH, Choi JH, Ki EY, Lee SJ, Yoon JH, Lee KH, et al. Incidence and risk factors of lower-extremity lymphedema after radical surgery with or without adjuvant radiotherapy in patients with FIGO stage I to stage IIA cervical cancer. Int J Gynecol Cancer. 2012;22(4):686–91.

    Article  PubMed  Google Scholar 

  18. Tiwari A, Myint F, Hamilton G. Management of lower limb lymphoedema in the United Kingdom. Eur J Vasc Endovasc Surg. 2006;31(3):311–5.

    Article  CAS  PubMed  Google Scholar 

  19. Burnand K, Clemenson G, Morland M, Jarrett PE, Browse NL. Venous lipodermatosclerosis: treatment by fibrinolytic enhancement and elastic compression. Br Med J. 1980;280(6206):7–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Casley-Smith JR. Measuring and representing peripheral oedema and its alterations. Lymphology. 1994;27(2):56–70.

    CAS  PubMed  Google Scholar 

  21. Liu NF, Olszewski W. Use of tonometry to assess lower extremity lymphedema. Lymphology. 1992;25(4):155–8.

    CAS  PubMed  Google Scholar 

  22. Ward LC. Regarding “edema and leg volume: methods of assessment”. Angiology. 2000;51(7):615–6.

    Article  CAS  PubMed  Google Scholar 

  23. Moseley AL, Carati CJ, Piller NB. A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Ann Oncol. 2007;18(4):639–46.

    Article  CAS  PubMed  Google Scholar 

  24. Hinrichs CS, Gibbs JF, Driscoll D, Kepner JL, Wilkinson NW, Edge SB, et al. The effectiveness of complete decongestive physiotherapy for the treatment of lymphedema following groin dissection for melanoma. J Surg Oncol. 2004;85(4):187–92.

    Article  PubMed  Google Scholar 

  25. Gary DE. Lymphedema diagnosis and management. J Am Acad Nurse Pract. 2007;19(2):72–8.

    Article  PubMed  Google Scholar 

  26. Ryan M, Stainton MC, Slaytor EK, Jaconelli C, Watts S, Mackenzie P. Aetiology and prevalence of lower limb lymphoedema following treatment for gynaecological cancer. Aust N Z J Obstet Gynaecol. 2003;43(2):148–51.

    Article  PubMed  Google Scholar 

  27. Hong JH, Tsai CS, Lai CH, Chang TC, Wang CC, Lee SP, et al. Postoperative low-pelvic irradiation for stage I-IIA cervical cancer patients with risk factors other than pelvic lymph node metastasis. Int J Radiat Oncol Biol Phys. 2002;53(5):1284–90.

    Article  PubMed  Google Scholar 

  28. Fuller J, Guderian D, Kohler C, Schneider A, Wendt TG. Lymph edema of the lower extremities after lymphadenectomy and radiotherapy for cervical cancer. Strahlenther Onkol. 2008;184(4):206–11.

    Article  PubMed  Google Scholar 

  29. Halaska MJ, Novackova M, Mala I, Pluta M, Chmel R, Stankusova H, et al. A prospective study of postoperative lymphedema after surgery for cervical cancer. Int J Gynecol Cancer. 2010;20(5):900–4.

    Article  PubMed  Google Scholar 

  30. Abu-Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C, et al. The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center. Gynecol Oncol. 2006;103(2):714–8.

    Article  PubMed  Google Scholar 

  31. Hopp EE, Osborne JL, Schneider DK, Bojar CJ, Uyar DS. A prospective pilot study on the incidence of post-operative lymphedema in women with endometrial cancer. Gynecol Oncol Rep. 2016;15:25–8.

    Article  PubMed  Google Scholar 

  32. Judson PL, Jonson AL, Paley PJ, Bliss RL, Murray KP, Downs LS Jr, et al. A prospective, randomized study analyzing sartorius transposition following inguinal-femoral lymphadenectomy. Gynecol Oncol. 2004;95(1):226–30.

    Article  PubMed  Google Scholar 

  33. Gaarenstroom KN, Kenter GG, Trimbos JB, Agous I, Amant F, Peters AA, et al. Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions. Int J Gynecol Cancer. 2003;13(4):522–7.

    Article  CAS  PubMed  Google Scholar 

  34. Farrell R, Gebski V, Hacker NF. Quality of life after complete lymphadenectomy for vulvar cancer: do women prefer sentinel lymph node biopsy? Int J Gynecol Cancer. 2014;24(4):813–9.

    Article  PubMed  Google Scholar 

  35. Cirik DA, Karalok A, Ureyen I, Tasci T, Kalyoncu R, Turkmen O, et al. Early and late complications after inguinofemoral lymphadenectomy for vulvar cancer. Asian Pac J Cancer Prev. 2015;16(13):5175–9.

    Article  PubMed  Google Scholar 

  36. Leermakers ME, Pleunis N, Boll D, Hermans RH, Ezendam NP, Pijnenborg JM. High incidence of erysipelas after surgical treatment for vulvar carcinoma: an observational study. Int J Gynecol Cancer. 2016;26(3):582–7.

    Article  PubMed  Google Scholar 

  37. Amdur RJ, Parsons JT, Fitzgerald LT, Million RR. Adenocarcinoma of the prostate treated with external-beam radiation therapy: 5-year minimum follow-up. Radiother Oncol. 1990;18(3):235–46.

    Article  CAS  PubMed  Google Scholar 

  38. Greskovich FJ, Zagars GK, Sherman NE, Johnson DE. Complications following external beam radiation therapy for prostate cancer: an analysis of patients treated with and without staging pelvic lymphadenectomy. J Urol. 1991;146(3):798–802.

    Article  CAS  PubMed  Google Scholar 

  39. Kavoussi LR, Sosa E, Chandhoke P, Chodak G, Clayman RV, Hadley HR, et al. Complications of laparoscopic pelvic lymph node dissection. J Urol. 1993;149(2):322–5.

    Article  CAS  PubMed  Google Scholar 

  40. Clark T, Parekh DJ, Cookson MS, Chang SS, Smith ER Jr, Wells N, et al. Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. J Urol. 2003;169(1):145–7; discussion 7–8.

    Google Scholar 

  41. Rasmusson E, Gunnlaugsson A, Blom R, Bjork-Eriksson T, Nilsson P, Ahlgen G, et al. Low rate of lymphedema after extended pelvic lymphadenectomy followed by pelvic irradiation of node-positive prostate cancer. Radiat Oncol. 2013;8:271.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Bevan-Thomas R, Slaton JW, Pettaway CA. Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson cancer center experience. J Urol. 2002;167(4):1638–42.

    Article  PubMed  Google Scholar 

  43. Jacobellis U. Modified radical inguinal lymphadenectomy for carcinoma of the penis: technique and results. J Urol. 2003;169(4):1349–52.

    Article  PubMed  Google Scholar 

  44. Ravi R. Morbidity following groin dissection for penile carcinoma. Br J Urol. 1993;72(6):941–5.

    Article  CAS  PubMed  Google Scholar 

  45. de Vries M, Vonkeman WG, van Ginkel RJ, Hoekstra HJ. Morbidity after inguinal sentinel lymph node biopsy and completion lymph node dissection in patients with cutaneous melanoma. Eur J Surg Oncol. 2006;32(7):785–9.

    Article  PubMed  Google Scholar 

  46. Ballo MT, Zagars GK, Gershenwald JE, Lee JE, Mansfield PF, Kim KB, et al. A critical assessment of adjuvant radiotherapy for inguinal lymph node metastases from melanoma. Ann Surg Oncol. 2004;11(12):1079–84.

    Article  PubMed  Google Scholar 

  47. Koifman L, Hampl D, Koifman N, Vides AJ, Ornellas AA. Radical open inguinal lymphadenectomy for penile carcinoma: surgical technique, early complications and late outcomes. J Urol. 2013;190(6):2086–92.

    Article  PubMed  Google Scholar 

  48. Baumgarten AS, Alhammali E, Hakky TS, Espiritu PN, Pow-Sang JM, Sexton WJ, et al. Salvage surgical resection for isolated locally recurrent inguinal lymph node metastasis of penile cancer: international study collaboration. J Urol. 2014;192(3):760–4.

    Article  PubMed  Google Scholar 

  49. Serpell JW, Carne PW, Bailey M. Radical lymph node dissection for melanoma. ANZ J Surg. 2003;73(5):294–9.

    Article  PubMed  Google Scholar 

  50. Burmeister BH, Smithers BM, Davis S, Spry N, Johnson C, Krawitz H, et al. Radiation therapy following nodal surgery for melanoma: an analysis of late toxicity. ANZ J Surg. 2002;72(5):344–8.

    Article  CAS  PubMed  Google Scholar 

  51. Hyngstrom JR, Chiang YJ, Cromwell KD, Ross MI, Xing Y, Mungovan KS, et al. Prospective assessment of lymphedema incidence and lymphedema-associated symptoms following lymph node surgery for melanoma. Melanoma Res. 2013;23(4):290–7.

    PubMed  Google Scholar 

  52. Theodore JE, Frankel AJ, Thomas JM, Barbour AP, Bayley GJ, Allan CP, et al. Assessment of morbidity following regional nodal dissection in the axilla and groin for metastatic melanoma. ANZ J Surg. 2016;87(1–2):44–8. [Epub ahead of print]

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. The University of Sydney, Faculty of Health Sciences, Discipline of Physiotherapy, Sydney, New South Wales, Australia

    Mi-Joung Lee PhD

  2. George Washington University, Washington, DC, USA

    Stanley G. Rockson MD

Authors
  1. Mi-Joung Lee PhD
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  2. Stanley G. Rockson MD
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Correspondence to Mi-Joung Lee PhD .

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Editors and Affiliations

  1. Center for the Lymphedema and Vascular Malformations, Division of Vascular Surgery, Department of Surgery, George Washington University, Washington, DC, USA

    Byung-Boong Lee

  2. Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, California, USA

    Stanley G. Rockson

  3. La Jolla, California, USA

    John Bergan

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Lee, MJ., Rockson, S.G. (2018). Lower Extremity Cancers. In: Lee, BB., Rockson, S., Bergan, J. (eds) Lymphedema. Springer, Cham. https://doi.org/10.1007/978-3-319-52423-8_70

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  • DOI: https://doi.org/10.1007/978-3-319-52423-8_70

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