Incidence, prevalence, and factors associated with lymphedema after treatment for cervical cancer: a systematic review.

BACKGROUND: Lower limb lymphedema is a frequent and debilitating complication after cervical cancer treatment. OBJECTIVE: To evaluate the incidence and prevalence of lymphedema after treatment for cervical cancer and evaluate the factors associated with this outcome. METHODS: The study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Eligible studies were identified through the databases Medline (via PubMed), LILACS, Scopus, and Web of Science. For the search, descriptors, keywords, and synonyms were used for cervical cancer, lymphedema, and outcomes of interest (incidence, prevalence, frequency, occurrence, morbidity, risk factors, and prognosis). Observational studies were included that were published in English, Portuguese, or Spanish, between January 1, 2013 and December 31, 2019, with frequency data and associated factors for lymphedema after cervical cancer treatment. Studies that evaluated the presence of lymphedema less than 6 months after surgery or radiotherapy and those in which frequency data were not stratified by tumor topography, were excluded. RESULTS: Twenty-three studies were included. The incidence of lymphedema varied between 0% and 69%. Different designs and methods were employed for lymphedema assessment. The main factors associated with lymphedema included extension of lymphadenectomy, number of lymph nodes removed, removal of circumflex iliac lymph nodes, and adjuvant radiotherapy. Other factors associated with lymphedema included cellulitis, lymphocyst formation, increased age, invasive lymph node staging, higher body mass index, and insufficient physical activity. CONCLUSIONS: The frequency of lymphedema after treatment for cervical cancer is variable. The different designs and methodology to measure this complication make it difficult to draw definitive conclusions about its prevalence. The method used for lymphedema assessment is not standardized.

Incidência, prevalência e fatores associados ao linfedema após tratamento para câncer do colo do útero: revisão sistemática / [ Incidence, prevalence and factors associated with lymphedema after treatment for cervical cancer: systematic review]

INTRODUÇÃO: Mulheres com câncer do colo do útero convivem com importantes complicações oriundas do tratamento, dentre elas, o linfedema em membros inferiores. Não é de nosso conhecimento estudo de revisão sistemática sobre incidência e fatores associados ao linfedema pós tratamento do câncer do colo do útero, o que dificulta as estratégias de prevenção. OBJETIVO: Realizar uma revisão sistemática da literatura de estudos de incidência e prevalência do linfedema, e fatores associados a esse desfecho, após tratamento para o câncer do colo do útero. METODOLOGIA: Foi realizada revisão sistemática da literatura, segundo as orientações do PRISMA. Os estudos elegíveis foram identificados por meio das bases de dados: Medline (via PubMed), LILACS, Scopus e Web of Science. Para a busca, utilizou-se descritores, palavras-chaves e sinônimos para: câncer do colo do útero, linfedema e os desfechos de interesse (incidência, prevalência, frequência, ocorrência, morbidade, fatores de risco e prognóstico). Foram incluídos estudos transversais, de coorte retrospectiva ou prospectiva, ou de caso-controle, publicados nos idiomas inglês, português ou espanhol, com dados de frequência ou fatores de risco para o linfedema pós câncer do colo do útero. Os dados foram extraídos e apresentados em tabelas. RESULTADOS: Quinze estudos foram incluídos na revisão. A incidência de linfedema variou de 0 a 69%. A discrepância pode ser atribuída a subnotificação, abordagem de tratamentos diferentes, inclusão de terapia adjuvante, momento e método de avaliação do linfedema e comorbidades. Os fatores de risco para linfedema incluíram radioterapia adjuvante, retirada de linfonodos ilíacos circunflexos, fechamento de retroperitônio, procedimento cirúrgico aberto, celulite, linfocisto pós-cirurgia, IMC ≥ 25 kg/m², realização de linfadenectomia pélvica e para-aórtica. CONCLUSÃO: A frequência de linfedema após o tratamento para câncer do colo do útero é extremamente variável. Os diferentes delineamentos e metodologia empregados pelos autores tornam difícil à comparação entre eles. Não existe um consenso sobre o melhor método empregado no diagnóstico do linfedema e os fatores de risco estão principalmente associados ao tratamento oncológico e a obesidade.

INTRODUCTION: Women with uterine cervical neoplasms coexist with important complications from the treatment, including lymphedema in the lower limbs. We don't know about a systematic review of the incidence and factors associated with lymphedema after treatment of the uterine cervical neoplasms, which hampers prevention strategies. MAIN PURPOSE: Realize a systematic review of the literature of studies of incidence and prevalence of lymphedema, and factors associated with this outcome, after treatment for uterine cervical neoplasms METHOD: A systematic review of the literature was performed according to the PRISMA guidelines. Eligible studies were identified using: Medline (via PubMed), LILACS, Scopus and Web of Science. For the search, we used descriptors, keywords and synonyms for: uterine cervical neoplasms, lymphedema and outcomes of interest (incidence, prevalence, frequency, occurrence, morbidity, risk factors and prognosis). We included cross-sectional, retrospective or prospective, or case-control studies published in the English, Portuguese or Spanish languages, with incidence, or risk factors for lymphedema after cervical cancer. Data were extracted and presented in tables. RESULTS: Fifteen studies were included in the review. The incidence of lymphedema ranged from 0 to 69%. The discrepancy may be attributed to underreporting, approach to different treatments, inclusion of adjuvant therapy, timing and method of lymphedema evaluation, and comorbidities. The risk factors reported included adjuvant radiotherapy, removal of circumflex iliac lymph nodes, retroperitoneal closure, open surgical procedure, cellulitis, lymphocyst formation, BMI ≥ 25 kg / m², pelvic and para-aortic lymphadenectomy. CONCLUSION: The frequency of lymphedema following treatment for uterine cervical neoplasms is extremely variable. The different designs and methodology employed by the authors make it difficult to compare them. There is no consensus on the best method used in the diagnosis of lymphedema and the risk factors are mainly associated with cancer treatment and obesity.