Early Detection of Lower Extremity Lymphedema After Lymphadenectomy in Gynecological Cancer
Condition: Lymphedema of Limb; Sentinel Lymph Node
MeSH terms: Lymphedema
Study type: Interventional

Summary: 
      This study aims to detect and treat early lower limb lymphedema secondary to lymphadenectomy
      with the aim of increasing the quality of life of patients with this chronic condition.

      To this end, a group of patients (treatment group) will be referred to the Rehabilitation
      service for a previous consultation and after surgery where lymphedema could be detected
      early. In addition, the usual follow-up will be carried out in Gynecology Oncology
      consultation (GO). In the second group, also called control, will be performed the usual
      follow-up in GO.

      For this we randomize to one of these two groups. The research project has the favorable
      report of the Center's Clinical Research Ethics Committee
    

Detailed description: 
      METHODOLOGY:

        1. Type of study: A) Randomized clinical trial B) Prospective cohort observational study

        2. Study period: from January 2017 to December 2017.

        3. Scope: health area of the province of Gipuzkoa and the University Hospital of Donostia
           as a reference center.

        4. Selection of the population:

           4.1. The inclusion criteria will be: A) Diagnostic gynecological cancer patients
           submitted to bilateral laparoscopic pelvic lymphadenectomy as laparotomics (B: Sentinel
           Node Biopsy study, SNB) within the usual surgical protocol, with expected survival
           greater than 12 weeks and adequate liver, renal and medullary functions to accept And
           sign informed consent 4.2. The exclusion criteria for the study will be: Blood clotting
           or hematological disorders, previous thromboembolic disease and history of lymphatic
           system disease (lymphedema or lymphocele), contraindication for physiotherapy or who do
           not wish to participate and / or do not sign informed consent.

           4.3. Sample size: A) Assuming that according to previous studies the overall incidence
           of lymphedema after LPL is 21% (Hareyama et al), its estimated that a minimum sample of
           44 patients will bi needed in order to be able to demonstrate at least 4-fold detection
           (Torres et al) of Lymphedemas with early follow-up with alpha = 0.05 and beta = 0.2,
           estimating that habitual follow-up detects 13% of lymphedema ( Mohler III et al).

           4.4. Recruitment Process: Will be selected consecutively and offered to participate in
           the study.

        5. 5.1 Intervention: A) After diagnosis and programming for surgery at the GO consultation,
           circometry is performed by a trained nurse. During the admission, the nurse delivers and
           explains recommendations sheet and is offered to participate in the clinical trial
           giving him the Informed Consent (IC) and Information Sheet created for this purpose. In
           case of accepting and signing the IC, it is randomized (total randomization) according
           to system of envelopes with code.

      Distribution of the intervention;

        -  Treatment group: Face-to-face consultation in Rehabilitation for early detection of
           lymphedema after surgery (1,6,12 months). Lower Limb measurement and care education

        -  Control group: The usual follow-up will be carried out in GO consultation (0,1,6,12
           months)

      The pelvic lymphadenectomy will be performed by the same surgical team using a
      transperitoneal approach. The limits of lymph node dissection will be: the psoas muscle,
      laterally, the postero-medially internal iliac artery, the bifurcation of the common iliac
      artery cranially, where it crosses the ureter, and caudally the origin of the epigastric
      vessels, to level of the deep circumflex iliac vein.

      B) After diagnosis and programming for surgery at the GO consultation, circometry is
      performed by trained and yearly nurse. During the entrance, it is delivered and explains the
      recommendations sheet. SNB is performed by detecting sentinel ganglion from the above
      mentioned areas according to the protocol of the service. The usual follow-up will be carried
      out in GO consultation (0,1,6,12 months)
    

Intervention name(s): Early lymphedema detection; Usual follow-up
Intervention type(s): Other; Other
Intervention description(s): Face-to-face consultation in Rehabilitation for early detection of lymphedema after surgery (1,6,12 months). Lower Limb measurement and care education; Usual follow-up carried out in GO consultation
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Recruitment Process: patients will be selected consecutively and offered to participate in the study
Masking: Single (Outcomes Assessor)
Primary purpose: Diagnostic
Keywords: physiotherapy