Onset and burden of lower limb lymphedema after radical prostatectomy: a cross-sectional study

Manuel Neuberger; Laura Schmidt; Frederik Wessels; Miriam Linke; Carina Müller; Niklas Westhoff; Philipp Nuhn; Jost von Hardenberg

doi:10.1007/s00520-021-06520-2

Onset and burden of lower limb lymphedema after radical prostatectomy: a cross-sectional study

Support Care Cancer. 2022 Feb;30(2):1303-1313. doi: 10.1007/s00520-021-06520-2. Epub 2021 Sep 3.

Authors

Manuel Neuberger¹, Laura Schmidt², Frederik Wessels³, Miriam Linke⁴, Carina Müller⁵, Niklas Westhoff³, Philipp Nuhn³, Jost von Hardenberg³

Affiliations

¹ Department of Urology and Urological Surgery, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. manuel.neuberger@medma.uni-heidelberg.de.
² Institute of Psychology, University of Heidelberg, Heidelberg, Germany.
³ Department of Urology and Urological Surgery, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
⁴ Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁵ Physiotherapy, Service Center Therapy, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.

PMID: 34477972
DOI: 10.1007/s00520-021-06520-2

Abstract

Objectives: To explore men's onset and burden of lower limb lymphedema (LLL) after radical prostatectomy (RP) with pelvic lymph node dissection (PLND).

Patients and methods: A cross-sectional survey-based study was conducted nation-wide and web-based in Germany. Part 1 included 15 multidisciplinary compiled questions with three questions from the Short Form 12 Health Survey (SF-12) and the WHO activity recommendation and part 2 included the validated German Lymph-ICF-Questionnaire (Lymph-ICF-LL). Subgroup comparisons and simple regression analyses were used to identify factors associated with therapy and burden of LLL, followed by multiple regression analyses to explain variance in impairment in the patients' daily life.

Results: Fifty-four patients completed the survey. Median time of LLL-onset was reported with 2.0 (0.5-9.75) months after RP. Nineteen patients (35.2%) reported bilateral lymphedema, 28 (51.9%) the use of individually fitted compression stockings (CS), 25 (46.3%) of manual lymphatic drainage (LD), and 26 (48.1%) complete regression. The Lymph-ICF-LL revealed a higher total burden for patients with an active LLL compared to complete regression (total score: 25.5 vs. 11.9, p = 0.01) especially for "physical function" (28.3 vs. 12.9, p < 0.01) and "mental function" (26.2 vs. 6.7, p < 0.01). In multiple linear regression analysis, a higher BMI (β = 0.28), lower subjective general health (β = -0.48), and active lymphedema (β = 0.28) were significant predictors of higher reported impairments in the Lymph-ICF-LL, accounting for 45.4% of variance.

Conclusion: Men with LLL after RP with PLND report a significant burden in daily life. Basic therapy needs to be offered early. Postoperative onset of LLL is variable, which should be considered when assessing complications after RP.

Keywords: Lower extremity; Lymph node excision; Manual lymphatic drainage; Postoperative complications; Prostate cancer; Surveys and questionnaires.

MeSH terms

Cross-Sectional Studies
Humans
Lower Extremity
Lymph Node Excision
Lymphedema* / epidemiology
Lymphedema* / etiology
Male
Prostatectomy / adverse effects
Prostatic Neoplasms* / surgery