Comprehensive laparoscopic lymphadenectomy from the deep circumflex iliac vein to the renal veins: Impact on quality of life ☆ Katherine A. O'Hanlan a, ⁎, Margaret S. Sten a , Deanna M. Halliday b , Ragini B. Sastry c , Danielle M. Struck a , Kathryn F. Uthman a a Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, United States b California State University, Fresno, CA, United States c Kaiser Permanente, Roseville, CA, United States HIGHLIGHTS • Comprehensive lymphadenectomy does not harm patients' quality of life. • Comprehensive lymphadenectomy does not cause lower extremity lymph- edema. • Comprehensive lymphadenectomy mildly contributes to lower extremity lymphedema after radiation and/or chemotherapy. • Routine omission of the distal circum- flex nodes may account for the low risk of lymphedema. • Numbness and tingling may be caused by trauma to the genitofemoral nerve and should be avoided. GRAPHICAL ABSTRACT abstract article info Article history: Received 22 November 2016 Received in revised form 10 December 2016 Accepted 19 December 2016 Available online xxxx Objective. Compare quality of life metrics for consecutive patients having total laparoscopic hysterectomy, bi- lateral salpingo-oophorectomy (TLHBSO) with and without comprehensive pelvic/aortic lymphadenectomy (CPALND) from proximal to the distal circumflex iliac nodes and vessels to the renal vessels. Methods. Analysis of mailed survey responses with 25 validated questions regarding musculoskeletal/lower extremity, gastro-intestinal, abdominal, urological, and energetic/activities of daily living. Data analyzed with Chi-Square tests of Association, Mann-Whitney U tests and follow up regression analysis. Results. Of 533 surveys mailed, 197 (37%) responded; 57 (28.9%) received CPALND. Age and parity were not different between groups, but the TLHBSO group had a higher BMI (31.4 v. 25.8, p b 0.001), and were less likely to receive chemotherapy (CT), radiotherapy (RT), or both (CT + RT). In the CPALND cohort, a mean of 47 nodes were removed, of which 26% were positive: 21% pelvic, 11% inframesenteric, 11% infrarenal. Both groups had sim- ilar total quality of life total scores of 86/92. Those having CPALND did not report more swelling but they did re- port more tingling/numbness (2.8 v. 3.5, p b 0.001). A series of hierarchical regressions confirmed that CPALND, per se, did not significantly reduce lower extremity scores apart from CT (p = 0.402) and CT + RT (p = 0.108). However, CPALND did predict for lower extremity swelling after receipt of CT, RT, or CT + RT. Node count, in total, or from each basin, did not correlate with any QOL decrement. Keywords: Quality of life Aortic lymphadenectomy Pelvic lymphadenectomy Lymphedema Gynecologic Oncology xxx (2016) xxx–xxx ☆ The author is a private practice Gynecologic Oncology surgeon in California, and consultant and/or speaker for Baxter, BD, and Medtronic. There is no off-label use of any medical device in this manuscript. No support was received for any part of this manuscript from any source. No proprietary interest is mentioned. ⁎ Corresponding author. E-mail address: Kate.OHanlanMD@gmail.com (K.A. O'Hanlan). YGYNO-976582; No. of pages: 6; 4C: http://dx.doi.org/10.1016/j.ygyno.2016.12.018 0090-8258/© 2016 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Gynecologic Oncology journal homepage: www.elsevier.com/locate/ygyno Please cite this article as: K.A. O'Hanlan, et al., Comprehensive laparoscopic lymphadenectomy from the deep circumflex iliac vein to the renal veins: Impact on quality of life, Gynecol Oncol (2016), http://dx.doi.org/10.1016/j.ygyno.2016.12.018