A prospective study in detection of lower-limb lymphedema and evaluation of quality of life after vulvar cancer surgery: Editorial comment
Abstract
Vulvar cancer is rare. The extent of inguinal lymph node involvement in this cancer correlates with 5-year survival: 90% without inguinal node involvement, 80% with 2 or more nodes involved, and 12% with 3 or more nodes with metastasis.
A major cause of morbidity during vulvar cancer surgery with lymph node removal is lower-limb lymphedema. Several studies have investigated its prevalence following surgery, but most were retrospective or did not use objective measurements for detection.
Moreover, the majority of these studies had small numbers of patients or used different methods of node removal. The absence of a standard detection method has hampered lymphedema diagnostics.
Multifrequency bioelectrical impedance analysis (MFBIA) was recently introduced as a method to detect lymphedema after vulvar cancer surgery. This noninvasive objective technique has been reported to have high sensitivity for lymphedema detection.
This prospective nonrandomized study had 2 aims. The first was to determine the prevalence of secondary lower-limb lymphedema after vulvar cancer surgery using objective methods (circumference measurements and MFBIA).
The second was to compare quality of life (QoL) before and 6 months after surgery. Subjects were 29 patients undergoing vulvar cancer surgery; 17 of these underwent inguinofemoral lymphadenectomy (RAD), and 12 underwent sentinel lymph node biopsy (CONS).
Before and 6 months after vulvar surgery, lower-limb lymphedema was assessed by measuring circumference of the lower limbs and with MFBIA; these measurements were also performed in a control group of 27 healthy women. Quality of life was evaluated in patients before and 6 months after surgery with the European Organisation for Research and Treatment of Cancer questionnaires (QLQ-C30 and QLQ-CX24).
Lymphedema was detected using circumference measurement in 9 patients (31%); 3 (25%) were in the CONS, and 6 (37.5%) in the RAD group; the difference between these groups was not statistically significant (P = 0.69). After surgery, patients in the RAD group reported more fatigue and worsening of physical and role functioning.
When comparing both groups, significantly worse parameters in social functioning, fatigue, and dyspnea were found in the RAD group. These findings show that, with lower radicality in inguinofemoral lymphadenectomy, there is a statistically nonsignificant trend toward lower morbidity and a significant improvement in QoL.
The data also show a higher prevalence of postoperative lymphedema with MFBIA than with circumference measurement.