RELEVANT-C study: patient-reported prevalence of lower extremity lymphedema after sentinel lymph node mapping vs lymphadenectomy after surgery for early-stage cervical cancer

To compare the prevalence of patient-reported lower extremity lymphedema and evaluate patient-reported quality of life after sentinel lymph node mapping vs comprehensive lymphadenectomy with or without sentinel lymph node mapping for the surgical management of early-stage cervical cancer. In July 2022, we mailed a survey that included a validated 13-item lower extremity lymphedema screening questionnaire to patients who underwent lymph node evaluation at the time of primary surgery for the 2018 International Federation of Gynecology and Obstetrics stage IA1 to IIB cervical cancer between January 1, 2006, and January 31, 2019. We excluded patients diagnosed with lower extremity lymphedema prior to surgery and those who answered ≤6 survey items, and we carried out 2 group comparisons: sentinel lymph node mapping vs lymphadenectomy with or without sentinel lymph node mapping, and patients with lower extremity lymphedema vs patients without. Of 459 potential participants, 90 (20%) responded to the survey, all of which were evaluable (37 sentinel lymph nodes; 53 lymphadenectomies ± sentinel lymph nodes). Self-reported lower extremity lymphedema prevalence was 10.8% (4/37) in the sentinel lymph node mapping group and 43.4% (23/53) in the lymphadenectomy with or without sentinel lymph node mapping group (OR 6.32, 95% CI 2.14 to 23.5, p = .002). Histologic subtype and number of lymph nodes removed were associated with increased prevalence of lower extremity lymphedema. After adjusting for the histology subtype, lymphadenectomy retained independent association with an increased prevalence of lower extremity lymphedema over sentinel lymph node mapping (OR 4.96, 95% CI 1.61 to 18.8, p = .009). Patients with self-reported lower extremity lymphedema had significantly worse quality of life compared to those without self-reported lower extremity lymphedema. We found sentinel lymph node mapping to be independently associated with a significantly decreased prevalence of patient-reported lower extremity lymphedema and with improved quality of life in patients undergoing surgical management of early-stage cervical cancer.