Addressing lymphedema post gynecological cancer surgery: a public health imperative

OBJECTIVES: Lymphedema has emerged as a significant health challenge, often resulting in social isolation and the restriction of daily activities. Despite advancements in surgical techniques, it remains a notable consequence of oncologic treatment, particularly following gynecological procedures. However, there is a notable lack of reliable information regarding secondary lymphedema after gynecological oncologic treatment from Eastern European countries. MATERIAL AND METHODS: This retrospective study was conducted among women who underwent surgery between 2017 and 2022 for endometrial, vulvar, or cervical cancer at a tertiary cancer center. Inclusion criteria required a history of radical gynecological cancer surgery, a valid phone number in the medical records, ICD-10 diagnosis for lymphedema (I89.0, I89.8, I89.9) confirmed by hospital discharge note or ambulatory care discharge note. Trained research assistant collected data on the presence or absence of lymphedema and whether patients received targeted treatments such as manual lymph drainage, flat-knit compression therapy, or surgery. Phone calls were made three times, spaced one week apart. RESULTS: Data were collected from 157 patients with endometrial cancer (EC), 90 with vulvar cancer (VC), and 57 with cervical cancer (CC). Lymphedema was observed in 25% of EC patients, 33% of VC patients, and 31% of CC patients. Additionally, 45% of EC patients, 50% of VC patients, and 66% of CC patients received one of the previously mentioned treatment modalities for lymphedema. CONCLUSIONS: The absence of consistent guidelines and protocols for post-surgery prophylactic management of lymphedema as well as specialized centers for lymphedema treatment after gynecological surgery contributes to unfavorable outcomes within cancer survivors.