BACKGROUND: To prospectively assess LLL incidence among cervical cancer patients treated by uterine surgery complemented by SLN biopsy, without PLND. METHODS: A prospective study in 150 patients with stage IA1-IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy. Objective LLL assessments, based on limb volume increase (LVI) between pre- and postoperative measurements, and subjective patient-perceived swelling were conducted in six-month periods over 24-months post-surgery. RESULTS: The cumulative incidence of LLL at 24 months was 17.3% for mild LLL (LVI 10-19%), 9.2% for moderate LLL (LVI 20-39%), while only one patient (0.7%) developed severe LLL (LVI > 40%). The median interval to LLL onset was nine months. Transient edema resolving without intervention within six months was reported in an additional 22% of patients. Subjective LLL was reported by 10.7% of patients, though only a weak and partial correlation between subjective-report and objective-LVI was found. No risk factor directly related to LLL development was identified. CONCLUSIONS: The replacement of standard PLND by bilateral SLN biopsy in the surgical treatment of cervical cancer does not eliminate the risk of mild to moderate LLL, which develops irrespective of the number of SLN removed.

Data Analysis Department Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University 62500 Brno Czech Republic

Department of Gynaecology and Obstetrics University Hospital Comenius University 814 99 Bratislava Slovakia

Department of Gynaecology Institute of Oncology Angel H Roffo University of Bueno s Aires Buenos Aires C1417 DTB Argentina

Department of Gynecologic Oncology Holycross Cancer Center 25 734 Kielce Poland

Department of Gynecology and Obstetrics Faculty of Medicine Masaryk University 60177 Brno Czech Republic

Department of Gynecology and Obstetrics Leuven Cancer Institute University Hospital Leuven 3000 Leuven Belgium

Department of Gynecology Biomedical Research Institute of Bellvitge University Hospital of Bellvitge University of Barcelona 08908 Barcelona Spain

Department of Obstetrics and Gynecology 1st Faculty of Medicine University Hospital Bulovka Charles University 18081 Prague Czech Republic

Department of Obstetrics and Gynecology Faculty Hospital Trencin 911 71 Trencin Slovakia

Department of Obstetrics and Gynecology Faculty of Medicine and Dentistry Palacky University University Hospital Olomouc 77900 Olomouc Czech Republic

Department of Obstetrics and Gynecology Faculty of Medicine Pilsen University Hospital in Pilsen and Charles University 30460 Pilsen Czech Republic

Department of Obstetrics and Gynecology Trondheim University Hospital 7030 Trondheim Norway

Department of Obstetrics and Gynecology University Hospital Ostrava 70800 Ostrava Poruba Czech Republic

Department of Special Operative and Oncologic Gynaecology Asklepios Clinic Hamburg 22763 Hamburg Germany

Departments of Gynecologic Oncology University Hospital of the Canary Islands 35016 Las Palmas de Gran Canaria Spain

Gynecologic Oncology Center Department of Obstetrics and Gynecology 1st Faculty of Medicine Charles University and General University Hospital 12000 Prague Czech Republic

Gynecologic Oncology Unit La Paz University Hospital 28046 Madrid Spain

Gynecology Department Instituto Valenciano de Oncologia 46009 Valencia Spain

Serviço de Ginecologia Instituto Portugues de Oncologia do Porto 1099 023 Porto Portugal

Unit of Gynecological Oncology Institute Clinic of Gynaecology Obstetrics and Neonatology Hospital Clinic Institut d'Investigacions Biomediques August Pi i Sunyer University of Barcelona 08036 Barcelona Spain

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