Lower extremity lymphedema after pelvic nodal dissection for urologic cancers is associated with metastatic recurrence.

Introduction: We aimed to evaluate the incidence and risk factors for lymphedema secondary to pelvic lymph node dissection (PLND) in urologic surgery. Secondary lymphedema is the most common type of lymphedema in the U.S. and the role of PLND in lower extremity lymphedema etiology is less well-defined.

Methods: We performed a retrospective review of all PLNDs performed for urologic malignancies at a single academic institution between April 2014 and April 2017. Patient demographics, comorbidities, cancer staging, and other treatment information were collected. Incidence of lower extremity lymphedema and associated risk factors were explored. Univariate analysis and multivariate logistic regression were performed.

Results: A total of 235 patients were included in our study. Mean (standard deviation) age was 68.8 (8.9) years, and the mean followup duration was 2.4 (1.7) years. Lymphedema occurred in 22 (9.4%) patients, and the mean time to lymphedema diagnosis was 7.4 (8.0) months. Age, body mass index, smoking, diabetes, pre- or postoperative radiation, number of resected lymph nodes, and number of positive lymph nodes were not significantly associated with postoperative lower extremity lymphedema; however, metastatic recurrence was significantly associated with the development of postoperative lymphedema. (odds ratio 2.83, 95% confidence interval 1.1-7.32, p=0.03) CONCLUSIONS: While the incidence of lower extremity lymphedema after PLND is low in urologic cancer patients, this complication is associated with metastatic recurrence. These results may allow for improved preoperative counseling on the risk of lower extremity lymphedema and inform cancer surveillance in patients with this complication. More research is needed to elucidate this association.