Purpose of investigation: To identify factors associated with bilateral lymphedema in lower extremities that occur after gynecological cancer surgery. Materials and methods: Retrospective chart review was performed on 110 patients who were hospitalized for lymphedema after gynecological cancer surgery from 2006 to 2018. Statistical significance was verified using Pearson’s Chi-square test, Fisher’s exact test, and exact logistic regression analysis. Results: The types of cancer, cancer stage, genital swelling, and extensive lymph node dissection were significantly different between the two groups. Exact logistic regression analysis showed that cancer stage and genital swelling were associated with bilateral lymphedema. Significant differences were observed for radiation therapy and lymphangitis. Exact logistic regression analysis revealed that radiation therapy and lymphangitis were factors associated with unilateral to bilateral progression. Conclusion: Cancer stage, genital swelling, and extensive lymph node dissection were identified as factors related to bilateral lower limb lymphedema. Radiation therapy and infection history were identified as factors related to lymphedema progressing from unilateral to bilateral. Content: The associated factors for bilateral lymphedema in lower extremities after gynecological cancer surgery.