Using patient questionnaires, we studied the long-term effect of leaving the peritoneum open on the incidence of
lymphedema of the legs in patients following pelvic
lymphadenectomy for gynecological
malignancies. The patients were retrospectively assigned to one of two groups, depending on whether the retroperitoneum was closed or left open at surgery. Three years after surgery, we obtained valid questionnaire responses from 101 patients (43 cervical, 46 endometrial, and 12
ovarian cancers) in the closure group and 83 patients (34 cervical, 40 endometrial, and 9
ovarian cancers) in the nonclosure group. In patients' self-analysis, the overall incidence of
lymphedema of the legs was significantly lower in the nonclosure group than in the closure group (25.3% and 50.5%, respectively; P<0.01). The incidence of
lymphedema of the legs was significantly increased by postoperative
radiotherapy. Especially in the nonclosure group, the incidence of
lymphedema was only 15.8% in patients who did not have
radiotherapy, but it increased significantly (44.4%) (P<0.05) when patients underwent
radiotherapy. In conclusion, this questionnaire survey suggested that leaving the retroperitoneum open after
lymphadenectomy is significantly effective in reducing the incidence of leg
lymphedema, which impairs patients' quality of life more than expected by physicians.