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Predicting Lymphedema After Groin Lymph Node Dissection: A Risk Stratification Model from a Decade of Outcomes at a Tertiary Cancer Center
Stav Brown, MD, Sarah Fargey, BS, Geronimo Salcedo, BS, Rohan Kumaran, BS, Parisa Lotfi, MD; Mehra Golshan, MD MBA, Siba Haykal MD PhD
1. Yale School of Medicine, New Haven, CT, United States.
Purpose: Groin lymph node dissection (GLND) is associated with a substantial risk of lower-extremity lymphedema, yet no clinically applicable model exists to estimate individual risk. This study aimed to identify predictors of lymphedema development after GLND and provide a clinically useful prediction algorithm.
Methods: We included all patients who underwent GLND at a tertiary cancer center from 2013 to 2024. Demographic and clinical data, along with lymphedema onset, were recorded. Two multivariate regression models were developed to predict 1) risk of lymphedema and 2) time to first diagnosis.
Results: 1644 patients were included. Significant predictors of lymphedema included male gender (OR = 0.49, p < 0.0001), BMI > 30 (OR = 1.91, p <0.0001), radiation therapy (OR = 2.32, p < 0.0001), hypertension (OR = 1.53, p = 0.0481), and peripheral vascular disease (OR = 1.43, p = 0.0478). The extent of dissection was also significantly associated with increased risk: deep lymphadenectomy carried the highest risk (OR = 10.95, p < 0.0001). Significant predictors of delayed onset included chemotherapy (β = 6.89 months, p = 0.0234), diabetes (β = 6.91 months, p = 0.0254), and peripheral vascular disease (β = 6.92 months, p = 0.0222). Deep lymphadenectomy was associated with significantly earlier onset (β = -9.63 months, p = 0.0118).
Conclusion: This is the largest study to identify key predictors of lymphedema following GLND. The findings support the development of individualized tools to guide early surveillance and preventative strategies in high-risk patients, with a focus on risk factors uniquely relevant to lower extremity lymphedema"”distinct from those associated with upper extremity disease.
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