A Prospective Study in Detection of Lower-Limb Lymphedema and Evaluation of Quality of Life After Vulvar Cancer Surgery

2012 ◽  
Vol 22 (6) ◽  
pp. 1081-1088 ◽  
Author(s):  
Marta Novackova ◽  
Michael J. Halaska ◽  
Helena Robova ◽  
Ivana Mala ◽  
Marek Pluta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lower Limb ◽  
Bioelectrical Impedance Analysis ◽  
Vulvar Cancer ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Cancer Surgery ◽  
Control Group ◽  
Inguinofemoral Lymphadenectomy

BackgroundLower-limb lymphedema is one of the most disabling adverse effects of vulvar cancer surgery. Multifrequency Bioelectrical Impedance Analysis (MFBIA) is a modern noninvasive method to detect lymphedema. The first aim of this study was to prospectively determine the prevalence of secondary lower-limb lymphedema after surgical treatment for vulvar cancer using objective methods, circumference measurements and MFBIA technique. The second aim was to compare quality of life (QoL) before and 6 months after vulvar surgery.MethodsTwenty-nine patients underwent vulvar cancer surgery in our study: 17 underwent inguinofemoral lymphadenectomy (RAD), and 12 underwent sentinel lymph node biopsy (CONS). Patients were examined before and 6 months after vulvar surgery by measuring the circumference of the lower limbs and with MFBIA. A control group of 27 healthy women was also measured. To evaluate QoL, the European Organisation for Research and Treatment of Cancer (EORTC) QoL questionnaires (QLQ-C30 and QLQ-CX24) were administered to patients before and 6 months after surgery.ResultsUsing circumference measurement, 9 lymphedemas (31%) were diagnosed: 3 (25%) in the CONS and 6 (37.5%) in the RAD group (P= 0.69). After vulvar surgery, patients in the RAD group reported more fatigue and worsening of physical and role functioning. When comparing both groups, the RAD group had significantly worse parameters in social functioning, fatigue, and dyspnea.ConclusionsLower radicality in inguinofemoral lymphadenectomy shows a trend toward lower morbidity and significantly improves QoL. Multifrequency Bioelectrical Impedance Analysis was tested in these patients as a noninvasive, objective method for lymphedema detection. Detection of lymphedema based on subjective evaluations proved to have an unsatisfactory sensitivity. Less radical surgery showed objectively better results in QoL.

A Prospective Study in the Evaluation of Quality of Life After Vulvar Cancer Surgery

2015 ◽  
Vol 25 (1) ◽  
pp. 166-173 ◽  
Author(s):  
Marta Novackova ◽  
Michael J. Halaska ◽  
Helena Robova ◽  
Ivana Mala ◽  
Marek Pluta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Vulvar Cancer ◽  
Lymph Node Biopsy ◽  
Cancer Surgery ◽  
Node Biopsy ◽  
Inguinofemoral Lymphadenectomy

ObjectiveThe aim of this study was to prospectively monitor the patients’ quality of life (QoL) after vulvar cancer surgery.DesignThe design was prospective clinical study.SettingThe study was set in the Department of Obstetrics and Gynecology, 2nd Medical Faculty of the Charles University and University Hospital Motol, Prague, Czech Republic.MethodsA group of 36 patients underwent vulvar cancer surgery: 24 patients were subject to inguinofemoral lymphadenectomy (RAD) and 12 to sentinel lymph node biopsy. To evaluate QoL, the European Organisation for Research and Treatment of Cancer, QoL questionnaires (QLQ-C30 and QLQ-CX24) were administered to patients before and 6 and 12 months after surgery.ResultsIn patients with vulvar cancer after inguinofemoral lymphadenectomy, increased fatigue and impaired lymphedema were observed. In the group of patients after sentinel lymph node biopsy, none of the QoL variables worsened postoperatively. Comparing both groups 12 months after surgery, the RAD group had significantly worse outcomes in body image and cognitive functioning than the sentinel lymph node biopsy group.Patients in the RAD group, who received adjuvant radiotherapy (n = 13), had worse QoL in symptom experience (P < 0.05) at 6 and 12 months after the surgery than patients without radiotherapy (n = 11).ConclusionsLess radical surgery showed objectively better QoL results.

A Prospective Study in Detection of Lower-Limb Lymphedema and Evaluation of Quality of Life After Vulvar Cancer Surgery

2012 ◽  
Vol 67 (12) ◽  
pp. 781-783
Author(s):  
Marta Novackova ◽  
Michael J. Halaska ◽  
Helena Robova ◽  
Ivana Mala ◽  
Marek Pluta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prospective Study ◽  
Lower Limb ◽  
Vulvar Cancer ◽  
Cancer Surgery ◽  
A Prospective Study

A Prospective Study of Postoperative Lymphedema After Surgery for Cervical Cancer

2010 ◽  
Vol 20 (5) ◽  
pp. 900-904 ◽  
Author(s):  
Michael J. Halaska ◽  
Marta Novackova ◽  
Ivana Mala ◽  
Marek Pluta ◽  
Roman Chmel ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lower Limb ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Conservative Surgery ◽  
Cancer Surgery ◽  
Lower Limbs ◽  
Control Group ◽  
The Right ◽  
A Prospective Study

Objective:Lymphedema is a severe postoperative complication in oncological surgery. Multifrequency bioelectrical impedance analysis (MFBIA) is a new method for early lymphedema detection. The objective was to establish the methodology of MFBIA for lower-limb lymphedema and to detect a lymphedema in patients undergoing cervical cancer surgery.Methods:From a population of 60 patients undergoing cervical cancer surgery, 39 underwent radical hysterectomy Wertheim III (RAD group), and 21 underwent conservative surgery (laparoscopic lymphadenectomy plus simple trachelectomy/simple hysterectomy - CONS group). A control group of 29 patients (CONTR group) was used to determine the SD of impedance at zero frequency (R0). Patients were examined before surgery and at 3 and 6 months after surgery by MFBIA and by measuring the circumference of the lower limbs.Results:No differences were found between the CONS and RAD groups on age, height, weight, and histopathologic type of tumor. However, the number of dissected lymph nodes differed significantly between the groups (17.3 in the CONS group vs 25.8 in the RAD group,P= 0.0012). The SD ofR0in the CONTR group was 36.0 and 39.0 for the right and the left leg, respectively. No difference in prevalence of lymphedema based on circumference method was found (35.9% in the RAD and 47.6% in the CONS groups, not statistically significant).Conclusions:No difference in the prevalence of lymphedema was found between the CONS and RAD groups. A methodology for MFBIA for the detection of lower-limb lymphedema was described.

Role of predictive markers for severe postoperative complications in gynecological cancer surgery: a prospective study (RISC-Gyn Trial)

2020 ◽  
Vol 30 (12) ◽  
pp. 1975-1982
Author(s):  
Melisa Guelhan Inci ◽  
Rolf Richter ◽  
Hannah Woopen ◽  
Julia Rasch ◽  
Kathrin Heise ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Postoperative Complications ◽  
Bioelectrical Impedance Analysis ◽  
Gynecological Cancer ◽  
Performance Status ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Predictive Markers ◽  
Surgical Data

BackgroundSurgery for gynecological cancer involves highly invasive and complex procedures potentially associated with various complications, which can cause extended hospital stays and delay of subsequent therapy, with a detrimental effect on the prognosis. The aim of this study was to explore and define the predictors of severe postoperative complications in patients undergoing surgery for gynecologic cancer.MethodsPatients undergoing surgery for gynecologic cancers were analyzed prospectively from October 2015 through January 2017. Using validated assessment tools preoperatively, we assessed comorbidities, performance status, quality of life, nutritional and body composition by bioelectrical impedance analysis, and the surgical data of each patient. Surgical complications were graded using the Clavien-Dindo criteria. Using stepwise logistic regression models, we identified predictive markers for postoperative complications.ResultsOf the 226 enrolled patients, 40 (17.7%) experienced a grade ≥IIIb complication according to the Clavien-Dindo criteria. In the regression analysis, overweight/obesity (body mass index >25) (OR 6.41, 95% CI 2.38 to 17.24; p<0.001) and impaired physical functioning defined by a quality of life questionnaire (OR 4.19, 95% CI 1.84 to 9.50; p=0.001) emerged as significant predictors of postoperative complications. Moreover, postoperative complications were predicted by phase angle of bioelectrical impedance analysis <4.75° (OR 3.11, 95% CI 1.35 to 7.16; p=0.008) and Eastern Cooperative Oncology Group (ECOG) performance status >1 (OR 2.51, 95% CI 1.06 to 5.92; p=0.04). Intraoperative factors associated with higher risk of postoperative complications were increased use of norepinephrine (>11 µg/kg/min) (OR 5.59, 95% CI 2.16 to 14.44; p<0.001) and performance of large bowel resection (OR 4.28, 95% CI 1.67 to 10.97; p=0.002).ConclusionIn patients undergoing surgery for gynecological cancer, preoperative evaluation of performance status according to ECOG, domains of quality of life and nutritional status, as well as intraoperative monitoring of risk factors, might help to identify patients at high risk for severe postoperative complications, and thus reduce surgical morbidity and mortality.

scholarly journals THU0462 CHARACTERIZATION OF PATIENTS WITH FIBROMYALGIA AFFECTS WITH OR WITHOUT JOINT HYPERLAXITY SYNDROME

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 468.1-468
Author(s):  
L. López-Núñez ◽  
J. Blanch ◽  
M. Ciria Recasens ◽  
M. J. Herrero Gascón ◽  
A. Juan-Mas ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bone Metabolism ◽  
Bioelectrical Impedance Analysis ◽  
Somatic Symptoms ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Joint Hypermobility ◽  
Medical Genetics ◽  
Sf 36

Background:The prevalence of joint hypermobility (JH) and Joint Hypermobility Syndrome (JHS) in patients with fibromyalgia (FM) is considerable and is much more than can be explained at random(1). Some authors propose that FM and JHS share a common pathophysiological mechanism is some patients. Currently it is accepted that Ehlers-Danlos Syndrome Hypermobility subtype (EDSh) and JHS are the same entity. We regard the subgroup of FM patients with JHS a different subtype of FM, even phenotypically similar to EDSh.Objectives:Determine the possible differences between both groups according to their body composition, bone metabolism and clinical findings.Methods:Our study is observational, descriptive, transverse cohort study in which we included 86 women with fibromyalgia recruited at the Fibromyalgia and Chronic Fatigue Unit at Parc Salut-Mar in Barcelona, Spain. The patients were grouped according to the presence or absence of JHS, following the Brighton Criteria. Diverse clinical data was collected: Pain Visual Analogue Scale (PVAS), time from pain onset, time from diagnosis, somatic symptoms, state of mind, presence of a FM trigger, concurrent medication, anxiety, quality of life, disease impact, anthropometric data, Bioelectrical Impedance Analysis (BIA), bone density test (BMD) and bone metabolism data in blood samples.Results:51 patients were included in the FM group and 35 patients in the FM-JHS group. We did not find differences between groups PVAS; time from pain onset; somatic symptoms using the Psychiatric Disorder and Somatic Pathology Scale (TOPYPS); nor Fibromyalgia Impact Questionnaire (FIQ). Both groups scored similarly on SF-36 Health Questionnaire. The use of opioids was more common in the FM group (p<0,001). Anxiety disorder (AnD) was present in a greater proportion of FM-JHS (p<0,001). We found the Body Mass Index and Muscle Mass (MM) to be less in the FM-JHS group (p=0.001 and p=0.008, respectively). Obesity and fat mass (FatM) were more frequent in the FM group. The FatM and less MM correlated with less quality of life on the SF-36 scale. There was less bone mass (BM) in the FM-JHS group (p=0.005). We found an inverse correlation between the Beighton score and the MM and BM in the FM-JHS group. The FM-JHS group also had less bone mineral density (BMD) at total hip DXA, with significant differences p=0.038. The BM by Bioelectrical Impedance Analysis (BIA) had a positive correlation on the BMD by DXA. The optimum point, capable of distinguishing between normal DXA and osteopenia/osteoporosis was 2,325kg with a specificity of 86% and sensibility of 52%. Vitamin D deficiency/insufficiency was found in 62/84 (73,8%) without significant differences between groups (p>0,05)Conclusion:Our work revealed that FM patients with JHS are different from FM without JHS, by manifesting differences in certain clinical, anthropometric, and bone metabolism features.References:[1]Lai S, Goldman JA, Child AH, Engel A, Lamm SH. Fibromyalgia, hypermobility, and breast implants. J Rheumatol. 2000;27(9):2237-41.[2]Malfait, F., Francomano, C., Byers, P., Belmont, J., Berglund, B., Black, J., ... & Castori, M. (2017, March). The 2017 international classification of the Ehlers–Danlos syndromes. InAmerican Journal of Medical Genetics Part C: Seminars in Medical Genetics(Vol. 175, No. 1, pp. 8-26).Disclosure of Interests: :None declared

Predicting composition of leg sections with anthropometry and bioelectrical impedance analysis, using magnetic resonance imaging as reference

1999 ◽  
Vol 96 (6) ◽  
pp. 647-657 ◽  
Author(s):  
N. J. FULLER ◽  
C. R. HARDINGHAM ◽  
M. GRAVES ◽  
N. SCREATON ◽  
A. K. DIXON ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Adipose Tissue ◽  
Magnetic Resonance ◽  
Coefficient Of Variation ◽  
Lower Limb ◽  
Bioelectrical Impedance Analysis ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Tissue Composition ◽  
Resonance Imaging

Magnetic resonance imaging (MRI) was used to evaluate and compare with anthropometry a fundamental bioelectrical impedance analysis (BIA) method for predicting muscle and adipose tissue composition in the lower limb. Healthy volunteers (eight men and eight women), aged 41 to 62 years, with mean (S.D.) body mass indices of 28.6 (5.4) kg/m2 and 25.1 (5.4) kg/m2 respectively, were subjected to MRI leg scans, from which 20-cm sections of thigh and 10-cm sections of lower leg (calf) were analysed for muscle and adipose tissue content, using specifically developed software. Muscle and adipose tissue were also predicted from anthropometric measurements of circumferences and skinfold thicknesses, and by use of fundamental BIA equations involving section impedance at 50 kHz and tissue-specific resistivities. Anthropometric assessments of circumferences, cross-sectional areas and volumes for total constituent tissues matched closely MRI estimates. Muscle volume was substantially overestimated (bias: thigh, -40%; calf, -18%) and adipose tissue underestimated (bias: thigh, 43%; calf, 8%) by anthropometry, in contrast to generally better predictions by the fundamental BIA approach for muscle (bias: thigh, -12%; calf, 5%) and adipose tissue (bias: thigh, 17%; calf, -28%). However, both methods demonstrated considerable individual variability (95% limits of agreement 20–77%). In general, there was similar reproducibility for anthropometric and fundamental BIA methods in the thigh (inter-observer residual coefficient of variation for muscle 3.5% versus 3.8%), but the latter was better in the calf (inter-observer residual coefficient of variation for muscle 8.2% versus 4.5%). This study suggests that the fundamental BIA method has advantages over anthropometry for measuring lower limb tissue composition in healthy individuals.

Effect of Rapid Rehabilitation Concepts on Quality of Life and Pain in Patients Undergoing Radical Breast Cancer Surgery in Perioperative Period

2021 ◽  
Vol 7 (5) ◽  
pp. 1538-1544
Author(s):  
Xin Li ◽  
Hai-yan An ◽  
Yi Zhao ◽  
Mingli Ji ◽  
Jing An ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Perioperative Period ◽  
Nursing Intervention ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
T Lymphocyte Subsets ◽  
Significant Difference

To study the effect of rapid rehabilitation nursing on patients’ quality of life and pain level during the perioperative period of radical breast cancer surgery. Methods: 126 patients who were hospitalized in our hospital from January 2018 to February 2020 and underwent radical breast cancer surgery were divided into control group and rapid rehabilitation group according to the perioperative period intervention method. Routine nursing intervention and rapid rehabilitation nursing intervention were used respectively. The general conditions of the two groups were recorded, and the differences of T cell subsets before operation and 3 days after operation were detected. Visual analogue pain (VAS) score was used to evaluate the changes of pain degree at 1 day, 3 days and 5 days after operation and on the day of discharge. Postoperative complications and satisfaction were compared between the two groups. Quality of life (QOL) was assessed at 1 month and 3 months after operation using the CARES-SF score. Results: Anesthesia waking time (26.12 ± 5.77) min, off-bed activity time (14.25 ± 2.87) h and hospital stay (7.82 ± 2.15) d in the rapid rehabilitation group were shorter than those in the control group (P < 0.05). The operation time (92.02 ± 14.78) min and intraoperative blood loss (57.96 ± 13.96) mL in the rapid rehabilitation group were not significantly different from those in the control group (P > 0.05). In the control group, 3d after operation, T lymphocyte subsets were decreased gradually than that before operation (P < 0.05), CD3+ was decreased 3d after operation than that before operation in the rapid rehabilitation group (P < 0.05), but CD4+, CD8+, CD4+ / CD8 + 3d after operation had no significant difference than that before operation (P > 0.05). In rapid rehabilitation group, T lymphocyte subsets at 3d after operation were higher than those in the control group (P < 0.05). The postoperative complication rate of the rapid rehabilitation group was lower than that of the control group, and the satisfaction degree was higher than that of the control group, with significant difference (P < 0.05). After follow-up, it was found that the scores of qualities of life, such as physiology, psychosocial, marriage, sexual life and relationship with medical staff in the rapid rehabilitation group were lower than those in the control group at 1 month and 3 months after operation (P < 0.05). Conclusion: The concept of rapid rehabilitation nursing can stabilize the immune function of patients after radical breast cancer surgery, promote the postoperative rehabilitation and improve the quality of life after operation.

Bioelectrical Impedance Analysis of Water Reduction in Lower-Limb Lymphedema by Lymphaticovenular Anastomosis

2018 ◽  
Vol 35 (04) ◽  
pp. 306-314 ◽  
Author(s):  
Yoshichika Yasunaga ◽  
Daisuke Yanagisawa ◽  
Erika Ohata ◽  
Kiyoshi Matsuo ◽  
Shunsuke Yuzuriha
Keyword(s):  
Lower Limb ◽  
Bioelectrical Impedance Analysis ◽  
Linear Regression Analysis ◽  
Reduction Rate ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Body Water ◽  
Volume Reduction ◽  
Water Volume ◽  
The Mean

Background Although lymphedema is fundamentally abnormal accumulation of excess water in the extracellular space, previous studies have evaluated the efficacy of physiological bypass surgery (lymphaticovenular anastomosis [LVA]) for lymphedema without measuring water volume. This study clarified the water reductive effect of LVA using bioelectrical impedance analysis (BIA). Methods The efficacy of LVA for unilateral lower-limb lymphedema was evaluated using BIA in a retrospective cohort. The water volume of affected and unaffected legs was measured using multifrequency BIA before and after LVA. Preoperative measurements were undertaken after compression therapy for at least 3 months. The follow-up period after LVA was a minimum of 6 months. Results Thirty consecutive patients with unilateral lower-limb lymphedema were enrolled. The mean water volume reduction of the affected leg by LVA (ΔLBW) was 0.86 L (standard deviation [SD]: 0.86, median: 0.65) with a mean number of 3.3 anastomoses (SD: 1.7). The mean reduction rate of edema was 45.1% (SD: 36.3). Multiple linear regression analysis revealed water volume difference between the affected and unaffected legs before LVA (excess LBW) as the strongest predictor of ΔLBW (R 2 = 0.759, p < 0.01; β = 0.500, p < 0.01). Conclusion The LVA reduces the volume of accumulated body water in lower-limb lymphedema. As excess LBW most strongly predicted the amount of water volume reduction by LVA, body water volume measurement by BIA before LVA might identify patients with low excess LBW not expected to benefit from LVA, regardless of apparent differences in limb circumference.

Morbidity and quality of life in patients with vulvar cancer after inguinal sentinel lymphadenectomy compared to radical inguinofemoral lymphadenectomy

2021 ◽  
Author(s):  
Fabinshy Thangarajah ◽  
Kristina Rogeé ◽  
Caroline Pahmeyer ◽  
Kathrin Kuhr ◽  
Matthias Schmidt ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Vulvar Cancer ◽  
Lymph Node Status ◽  
P Value ◽  
Sentinel Lymphadenectomy ◽  
Significant Difference ◽  
Inguinofemoral Lymphadenectomy

Abstract Aim Probability of survival of patients with vulvar cancer directly depends on the lymph node status. Surgery of lymph nodes can be performed as radical inguinofemoral lymphadenectomy or in cases with certain conditions as sentinel lymph node surgery. The aim of this study is to obtain an overview of the intervention-related morbidity and quality of life in patients with vulvar carcinoma after lymphadenectomy. Methods Quality of life and morbidity was compared between patients who underwent radical inguinofemoral lymphadenectomy with those who underwent sentinel lymph node surgery. Results All recorded postoperative complications occur more frequently in the non-sentinel group, Significant difference was shown for the occurrence of lymphedema (p-value = 0.024) and sensitivity loss (p-value = 0.024). Recurrence of disease was more frequent in the non-sentinel group (38 % vs. 20 %, p = 0.621, n.s.) and satisfaction with groin surgery is slightly higher in the sentinel group (94 % vs. 89 %, p = 1.000, n.s.). Conclusion We could demonstrate a significantly lower morbidity of sentinel lymphadenectomy compared to conventional inguinofemoral lymphadenectomy while maintaining the same oncological safety. The low morbidity of sentinel- lymphadenectomy does not seem to influence the postoperative quality of life significantly. However, recording of the individual burden of lymphadenectomy by questionnaires should be optimized.

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