Résumé
Objective To explore the effects of complex decongestive therapy among patients with postoperative lower extremity lymphedema following treatment for gynecological cancer. Methods A total of 40 patients with secondary lower extremity lymphedema resulting from gynecological cancer treatment received complex decongestive physiotherapy (CDP) by oncology nursing specialist in the lymphedema rehabilitation clinic between March 2016 to February 2017.Before and after CDP,patients were evaluated by circumferential measurements and multiple frequency bioelectrical impedance analysis. Results After CDP, lymphedema volume decreased from (8 668.30 ± 1 909.23) cm3to (7 599.81 ± 1 297.45)cm3, and the percentage of excess volume (PEV) reduced from 14.10 (5.82-66.86)% to 2.95(0.38-28.56)%, the differences were statistically significant(t=6.909,Z=-5.511,P<0.05).The accumulated edema fluid in tissue decreased from(6.11±1.63)L to (5.06 ± 0.88) L and the rate of extracellular water decreased from (41.15 ± 1.86)% to (39.51 ± 0.88)%, the differences were statistically significant (t=6.336, 8.295, P < 0.05). Percentage reduction of excess volume (PREV)was(77.33±14.55)%,and was correlated with duration of lower extremity lymphedema. Conclusions CDP was effective for lower extremity lymphedema secondary to treatment of gynecological cancer.It is a set of safe and noninvasive technique. Patients with lower extremity lymphedema should be encouraged to undergo CDP, even when it is mild.
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Objective To investigate the multiple risk factors for lower extremity lymphedema in patients following treatment of common gynecologic cancers by meta-analysis for systematic analysis and comprehensive quantitative study.Methods Clinical trials published up until August 2016 were retrieved from PubMed, Embase, and the Cochrane Library.The quality of the included studies was assessed by the Newcastle-Ottawa Scale, and data analysis was performed using Stata 14.0 and RevMan 5.3.The strength of the associations between risk factors and gynecologic cancer-related lower extremity lymphedema was described as odds ratio (OR) and 95% confidence intervals (CI).Results Eighteen studies were included in the meta-analysis, and 8 relevant factors were identified.The risk factors for lower extremity lymphedema after treatment of gynecologic cancer mainly included radiotherapy (OR=2.45, 95%CI:2.05-2.95, P=0.000), FIGO stage (OR=2.29, 95%CI:1.66-3.14, P=0.000), and pelvic lymph node dissection (OR=2.00, 95%CI:1.02-3.91, P=0.040).Conclusions Radiotherapy, FIGO stage, and pelvic lymph node dissection are the main risk factors for lower extremity lymphedema after treatment of gynecologic cancers.
Résumé
<b>Introduction:</b> We report three cases of women who developed secondary lower-extremity lymphedema after surgery for endometrial cancer. The cancer stage was 2 as per the International Society of Lymphology risk stratification. <b>Case Reports:</b> We performed intensive lymphdrainage of two-phase complex decongestive physiotherapy in each case during a 1-week hospitalization period. The average leg circumference at discharge improved to 92～96% from baseline. Case 1: After primary treatment, a 35-year-old woman presented with temporarily poor self lymphatic drainage during maintenance therapy, and her leg circumference progressively enlarged. However, the patient received reeducation for self lymphatic drainage and outpatient service for lymphedema regularly. Since then, the leg lymphedema has improved. Case 2: A 63-year old woman improved to 92% of baseline and continued an excellent self lymphatic drainage, maintaining 83% with her depression recovered 2.5 years after this hospitalization. Case 3: This case involved a 70-year-old woman in whom maintenance therapy progressed well without aggravation of lymphedema; however, she died in 1.2 years after the first phase treatment due to cancer recurrence. <b>Discussion:</b> Intensive care under short-term hospitalization (for one week) for lower-extremity lymphedema was effective. However, there was one patient in whom self lymphatic drainage became poor. The patients required long-term care for maintenance therapy after primary treatment.