The Qaly study: Quality of life and lower extremity lymphedema in 174 patients after inguinal lymphadenectomy

BACKGROUND: Lower extremity lymphedema (LEL) can develop in patients who undergo inguinal lymph node dissection (ILND) in the treatment of gynecologic, genitourinary, and skin and soft tissue malignancies. While LEL can negatively impact quality of life, the poorly documented prevalence and severity of lymphedema-related symptoms complicates the ability to identify high-risk patients and improve the selection of candidates for emerging microsurgical interventions. METHODS: This multicenter, cross-sectional study included patients who underwent ILND between 1990 and 2022 across three medical centers in the Netherlands. Retrospective clinical data, including demographic, surgical, and postoperative variables, were abstracted from medical records. Lymphedema prevalence and severity were assessed using the Lymph-ICF-LL questionnaire, while additional patient-reported outcome measures (PROMs) evaluated quality of life and lower extremity function. Statistical analyses included multivariate logistic and linear regression to identify predictors of lymphedema-related symptoms and their impact on PROMs. RESULTS: Among 174 patients who underwent ILND, 77 % reported lymphedema-related symptoms, which were associated with significantly lower quality of life. Multivariable analysis identified that younger age at time of surgery, medical history of cardiovascular disease, and postoperative complications such as surgical site infections (SSI) and prolonged wound healing were significant predictors of developing lymphedema-related symptoms. Additionally, the presence of lymphedema was strongly linked to poorer physical and mental health PROMs, with malignancy type and surgical factors influencing these outcomes. CONCLUSION: This study emphasizes the significant burden of lymphedema-related symptoms following ILND, while highlighting the potential role of reconstructive microsurgery in reducing morbidity for high-risk patients.