Morbidity after lymph node dissection in patients with cancer: Incidence, risk factors, and prevention

This thesis contains a diversity of studies related to morbidity after lymph node dissection in patients with cancer. Morbidity varies in relation to the anatomical region of the lymph node dissection and may include wound complications, lymphoedema and peripheral nerve damage. Chapter one is a general introduction into the role of lymph node dissection in cancer treatment, and its subsequent morbidity. Chapter two and three are historical cohort studies that assess the incidence of postoperative wound complications and associated risk factors in patients with melanoma and penile cancer. Chapter four reports on a randomized controlled trial on the effectiveness of graduated compression stockings for prevention of lymphoedema in the lower limb after ILND. Chapter five is a systematic review of studies on conservative interventions for prevention of clinically detectable upper-limb lymphoedema after breast cancer treatment.
Chapter six reports on a cohort study that investigated the incidence of shoulder dysfunction after neck dissection, it’s impact on perceived disability, and it’s relation to quality of life. Chapter seven is a clinimetric study on the psychometric properties of the Shoulder Disability Questionnaire, the Shoulder Pain and Disability Index and the Neck Dissection Impairment Index in a population of patients after neck dissection. We used classical test theory to investigate reliability and validity of each of the scales. In addition, we used item response theory scaling (Rasch analysis). In chapter eight, the results of each of the studies are put into a clinical perspective and recommendations for future research are made.