Self-reported lower extremity lymphedema and quality of life after surgical staging of endometrial carcinoma: A population based cross-sectional study
Trent, Pernille Kristina Bjerre; Nordskar, Nina Jebens; Wangen, Knut Reidar; Engeskaug, Ida; Opheim, Linn Ø.; Aune, Guro; Staff, Anne Cathrine; Thorsen, Lene; Falk, Ragnhild Sørum; Eriksson, Ane Gerda Zahl
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2023Metadata
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Abstract
Objectives. Sentinel lymph node biopsy (SLN) has replaced lymphadenectomy in staging of endometrial car-
cinoma. The aims of the study were to explore the prevalence of self-reported lymphedema (LEL), identify factors
associated with LEL, compare quality of life (QoL) scores using thresholds of clinical importance, and assess cor-
relation between different questionnaires.
Methods. Women who underwent staging for endometrial carcinoma from 2006 to 2021 were invited to
complete the Lower Extremity Lymphedema Screening Questionnaire (LELSQ), EORTC QLQ-C30, QLQ-EN24
and EQ-5D-5L.
Results. Of 2156 invited survivors, 61% participated in the study, whereof 1127 were evaluable by LELSQ. The
LEL prevalence was 51%, 36% and 40% after lymphadenectomy, SLN and hysterectomy, respectively (p < 0.001).
Higher BMI, undergoing lymphadenectomy and receiving adjuvant chemotherapy were associated with LEL;
odds ratios 1.07 (95% CI 1.05–1.09), 1.42 (95% CI 1.03–1.97) and 1.43 (95% CI 1.08–1.89) respectively. QoL was
lower for women with LEL compared to those without. In women with musculoskeletal complaints the preva-
lence of LEL was 59%, 50% and 53% after lymphadenectomy, SLN and hysterectomy (p = 0.115), respectively,
compared to 39%, 17% and 18% (p < 0.001) in women without musculoskeletal complaints. Spearman's correla-
tion was moderate to strong between the questionnaires.
Conclusion. SLN implementation is not associated with increased LEL prevalence compared to hysterectomy
alone, but is associated with a significantly lower prevalence compared to lymphadenectomy. LEL is associated
with lower QoL. Our study demonstrates moderate to strong correlation between self-reported LEL and QoL scores. Available questionnaires may not distinguish between symptoms caused by LEL and musculoskeletal
disease.