What has not been reported on in depth is the possible complication of either abdominal or pelvic lymphedema from the same procedure. This is surprising to me as one of the earliest reports I ever read was one regarding abdominal lymphedema from surgery, written in 1963 by my former doctors in Portland, Oregon.
With the rising cases of all cancers relating to the abdomen or pevlic regions, it is clearly time that we be informed of this risk.
June 29, 2009
Med Hypotheses. 2009 Mar
Vannelli A, Battaglia L, Poiasina E, Leo E. Division of General Surgery B Foundation IRCCS “National Institute of Tumour”, Lymphology La Statale University, Milan, Via Venezian 1, 20133 Milan, Italy. email@example.com
Pelvis is a functional shell-like unit consisting of the pelvic floor and perineum. The patients, who underwent a radical operation of the pelvis due to an oncological disease, often develop pelvic disorders. These disorders do not depend on the type of surgery or any presence of postoperative treatment (radio- and chemotherapy). The reason for this is still mostly unknown. These disorders without an appropriate treatment of rehabilitation always result in the following symptoms: fatty tissue hypertrophy and fibrosis as well as functional chronic disorders.
Lymphedema is described as a progressive pathological condition with retention of protein-rich liquid in the interstitial space, fatty tissue hypertrophy and fibrosis. It is possible to assume that lymphadenectomy related to pelvic surgery results in a localized lymphedema in the pelvis developing disorders of perineum and pelvic floor: a pelvic lymphedema, or rather a blind lymphedema, i.e. with symptoms but with no signs. The clinical evidence shows that the lymphatic vessels play a relevant role in the pathology of the pelvic floor and perineum. The study of pelvic lymphedema could be the key when choosing the therapies for pelvic disorders resulting from surgery.
J Med Assoc Thai. 2009 Apr
Manchana T, Sirisabya N, Lertkhachonsuk R, Worasethsin P, Khemapech N, Sittisomwong T, Vasuratna A, Termrungruanglert W, Tresukosol D. Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
OBJECTIVE: To evaluate the incidence of long-term complications in stage IB and IIA cervical cancer patients undergoing radical hysterectomy with bilateral pelvic lymphadenectomy.
MATERIAL AND METHOD: A retrospective review on 290 patients who were treated with primary type III radical hysterectomy with bilateral pelvic lymphadenectomy between January 1, 1997 and December 31, 2005. Long-term complications were classified in two categories, voiding dysfunction and complication from lymphadenectomy such as lymphocyst and lymphedema.
RESULTS: Forty-two patients (14.5%) required urethral catheterization more than four weeks. Only four patients (1.4%) were diagnosed as neurogenic bladder and required permanent self-catheterization. Two hundred forty eight patients (85.5%) returned to normal voiding within 1 month postoperatively. The incidence of lymphocyst was 9.3%; however, almost of them were asymptomatic and resolved spontaneously within a few months. Only four patients (1.4%) had complicated lymphocyst and required hospitalization with intravenous antibiotic and drainage procedure. Six patients (2.1%) were diagnosed as lymphedema after exclusion of deep vein thrombosis and recurrent cervical carcinoma. Pelvic lymph node metastasis and postoperative adjuvant radiation were not significant risk factors for lymphocyst and lymphedema.
CONCLUSION: Radical hysterectomy with lymphadenectomy is the treatment of choice in stage IB and IIA cervical cancer with excellent survival rate. However there are long-term complications such as voiding dysfunction, lymphocyst, and lymphedema. Although these complications are not life threatening, they can affect the quality of life.
Pelvic lymphedema: Truth or fiction?
Akush Ginekol (Sofiia). 2006
Kornovski Ia, Ianeva R, Tiufekchieva E.
OBJECTIVE: To evaluate the most common complications following surgery and radiotherary of cervical cancer based on own experience and to compare them to the complications rates reported by other authors.
MATERIAL: One hundred eight patients with invasive cervical cancer, staged (IB-IVB) are enrolled in the study. They all had been operated on in Varna between the period XI.2003-VI.2006 by the author.
METHODS: Surgical management includes radical hysterectomy class ll-IV, selective and total pelvic and paraaortic lymph node dissection. Radiotherapy is preoperative 30-52 Gy and adjuvant postoperative 52 Gy TGT Cisplatin-based neoadjuvant chemotherapy had been administered 3 courses at intervals of 21 days before surgery. Peritonization with two retroperitoneal drains in fossa obtoratoria had been performed in 91 patients. Seventeen patients were non-peritonized with abdominal drianage.
RESULTS: In the group of patients with peritonization and retroperitoneal drainage the incidence rates of fistulas,lymphocysts, ureteral strictures, urinary infections, ileus, radiation-induced proctitis are: 1,1%, 5,5%, 2,2%, 3,3%, 1,1% and 2,2%, respectively. In the group of patients without peritonization the incidence rates of same complications are: 5,9%, 17,6%, 0%, 0%, 29,4% and 11,8%, respectively.
CONCLUSION: Pelvic peritonization and retroperitoneal drainage decreases significantly the early and late postoperative complications, especially the incidence rate of fistulas, lymphocysts, lymphedema, ileus, radiation- induced proctitis and proctosygmoiditis and makes them comparable to these complication rates,reported by other authors and centres. This method allows the patients to be discharged at the light postoperative day, optimizes the quality of life and the survival.
PMID: 17489166 PubMed - indexed for MEDLINE
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