Lymphedema in Gynecologic Oncology

Lymphedema is a chronic disorder characterized by the accumulation of protein-rich fluid in the tissues due to impaired lymphatic drainage, resulting in inflammation and tissue damage. In gynecologic oncology, lower extremity lymphedema (LEL) represents a significant morbidity, particularly following pelvic and para-aortic lymph node dissection and adjuvant radiotherapy. The reported incidence of LEL ranges from 1.2% to 39%, varying with surgical technique, radiotherapy protocols, body mass index, age, and comorbidities. Diagnosis is primarily based on clinical evaluation and circumferential limb measurements, supported by imaging modalities such as lymphoscintigraphy and magnetic resonance imaging. The risk of lymphedema differs among gynecologic cancers, being highest in vulvar cancer and lowest in ovarian cancer. In cervical and endometrial cancers, the extent of lymph node dissection significantly influences risk. Management requires a multidisciplinary approach focusing on patient education, infection prevention, and preservation of mobility. The current gold-standard treatment is Complex Decongestive Therapy (CDT), which includes manual lymph drainage, compression, skin care, and exercise. In refractory cases, surgical interventions such as liposuction may be considered. Sentinel lymph node mapping and lymph node–sparing surgical techniques offer promising strategies for reducing lymphedema risk.