Close relationship between removal of circumflex iliac nodes to distal external iliac nodes and postoperative lower-extremity lymphedema in uterine corpus malignant tumors

• Removal of CINDEIN is associated with lower-extremity lymphedema.
• Removal of CINDEIN can be eliminated in patients with endometrial cancer.
• CINDEIN dissection may become obsolete in future treatment of endometrial cancer.

ObjectiveThe aim of this study was to confirm a causal relationship between removal of circumflex iliac nodes to the distal external iliac nodes (CINDEIN) and lower-extremity lymphedema after systematic lymphadenectomy in patients with uterine corpus malignancies.MethodsA retrospective chart review was carried out for all patients with uterine corpus malignant tumor managed at Hokkaido Cancer Center between 1991 and 2013. All 318 patients underwent CINDEIN dissection as a part of initial surgery and 217 patients did not. Patients had undergone hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy and their medical records were reviewed. The type of lymphadenectomy gradually shifted from pelvic lymphadenectomy with removal of CINDEIN to full lymphadenectomy without CINDEIN dissection during this period. We identified patients with postoperative lower-extremity lymphedema (POLEL). Logistic regression analysis was used to select the risk factors for POLEL.ResultsOf 535 patients evaluated, POLEL was noted in the medical records of 126 patients (23.6%), with median follow-up of 71 months. The occurrence of POLEL was significantly higher in the CINDEIN-dissection group than in the CINDEIN-sparing group (34.3% vs. 7.8%, P < 0.0001). Multivariate analysis confirmed that adjuvant radiation therapy [odds ratio (OR) = 6.3, 95% confidence interval (CI) = 2.6–14.9], resection of more than 31 lymph nodes (OR = 2.0, 95% CI = 1.2–3.5), and removal of CINDEIN (OR = 5.4, 95% CI = 3.1–9.3) were independent risk factors for POLEL.ConclusionsElimination of CINDEIN dissection can be helpful in reducing the incidence of POLEL.