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A Prospective Study in Detection of Lower-Limb Lymphedema and Evaluation of Quality of Life After Vulvar Cancer Surgery

Novackova, Marta MD*; Halaska, Michael J. MD, PhD*; Robova, Helena MD, PhD*; Mala, Ivana PhD; Pluta, Marek MD, PhD*; Chmel, Roman MD*; Rob, Lukas MD, PhD*

International Journal of Gynecological Cancer: July 2012 - Volume 22 - Issue 6 - p 1081–1088
doi: 10.1097/IGC.0b013e31825866d0
Quality of Life

Background Lower-limb lymphedema is one of the most disabling adverse effects of vulvar cancer surgery. Multifrequency Bioelectrical Impedance Analysis (MFBIA) is a modern noninvasive method to detect lymphedema. The first aim of this study was to prospectively determine the prevalence of secondary lower-limb lymphedema after surgical treatment for vulvar cancer using objective methods, circumference measurements and MFBIA technique. The second aim was to compare quality of life (QoL) before and 6 months after vulvar surgery.

Methods Twenty-nine patients underwent vulvar cancer surgery in our study: 17 underwent inguinofemoral lymphadenectomy (RAD), and 12 underwent sentinel lymph node biopsy (CONS). Patients were examined before and 6 months after vulvar surgery by measuring the circumference of the lower limbs and with MFBIA. A control group of 27 healthy women was also measured. To evaluate QoL, the European Organisation for Research and Treatment of Cancer (EORTC) QoL questionnaires (QLQ-C30 and QLQ-CX24) were administered to patients before and 6 months after surgery.

Results Using circumference measurement, 9 lymphedemas (31%) were diagnosed: 3 (25%) in the CONS and 6 (37.5%) in the RAD group (P = 0.69). After vulvar surgery, patients in the RAD group reported more fatigue and worsening of physical and role functioning. When comparing both groups, the RAD group had significantly worse parameters in social functioning, fatigue, and dyspnea.

Conclusions Lower radicality in inguinofemoral lymphadenectomy shows a trend toward lower morbidity and significantly improves QoL. Multifrequency Bioelectrical Impedance Analysis was tested in these patients as a noninvasive, objective method for lymphedema detection. Detection of lymphedema based on subjective evaluations proved to have an unsatisfactory sensitivity. Less radical surgery showed objectively better results in QoL.

*Department of Obstetrics and Gynaecology, 2nd Medical Faculty of Charles University in Prague; and Faculty Hospital Motol; and †Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic.

Address correspondence and reprint requests to Marta Novackova, MD, Department of Obstetrics and Gynaecology, 2nd Medical Faculty of Charles University in Prague, V Uvalu 84, 150 00, Praha 5, Czech Republic. E-mail:

The work was supported by grant of the Ministry of Health of the Czech Republic IGA MZ 9914-4.

All authors declare no conflict of interest.

The ethical committee of the Faculty Hospital Motol has approved the study combined with a study with cervical cancer patients.

Received September 20, 2011

Accepted April 2, 2012

Copyright © 2012 by IGCS and ESGO