Sarcoma-related lymphedema after limb salvage for extremity bone and soft-tissue sarcoma: incidence, timing, and risk factors – a single-center cohort of 282 patients

Background: Sarcomas are rare, aggressive cancers, most commonly arising in the extremities. Most patients treated with curative intent undergo limb salvage surgery. Given the extent of surgery required, this can result in damage to lymphatic and blood vessels, leading to secondary lymphedema. Unfortunately, despite the significant impact of lymphedema on patients, there has been little research to investigate the prevalence of lymphedema and the risk factors associated with its development in sarcoma patients. Material and methods: All patients treated with limb-salvage surgery for extremity sarcoma at our service between July 2012 and July 2017 were identified from a prospective database. Lymphedema severity was evaluated according to the International Society of Lymphology classification system, and information on risk factors was collected from clinical records. Binary logistic regression was used to evaluate the role of risk factors in the development of lymphedema. Results: A total of 282 patients were identified as suitable for inclusion in the study. A total of 49 patients (17.4%) developed lymphedema during follow-up, with a median time to development of 6 months. Sarcomas arising in the lower extremity [odds ratio (OR) 5.661, P < 0.001], early post-operative complications such as seroma or wound infection (OR 4.612, P < 0.001), and radiotherapy (OR 8.876, P < 0.001) were all associated with an increased risk of lymphedema development, all remaining significant at the multivariate level. Conclusion: Lymphedema is a significant long-term complication that affects a high proportion (17.4%) of patients with extremity sarcoma. Further work is needed both to prevent this complication and to improve the early identification and management of these patients.