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Zhao L, Xie X, Fan W, Wen Y, Zhang N, Xu J, Meng Y, Gu C. Vascular clips for preventing lymphocele and symptomatic lymphocele in patients with gynecologic malignancies after laparoscopic pelvic lymphadenectomy. J Minim Invasive Gynecol 2024:S1553-4650(24)00276-0. [PMID: 38944337 DOI: 10.1016/j.jmig.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 06/04/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
STUDY OBJECTIVE To evaluate the effectiveness of using vascular clips to seal targeted lymphatics in gynecological malignancies for the prevention of postoperative pelvic lymphocele and symptomatic lymphocele after laparoscopic pelvic lymphadenectomy. DESIGN Retrospective analysis. SETTING Single-center academic hospital. PATIENTS In total, 217 patients with gynecological malignancies were included. INTERVENTIONS Patients were classified into two groups: group 1 (vascular clips were used to seal the targeted lymphatics) and group 2 (electrothermal instruments were used to seal the targeted lymphatics). The patients were followed up 4-6 weeks after surgery to evaluate the incidence of lymphoceles by ultrasound or CT. Symptomatic lymphoceles are defined as those that cause infection, deep vein thrombosis with or without swelling of the extremities, edema (swelling) of the extremities or perineum, hydronephrosis and/or moderate to severe pain. MEASUREMENT AND MAIN RESULTS One hundred and thirteen patients were enrolled in group 1, and 104 patients were enrolled in group 2. Lymphoceles were observed in 46 (21.2%) patients. Fewer lymphoceles occurred in group 1 than in group 2 [8 (7.1%) vs. 38 (36.5%), p < 0.001]. The percentage of significantly sized lymphoceles was lower in group 1 than that in group 2 [4 (3.5%) vs. 30 (28.8%), p < 0.001]. Symptomatic lymphoceles occurred in 18 patients (8.3%), and only one (1.0%) occurred in group 1, while 17 (16.3%) occurred in group 2 (p < 0.001). A multivariate analysis revealed that vascular clips were the only independent factor for preventing lymphocele (OR = 7.65, 95% CI = [3.30, 17.13], p < 0.001) and symptomatic lymphocele (OR = 22.03, 95% CI = [2.84, 170.63], p = 0.003). CONCLUSIONS The results indicate that the use of vascular clips may be useful for the prevention of the development of lymphocele and symptomatic lymphocele secondary to pelvic lymphadenectomy performed via laparoscopy.
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Affiliation(s)
- Luyang Zhao
- Department of Obstetrics and Gynaecology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiufeng Xie
- Department of Obstetrics and Gynaecology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wensheng Fan
- Department of Obstetrics and Gynaecology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang Wen
- Department of Obstetrics and Gynaecology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Nina Zhang
- Department of Obstetrics and Gynaecology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jia Xu
- Department of Obstetrics and Gynaecology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuanguang Meng
- Department of Obstetrics and Gynaecology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chenglei Gu
- Department of Obstetrics and Gynaecology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China.
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Treatment of symptomatic postoperative pelvic lymphoceles: A systematic review. Eur J Radiol 2020; 134:109459. [PMID: 33302026 DOI: 10.1016/j.ejrad.2020.109459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE A broad range of therapeutic options exists for symptomatic postoperative lymphoceles. However, no consensus exists on what is the optimal therapy. In this study, we aimed to compare the efficacy of currently available radiologic interventions in terms of number of successful interventions, number of recurrences, and number of complications. METHODS A systematic review was conducted with a pre-defined search strategy for PubMed, EMBASE, and Cochrane databases from inception until September 2019. Quality assessment was performed using the 'Risk Of Bias In Non-randomized Studies - of Interventions' tool. Statistical heterogeneity was assessed using the I2 and χ2 test and a meta-analysis was considered for studies reporting on multiple interventions. RESULTS 37 eligible studies including 732 lymphoceles were identified. Proportions of successful interventions for percutaneous fine needle aspiration, percutaneous catheter drainage, percutaneous catheter drainage with delayed or instantaneous addition of sclerotherapy, and embolization were as follows: 0.341 (95% confidence interval [CI]: 0.185-0.542), 0.612 (95% CI: 0.490-0.722), 0.890 (95% CI: 0.781-0.948), 0.872 (95% CI: 0.710-0.949), 0.922 (95% CI: 0.731-0.981). Random-effects meta-analysis of seven studies revealed a pooled relative risk for percutaneous catheter drainage with delayed addition of sclerotherapy of 1.57 (95% CI: 1.17-2.10) when compared to percutaneous catheter drainage alone. The risk of bias in this study was severe. CONCLUSIONS This systematic review demonstrates that the success rates of percutaneous catheter drainage with sclerotherapy are more favorable when compared to percutaneous catheter drainage alone in the treatment of postoperative pelvic lymphoceles. Overall, percutaneous catheter drainage with delayed addition of sclerotherapy, and embolization showed the best outcomes.
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Weinberger V, Fischerova D, Semeradova I, Slama J, Cibula D, Zikan M. Ultrasound characteristics of a symptomatic and asymptomatic lymphocele after pelvic and/or paraaortic lymphadenectomy. Taiwan J Obstet Gynecol 2019; 58:266-272. [PMID: 30910151 DOI: 10.1016/j.tjog.2019.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To describe the sonographic characteristics of a lymphocele after pelvic and/or paraaortic lymphadenectomy for gynecological malignancy, analyze and identify ultrasound characteristics related to the symptomatic and asymptomatic lymphoceles. MATERIALS AND METHODS This is a retrospective analysis of ultrasound examination data collected consecutively in patients after pelvic and/or paraaortic lymphadenectomy in one institution. We recorded the number of lymphoceles, localization, size; ultrasound morphology following International Ovarian Tumor Analysis group classification and symptoms. RESULTS We described and analyzed 227 lymphoceles (150 asymptomatic and 77 symptomatic) in 161 patients. The asymptomatic lymphocele is typically a thick-walled cystic lesion without vascularization, round and unilocular with anechoic or ground-glass content. The symptomatic lymphocele is typically an oval, or ovoid, unilocular lesion with low-level or anechoic content (ground glass content is unlikely to be present, p < 0.001) and the presence of debris and septations. The lymphocele size (p = 0.001), number of lymphoceles (>1) (p = 0.005), septa (p = 0.002), and debris (p < 0.001) were independent ultrasound features correlating to symptoms development. More than one lymphocele (p = 0.047), septations (p = 0.007) and presence of debris (p < 0.001) were independent ultrasound features correlated to infection. CONCLUSION Ultrasound features of symptomatic and asymptomatic lymphocele differ. The clues for lymphocele differential diagnosis are the history of lymphadenectomy and the finding cystic lesion with typically ultrasound features of lymphocele, adjacent to great pelvic vessels. Unique ultrasound features of lymphocele may help to distinguish from tumor relapse, hematoma, abscess, seroma or urinoma.
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Affiliation(s)
- Vit Weinberger
- Department of Obstetrics and Gynecology, Masaryk University, Faculty of Medicine, Jihlavska 20, 625 00, Brno, Czech Republic
| | - Daniela Fischerova
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University - First Faculty of Medicine and General University Hospital, Apolinarska 18, 128 00 Prague, Czech Republic
| | - Ivana Semeradova
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University - First Faculty of Medicine and General University Hospital, Apolinarska 18, 128 00 Prague, Czech Republic
| | - Jiri Slama
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University - First Faculty of Medicine and General University Hospital, Apolinarska 18, 128 00 Prague, Czech Republic
| | - David Cibula
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University - First Faculty of Medicine and General University Hospital, Apolinarska 18, 128 00 Prague, Czech Republic
| | - Michal Zikan
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University - First Faculty of Medicine and General University Hospital, Apolinarska 18, 128 00 Prague, Czech Republic; Department of Obstetrics and Gynecology, Charles University - First Faculty of Medicine and Na Bulovce Hospital, Budinova 67/2, 181 00 Prague, Czech Republic.
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Predictors of Lymphoceles in Women Who Underwent Laparotomic Retroperitoneal Lymph Node Dissection for Early Gynecologic Cancer: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060936. [PMID: 30875912 PMCID: PMC6466375 DOI: 10.3390/ijerph16060936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/03/2019] [Accepted: 03/12/2019] [Indexed: 12/20/2022]
Abstract
Background: Lymphoceles could represent a detrimental complication after retroperitoneal lymph node dissection. Our aim was to elucidate predictors of lymphoceles. Methods: Between 2011 and 2017, medical records of consecutive women who underwent laparotomic retroperitoneal lymph node dissection for FIGO stage I or II gynecologic cancer were reviewed. Results: A total of 204 women, including those with lymphoceles (n = 31) and symptomatic lymphoceles (n = 7), were reviewed. According to multivariable analysis, parity (odds ratio = 0.59, p = 0.003), adjuvant pelvic radiotherapy (odds ratio = 2.60, p = 0.039), and peritoneal nonclosure without pelvic drainage (odds ratio = 2.31, p = 0.048) were predictors of lymphoceles. In addition, parity (odds ratio = 0.73, p = 0.03), hypertension (odds ratio = 2.62, p = 0.02), and peritoneal partial closure with pelvic drainage (odds ratio = 0.27, p = 0.02) were predictors of complications. Conclusion: Low parity, adjuvant pelvic radiotherapy, and peritoneal nonclosure without pelvic drainage were associated with increased lymphocele formation. In addition, a lower complication rate was found in the peritoneal partial closure with pelvic drainage group; thus, peritoneal partial closure with pelvic drainage might be suggested for women who undergo laparotomic retroperitoneal lymph node dissection.
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Sahbaz A, Gungorduk K, Gulseren V, Ozdemir IA, Harma M, Harma M, Sancı M. What Are the Risk Factors for Lymphocyst Formation Apart From Lymphnode Dissection and Lymphnode Count in Gynecologic Malignancy? Geburtshilfe Frauenheilkd 2016; 76:403-407. [PMID: 27134296 DOI: 10.1055/s-0041-110804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Aim: Lymphocyst is one of the most common complications of lymphadenectomy and generally encountered during uro-gynecological oncology surgeries. We aimed to define the risk factors for formation of a lymphocyst in patients with various gynecological cancer types in whom a lymphadenectomy was performed. Methods: This retrospective study was performed on 206 patients. Of the 206 patients, 100 were diagnosed with a lymphocyst, and 106 were assigned to a control group. Laboratory findings and surgical characteristics of the patients were compared. Results: No differences were observed in age, pre-operative hemoglobin; platelet, white blood cell, and lymphocyte counts; or pre-operative albumin level (p = 0.315, 0.500, 0.525, 0.683, 0.740, and 0.97, respectively). A significant effect of the heparin dose × heparin days interaction and lymphocyst formation was observed (p = 0.002). Lymphocysts were most frequently detected in the ovarian cancer subgroup (49 %). Significant differences were detected between the groups in the percentages of patients who underwent CT only and RT only treatments (p = 0.001 and 0.002, respectively). The logistic regression analysis revealed a relationship between the LMWH dose × days interaction and formation of a lymphocyst (OR, 1.10; 95 % CI, 1.0-1.13; p = 0.01). Conclusion: The association between total LMWH dose administered and the formation of lymphocysts in patients with gynecological pelvic cancer was investigated for the first time. Significant relationship between heparin dose × days and lymphocyst formation was found. Although anticoagulation with LMWH is essential for preventing thromboembolism, it should be used appropriately to prevent other complications, such as bleeding and lymphocysts.
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Affiliation(s)
- A Sahbaz
- Zonguldak Bulent Ecevit University School of Medicine, Department of Obstetrics and Gynecology, Zonguldak, Turkey
| | - K Gungorduk
- Izmir Tepecik Research and Training Hospital, Department of Gynecology and Oncology, Izmir, Turkey
| | - V Gulseren
- Izmir Tepecik Research and Training Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - I A Ozdemir
- Bakirkoy Sadi Konuk Research and Training Hospital, Department of Gynecology and Oncology, Istanbul, Turkey
| | - M Harma
- Zonguldak Bulent Ecevit University School of Medicine, Department of Obstetrics and Gynecology & Obstetrics and Gynecology, Zonguldak, Turkey
| | - M Harma
- Zonguldak Bulent Ecevit University School of Medicine, Department of Obstetrics and Gynecology & Obstetrics and Gynecology, Zonguldak, Turkey
| | - M Sancı
- Izmir Tepecik Research and Training Hospital, Department of Gynecology and Oncology, Izmir, Turkey
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Hiramatsu K, Kobayashi E, Ueda Y, Egawa-Takata T, Matsuzaki S, Kimura T, Sawada K, Yoshino K, Fujita M, Kimura T. Optimal timing for drainage of infected lymphocysts after lymphadenectomy for gynecologic cancer. Int J Gynecol Cancer 2015; 25:337-41. [PMID: 25594145 DOI: 10.1097/igc.0000000000000353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A lymphocyst (lymphocele) is a common complication of lymphadenectomy, which is a widely used surgical method for gynecologic cancers. In cases of infected lymphocysts, therapeutic strategies, including the timing and duration of antibiotics administration and cyst drainage, may vary depending on the physician. The aim of this study was to determine the optimal timing for drainage of lymphocysts infected with bacteria resistant to antibiotic treatment. MATERIALS AND METHODS Clinical data for 1175 patients who underwent a lymphadenectomy as part of surgery for a gynecologic malignancy between April 2000 and August 2012 at Osaka University Hospital, Osaka, Japan, were analyzed. RESULTS Of the 282 patients who developed a lymphocyst (24%), 35 with infected lymphocysts (12%) were analyzed. Lymphocyst infection was not associated with tumor origin, type of hysterectomy, or region of lymphadenectomy (P = 0.81, P = 0.59, and P = 0.86, respectively). The total treatment period of cases treated only with antibiotics tended to be shorter than that of cases treated with combined antibiotics and drainage, but the difference was not significant (P = 0.061). However, for severe cases which needed drainage, initiating the drainage by day 5 significantly shortened the total treatment period compared with cases started on or after day 6 (P = 0.042). CONCLUSIONS The appropriate time point for initiating lymphocyst drainage has been difficult to determine. The present study implies that for severe lymphocyst infections, where drainage is required in addition to antibiotics, the earlier the drainage is performed, the shorter the treatment period is. Further studies may be required to decide other optimal treatment strategies for infected lymphocysts.
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Affiliation(s)
- Kosuke Hiramatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Hotwani C, Chopra S, Moirangthem N, Mohanty S. Impact of lymphoceles on organ at risk doses in patients undergoing adjuvant pelvic radiation for carcinoma cervix. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.32.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Zikan M, Fischerova D, Pinkavova I, Slama J, Weinberger V, Dusek L, Cibula D. A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer. Gynecol Oncol 2015; 137:291-8. [DOI: 10.1016/j.ygyno.2015.02.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 02/16/2015] [Indexed: 11/25/2022]
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Weinberger V, Cibula D, Zikan M. Lymphocele: prevalence and management in gynecological malignancies. Expert Rev Anticancer Ther 2014; 14:307-17. [DOI: 10.1586/14737140.2014.866043] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kondo E, Tabata T, Shiozaki T, Motohashi T, Tanida K, Okugawa T, Ikeda T. Large or persistent lymphocyst increases the risk of lymphedema, lymphangitis, and deep vein thrombosis after retroperitoneal lymphadenectomy for gynecologic malignancy. Arch Gynecol Obstet 2013; 288:587-93. [DOI: 10.1007/s00404-013-2769-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 02/14/2013] [Indexed: 10/27/2022]
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McGonigle KF, Amneus MW. Perioperative Issues in the Management of Vulvar Cancer. Gynecol Oncol 2011. [DOI: 10.1002/9781118003435.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Ramsewak SS, Wu-shun-Wong F, Buck P, Fouracres M, Tindall VR. Pelvic lymphocysts occurring after Wertheim's operation: a review of 11 years' experience. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443618609079222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Tam KF, Lam KW, Chan KK, Ngan HYS. Natural history of pelvic lymphocysts as observed by ultrasonography after bilateral pelvic lymphadenectomy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:87-90. [PMID: 18548478 DOI: 10.1002/uog.5345] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To determine, in patients who have undergone bilateral pelvic lymphadenectomy for gynecological cancer, the incidence of lymphocyst formation, their change in size with time, risk factors and correlation with symptoms. METHODS This was a prospective observational study of 108 patients undergoing bilateral pelvic lymphadenectomy for gynecological cancer in our unit. We performed serial three-dimensional (3D) ultrasound assessment at 2 and 6 weeks and 3, 6, 9 and 12 months after surgery. Before each ultrasound assessment, symptoms were recorded and a physical examination was performed. RESULTS Forty-eight (44.4%) patients had unilateral or bilateral lymphocysts detected during the follow-up period; 26 were on the left side, 16 were on the right side and six were bilateral. In 39 (81.2%) of the patients, the lymphocysts were first noted 2 weeks after the operation. In nine (18.8%) the lymphocysts persisted until 12 months after surgery. There was no association between lymphocyst formation and diagnosis, type of operation performed, surgeon, operative blood loss, adjuvant radiotherapy and number of lymph nodes removed. Four lymphocysts were detected by physical examination before the ultrasound diagnosis. There was no association between lymphocyst and symptoms, including pain over the abdomen, pelvis, thigh, legs or back, lymphedema, fever or symptoms of cystitis. Only one patient developed an infection of the lymphocyst, which required surgical intervention. CONCLUSION Lymphocyst formation is common following bilateral pelvic lymphadenectomy. Most patients with lymphocysts are asymptomatic and the development of major complications is rare.
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Affiliation(s)
- K F Tam
- Department of Obstetrics and Gynaecology, Gynaecological Oncology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
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Tanaka T, Ohki N, Kojima A, Maeno Y, Miyahara Y, Sudo T, Takekida S, Yamaguchi S, Sasaki H, Nishimura R. Radiotherapy negates the effect of retroperitoneal nonclosure for prevention of lymphedema of the legs following pelvic lymphadenectomy for gynecological malignancies: an analysis from a questionnaire survey. Int J Gynecol Cancer 2007; 17:460-4. [PMID: 17316358 DOI: 10.1111/j.1525-1438.2007.00869.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- T Tanaka
- Department of Gynecology, Hyogo Medical Center for Adults, Akashi, Japan
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Karcaaltincaba M, Akhan O. Radiologic imaging and percutaneous treatment of pelvic lymphocele. Eur J Radiol 2005; 55:340-54. [PMID: 15885959 DOI: 10.1016/j.ejrad.2005.03.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 03/07/2005] [Accepted: 03/10/2005] [Indexed: 11/19/2022]
Abstract
Pelvic lymphocele, also known as lymphocyst, is a cystic structure caused by lymphatic injury usually secondary to pelvic lymphadenectomy and renal transplantation. Lymphoceles can cause morbidity and rarely mortality by compression of adjacent structures and infectious complications. This review discusses etiology and treatment options for pelvic lymphoceles including surgical and percutaneous methods with emphasis on percutaneous techniques particularly in conjunction with sclerotherapy. Percutaneous catheter drainage with sclerotherapy procedure with various sclerosing agents is described in detail. Ethanol, povidone-iodine, tetracycline, doxycycline, bleomycin, talc and fibrin glue can be used as sclerosing agents. Combination of sclerosing agents to percutaneous catheter drainage significantly improves success rate in the treatment of pelvic lymphoceles. Infected lymphoceles are usually treated solely with percutaneous catheter drainage. Percutaneous treatment can be tailored according to volume of lymphoceles. We generally prefer single session sclerotherapy and 1 day catheter drainage in lymphoceles less than 150 mL, and larger ones are treated by multi-session sclerotherapy until daily drainage decreases below 10 mL. Percutaneous treatment preferably with sclerotherapy should be considered as the first-line treatment modality for pelvic lymphoceles due to its effectiveness, widespread applicability on an outpatient basis, ease of procedure and low complication rate.
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Affiliation(s)
- Musturay Karcaaltincaba
- Department of Radiology, Division of Abdominal and Interventional Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara 06100, Turkey
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Alkon JD, Smith A, Losee JE, Illig KA, Green RM, Serletti JM. Management of Complex Groin Wounds: Preferred Use of the Rectus Femoris Muscle Flap. Plast Reconstr Surg 2005; 115:776-83; discussion 784-5. [PMID: 15731678 DOI: 10.1097/01.prs.0000152436.50604.04] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study reviews our experience with the rectus femoris muscle flap for complex groin wound reconstruction. Over the past 5 years, the rectus femoris has become our routine method of groin wound reconstruction. The rectus femoris is harvested through a midanterior incision extending over the distal two-thirds of the thigh. The muscle is elevated on its pedicle and transposed into the groin wound defect either directly or through an intervening skin bridge. Hospital and outpatient records were reviewed for all patients undergoing groin wound reconstruction with this technique from 1999 through 2003. Thirty-seven rectus femoris muscle flaps were performed in 33 patients. The mean patient age was 65.3 years (range, 25 to 88 years). Thirty groin wounds (81.1 percent) occurred after infrainguinal revascularization, 23 (76.7 percent) of which contained prosthetic material. Five (21.7 percent) of these wounds had their prosthetic material removed at the time of reconstruction. The remaining seven groin wounds (18.9 percent) occurred after femoral vessel cannulation for either cardiac or transplant surgery. There were no intraoperative mortalities and no anastomotic hemorrhages. There were no flap losses. Thirty-five of the 37 treated wounds healed (94.6 percent), 26 primarily (70.3 percent) and nine (24.3 percent) after delayed healing and contracture. Reoperation was performed in one patient for flap readvancement and in three patients for prosthetic graft removal after initial flap reconstruction. Two patients (6.1 percent) died during their hospitalization with persistent open groin wounds after flap reconstruction. All muscle flap donor incisions healed, with only two (5.4 percent) experiencing minimal delayed healing. There were no donor-site wound infections and no donor sites required reoperation. Thirty-three groin wounds (89.2 percent) demonstrated culture-positive microbial infection, 15 (45.5 percent) of which were polymicrobial. The 30-day mortality rate was 15.2 percent and the 6-month mortality rate increased to 27.2 percent, with multisystem organ failure as the most common cause. The rectus femoris muscle flap is an effective and reliable means of complex groin wound reconstruction. The muscle flap is dependable and the donor site is not problematic, even in the presence of peripheral vascular disease. On the basis of our clinical results, we believe that the rectus femoris muscle flap is the flap of choice for groin wound reconstruction.
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Affiliation(s)
- Joseph D Alkon
- Division of Plastic Surgery, Strong Memorial Hospital, University of Rochester, Rochester, NY, USA
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Abstract
Vascular tumors of the pelvis are a rare, diverse group of neoplasms. These benign or malignant tumors can arise from the endothelium, smooth muscle cells, or pericytes of the arterial venous or lymphatic walls. They are rarely diagnosed by physical examination but more commonly seen with imaging studies such as computed tomography, magnetic resonance imaging, or angiography. Benign and malignant tumors can be differentiated pathologically by the two major anatomic characteristics of vascular channel formation and the regularity of endothelial cell proliferation. This review will focus on the clinical presentation, diagnosis, treatment, outcomes, and surgical approaches to benign and malignant vascular tumors of the pelvis.
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Affiliation(s)
- T M Bergamini
- Department of Surgery and James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky 40202, USA.
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Sieber PR, Rommel FM, Agusta VE, Breslin JA, Harpster LE, Huffnagle HW, Stahl C. Is heparin contraindicated in pelvic lymphadenectomy and radical prostatectomy? J Urol 1997; 158:869-71. [PMID: 9258101 DOI: 10.1097/00005392-199709000-00050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE We initiated a prospective study to verify or refute the complications of lymphocele formation and excessive blood loss associated with heparin prophylaxis in pelvic lymphadenectomy and radical prostatectomy. MATERIALS AND METHODS A prospective study was completed on 579 men undergoing pelvic lymphadenectomy usually in association with radical prostatectomy. Patients were assigned to group 1 (given preoperative and postoperative subcutaneous heparin) and group 2 (no heparin). All patients were evaluated 2 to 3 weeks after surgery with ultrasound for pelvic lymphocele. RESULTS There was no statistically significant difference in the number or size of pelvic lymphoceles or blood loss in group 1 versus group 2. CONCLUSIONS The use of heparin prophylaxis to prevent thromboembolic complications in conjunction with pelvic lymphadenectomy and radical prostatectomy is not associated with increased blood loss or increased rate of lymphocele formation.
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Affiliation(s)
- P R Sieber
- Urological Associates of Lancaster, Ltd., Pennsylvania, USA
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20
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Daskalakis G, Mesogitis S, Antsaklis A, Papantoniou N, Papageorgiou I, Michalas S, Aravantinos D. Percutaneous management of lymphocoeles following pelvic lymphadenectomy for cervical carcinoma. J OBSTET GYNAECOL 1997; 17:192-4. [PMID: 15511820 DOI: 10.1080/01443619750113852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Eighteen patients with 26 pelvic lymphocoeles following radical hysterectomy underwent percutaneous therapeutic intervention with either needle aspiration, or catheter drainage. In eight patients a percutaneous needle aspiration under sonographic control was performed. Five out of eight patients were successfully managed with needle aspiration, three of them requiring repetitive aspirations. Thirteen patients, with a total of 21 lymphocoeles underwent catheter drainage. Seventeen of the 21 lymphocoeles completely resolved. Redrainage was performed in four cases and it was successful in two of them. The duration of the catheter drainage was 8 to 34 days. Nine of the lymphocoeles were infected at initial drainage. Two patients underwent surgery because of increased volume of output. Percutaneous drainage is a safe and effective method and should be considered as the initial treatment for all patients with postoperative lymphocoeles.
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Affiliation(s)
- G Daskalakis
- University of Athens, Alexandra Maternity Hospital, Greece
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21
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Perrin LC, Goh J, Crandon AJ. The treatment of recurrent pelvic lymphocysts with marsupialization and functioning omental flap. Aust N Z J Obstet Gynaecol 1995; 35:195-7. [PMID: 7677688 DOI: 10.1111/j.1479-828x.1995.tb01869.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A new treatment for recurrent pelvic lymphocysts is reviewed. Nine women with recurrent symptomatic lymphocyst were treated by marsupialization of the lymphocyst to the peritoneal cavity and functioning omental flap. The omental flap was dissected off the greater curve of the stomach maintaining its blood supply from the appropriate gastroepiploic vessels. The flap functioned by absorbing the lymph that previously accumulated in the lymphocyst. The efficacy of treatment was accessed both clinically and with diagnostic imaging. The pelvic lymphocysts were successfully treated in all 9 cases. There was no significant morbidity and the average hospital stay was 7 days. Marsupialization of pelvic lymphocysts combined with an omental flap is effective, not associated with increased morbidity and has a very low recurrence rate.
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Affiliation(s)
- L C Perrin
- Queensland Centre for Gynaecological Cancer, Royal Women's Hospital, Brisbane
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22
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Albala DM, Kevwitch MK, Waters WB. Treatment of persistent lymphatic drainage after laparoscopic pelvic lymph node dissection and radical retropubic prostatectomy. J Endourol 1993; 7:337-40. [PMID: 8252030 DOI: 10.1089/end.1993.7.337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A patient with a lymphocele after laparoscopic pelvic lymphadenectomy and radical retropubic prostatectomy was treated successfully with a single instillation of diatrizoate meglumine through a Jackson-Pratt drain. The authors review the origin of lymphoceles and various methods for treating them.
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Affiliation(s)
- D M Albala
- Department of Urology, Loyola University Medical Center, Maywood, IL
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23
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Bardot SF, Montie JE, Jackson CL, Seiler JC. Laparoscopic surgical technique for internal drainage of pelvic lymphocele. J Urol 1992; 147:908-9. [PMID: 1531687 DOI: 10.1016/s0022-5347(17)37419-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A previously unreported technique of internal drainage of a pelvic lymphocele is described using a laparoscopic approach to create the peritoneal window for drainage in 2 patients. The technique avoids a larger incision and permits a shorter recovery period.
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Affiliation(s)
- S F Bardot
- Department of Urology, Cleveland Clinic Florida, Ft. Lauderdale
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24
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Abstract
Lymphocyst is a well-known complication after Wertheim's operation with an incidence varying from 2 to 20%. The majority are asymptomatic. However, when complications occur, the symptoms depend on the location and the pressure effects created. Most of the lymphocysts occur within 1 year after surgery and need to be differentiated from a hematoma or urinoma. At present, there is no standard management of early lymphocysts. Conservative management, ultrasound-guided needle aspiration, or percutaneous insertion of an indwelling catheter have been successfully employed. Intraperitoneal marsupilization with or without omental falp is also highly effective. When pelvic lymphocysts occur later than normal, the diagnostic dilemma is to differentiate benign collections from those involving recurrent tumor. Fine-needle biopsy of the cyst wall under ultrasound guidance is more effective in identifying recurrence than cytological evaluation of the fluid. Nonetheless, if such facility is not readily available, surgical drainage and excision of the cyst wall should be considered to ensure early diagnosis of recurrence.
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Affiliation(s)
- Y M Fung
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories
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25
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Barton DP, Cavanagh D, Roberts WS, Hoffman MS, Fiorica JV, Finan MA. Radical hysterectomy for treatment of cervical cancer: a prospective study of two methods of closed-suction drainage. Am J Obstet Gynecol 1992; 166:533-7. [PMID: 1536223 DOI: 10.1016/0002-9378(92)91665-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Two closed-suction drainage methods were prospectively compared in 96 patients after radical hysterectomy with pelvic lymphadenectomy in stage IB cervical cancer. In group 1 (n = 49) two pelvic sidewall drains and a vaginal drain were used, and in group 2 (n = 47) only the vaginal drain was used. The groups were similar for mean age, preoperative weight, hemoglobin and serum albumin level, operating time, operative blood loss, and blood transfusions. The febrile morbidity rates and the operative site infection rates were similar in the two groups. Ninety vaginal drains were removed by day 3. By day 6 55% of patients in group 1 had at least one sidewall drain, with a mean drainage of 150 ml/day. The median postoperative stay was similar in both groups. A pelvic lymphocyst developed in one patient in each group. The single vaginal closed-suction drain is safe, efficient, more acceptable to patients, and more cost-effective.
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Affiliation(s)
- D P Barton
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa 33612-9497
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26
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NORSTRÖM A. The use of ultrasound in the identification and treatment of lymphocysts after radical hysterectomy. Int J Gynecol Cancer 1991. [DOI: 10.1111/j.1525-1438.1991.tb00055.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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27
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Abstract
A case report of a pelvic lymphocele developing after lymphadenectomy for staging of prostatic carcinoma is described. This collection was successfully managed by percutaneous catheter drainage. The incidence, pathophysiology, clinical symptomatology, differential diagnosis, and treatment options of pelvic lymphocele are reviewed. We believe that percutaneous catheter drainage is currently the optimal treatment modality.
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Affiliation(s)
- J H Heyman
- Department of Urology, Beth Israel Medical Center, New York, New York
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Petru E, Tamussino K, Lahousen M, Winter R, Pickel H, Haas J. Pelvic and paraaortic lymphocysts after radical surgery because of cervical and ovarian cancer. Am J Obstet Gynecol 1989; 161:937-41. [PMID: 2801842 DOI: 10.1016/0002-9378(89)90757-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To determine the incidence and clinical import of lymphocysts after radical gynecologic surgery including lymphadenectomy, we reviewed the records of 173 patients with cervical cancer and 135 patients with ovarian cancer who were followed up by computed tomography. Lymphocysts were found in 35 (20%) and 43 (32%) of the patients, respectively. Patients with cervical cancer and positive lymph nodes had a significantly higher rate of lymphocyst formation than did those with negative nodes (29% versus 14%, respectively, p less than 0.02). Age, type of lymphadenectomy, volume of fluid furthered by postoperative drains, disease stage, and tumor histology were not related to lymphocyst development. We saw no complications strictly attributable to lymphocysts. The clinical import and treatment possibilities are discussed.
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Affiliation(s)
- E Petru
- Department of Obstetrics and Gynecology, University of Graz, Austria
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29
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Mann WJ, Vogel F, Patsner B, Chalas E. Management of lymphocysts after radical gynecologic surgery. Gynecol Oncol 1989; 33:248-50. [PMID: 2703185 DOI: 10.1016/0090-8258(89)90561-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Pelvic lymphocysts developed in 3 of 124 patients undergoing radical surgery for cervical cancer. All were managed by percutaneous aspiration under local anesthesia in an outpatient setting. Sclerosis was required in one patient. This management plan is superior to laparotomy in being less morbid and equally effective.
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Affiliation(s)
- W J Mann
- Department of Obstetrics and Gynecology, State University of New York, Stony Brook 11794-8091
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30
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Abstract
Pelvic lymphocysts occur infrequently after radical surgery for cervical cancer. The problem is one of recognition. In a retrospective analysis of patients seen over 10 years in this department, the incidence was 25.3%. All were diagnosed by bimanual, clinical examination only. The only factor that appears to relate to the formation of lymphocysts is the presence of poorly differentiated tumors; 70.8% of patients developing lymphocysts had poorly differentiated tumors. All the lymphocysts in this series resolved spontaneously and did not produce any major complications.
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Affiliation(s)
- A Ilancheran
- Regional Department of Gynecologic Oncology, Queen Elizabeth Hospital, Gateshead, United Kingdom
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31
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Henry RJ, Crandon AJ. The use of a functioning omental flap to drain a recurrent pelvic lymphocyst after radical hysterectomy. Case report. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1988; 95:306-8. [PMID: 3370203 DOI: 10.1111/j.1471-0528.1988.tb06875.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- R J Henry
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, Australia
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32
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Zaontz MR, Firlit CF. Pelvic lymphocele after pediatric renal transplantation: a successful technique for prevention. J Urol 1988; 139:557-9. [PMID: 3278133 DOI: 10.1016/s0022-5347(17)42522-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Pelvic lymph accumulation (lymphocele) is a recognized complication of renal transplantation. During a 12-year period 166 renal transplants were performed in 143 children at our institution. From 1973 to 1979, 5 lymphoceles were treated in 64 children. From 1979 until the present a technique of peritoneal fenestration has been performed in 69 children, in whom 1 lymphocele developed. Lymphoceles required surgical treatment in 5 of the remaining 10 cases that were not fenestrated. Our experience with peritoneal fenestration as a method of lymphocele prevention has been excellent, and we recommend it as a prophylactic addition to renal transplant surgery.
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Affiliation(s)
- M R Zaontz
- Division of Urology, Children's Memorial Hospital, Chicago, Illinois
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33
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Choo YC, Wong LC, Wong KP, Ma HK. The management of intractable lymphocyst following radical hysterectomy. Gynecol Oncol 1986; 24:309-16. [PMID: 3721302 DOI: 10.1016/0090-8258(86)90307-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Six cases of intractable lymphocyst occurred in a series of 108 patients undergoing radical hysterectomy, an incidence rate of 5.6%. The complexities of pelvic lymphocyst are illustrated by their unusual presentation and problems in their management. Large lymphocysts should initially be treated by percutaneous catheter drainage before resorting to peritoneal marsupialization.
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34
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Abstract
A patient is presented in whom a lymphocele developed after a retroperitoneal lymph node dissection for Stage II embryonal carcinoma of the testicle. The benign nature of this lymphocele has been confirmed not only by the diagnostic procedures outlined, but by its stability over a 42-month follow-up period with no further antitumor therapy. We conclude from reviewing the literature that while aggressive measures are necessary to confirm the diagnosis of a lymphocele, its management should be expectant. If significant obstruction of neighboring structures occurs, an attempt at percutaneous drainage (and possibly sclerosis) seems appropriate despite potential risks of interventional treatment such as hemorrhage and introduction of infection. Open procedures for marsupialization and drainage should be reserved for cases in which more conservative measures fail.
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35
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Ali Khan S, Hu KN. Internal drainage of lymphocele by a pedicled omental flap. Int Urol Nephrol 1983; 15:333-8. [PMID: 6662653 DOI: 10.1007/bf02082553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
An unusual case of huge pelvic and retroperitoneal lymphocele following bilateral pelvic lymphadenectomy is presented. The lymphocele was successfully managed by the procedure of internal drainage with pedicled omental flap.
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36
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Aronowitz J, Kaplan AL. The management of a pelvic lymphocele by the use of a percutaneous indwelling catheter inserted with ultrasound guidance. Gynecol Oncol 1983; 16:292-5. [PMID: 6629129 DOI: 10.1016/0090-8258(83)90105-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The management of a pelvic lymphocele is initially expectant. Surgical intervention is not utilized until major problems occur. The first reported case of a postsurgical pelvic lymphocele managed by the use of a percutaneous indwelling catheter inserted and monitored with ultrasound guidance is presented. If this technique proves to be generally successful with more experience, intervention could be considered at an earlier point since a major surgical procedure is not involved.
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37
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Khan SA, Smith NL, Hu KN, Dailey BD. An unusual case of delayed rectosigmoid compression by pelvic mass following cystectomy: report of a case. Dis Colon Rectum 1982; 25:720-2. [PMID: 7128377 DOI: 10.1007/bf02629548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A rare case of rectosigmoid compression by an enormous obscure pelvic mass after cystectomy is reported. Pelvic collections in the form of abscess, hematoma, lymphocele, and urinoma are not uncommon in the early postoperative period following pelvic surgery. However, delayed appearance of a benign pelvic mass as a late complication of surgery is very rare. Localized pelvic masses discovered years after cystectomy for bladder tumor may lead to an erroneous clinical impression of local recurrence of the primary neoplasm. Differential diagnosis of common pelvic masses, diagnostic studies, and treatment are discussed.
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38
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Clarke-Pearson DL, Synan IS, Creasman WT. Significant venous thromboembolism caused by pelvic lymphocysts: diagnosis and management. Gynecol Oncol 1982; 13:136-43. [PMID: 7060988 DOI: 10.1016/0090-8258(82)90019-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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39
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Abstract
Pelvic lymphadenectomy is used widely for staging prostatic or bladder carcinoma. In 9 of 187 patients (4.7 per cent) who underwent bilateral pelvic lymphadenectomy for urologic cancer pelvic lymphocele diveloped. The management of these patients is presented along with review of causes, clinical features, diagnosis, and treatment. Pelvic CT scan is a noninvasive modality which aids in the diagnosis of this complication. Minidose heparin used for prophylaxis of thromboembolic complications may increase lymphocele formation.
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40
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Abstract
Although numerous articles regarding the etiology, incidence, complications, and management of pelvic lymphocysts have been published in the American literature since 1958, there has been no mention of para-aortic lymphocyst as a complication of para-aortic node dissection. Two recent cases of symptomatic para-aortic lymphocyst have prompted a review of our para-aortic node dissection technique when this procedure is not combined with a more extensive pelvic lymphadenectomy. Our modification in technique is to use retroperitoneal para-aortic drainage by constant pressure-controlled suction following closure of the posterior parietal peritoneum, and the results in our first 15 patients are presented. There were no complications related to the drainage technique. Abdominal ultrasound and intravenous urography have proved to be excellent diagnostic tools in the initial evaluation and subsequent follow-up of para-aortic lymphocytes.
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41
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Abstract
Lymphoceles following pelvic surgery are not rare events. The management of this postoperative complication in 18 patients included needle aspiration, external drainage, and intraperitoneal marsupialization. The following diagnostic and therapeutic approach is recommended: ultrasonographic definition of the lymphocele; excretory urography to assess upper urinary tract obstruction; observation of small, nonobstructing, asymptomatic lymphoceles; needle aspiration for diagnosis confirmation; intraperitoneal marsupialization for noninfected, large lymphoceles that are obstructing the upper urinary tract or are symptomatic; and incision and drainage of small or infected lymphoceles.
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42
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Jonsson K, Wallace S, Jing BS, Johnson DE, Dodd GD. Changes in the lymphatic dynamics after retroperitoneal lymph node dissection. J Urol 1977; 118:814-8. [PMID: 916106 DOI: 10.1016/s0022-5347(17)58205-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lymphatic dynamics in the retroperitoneal space are altered after retroperitoneal lymph node dissection. Obstruction with or without visible collaterals is seen frequently. Lymphaticovenous communications and lymphocysts are also common findings. The immediate sequelae are of minor importance, although the mass effect of lymphocysts may be serious. The collateral pathways and lymphaticovenous anastomoses may result in the appearance of metastases in unusual sites.
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43
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Lipshultz LI, Barker CF, Wein AJ, Perloff LJ, Arger PH, Murphy JJ. Post-transplantation lymphocyst: use of ultrasound as adjunct in diagnosis. Urology 1976; 8:624-8. [PMID: 793143 DOI: 10.1016/0090-4295(76)90537-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ultrasound examination has proved to be a useful diagnostic tool in the differentiation of lymphocyst from other causes of upper urinary tract obstruction in the renal transplant recipient.
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44
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Jalůvka V. [Gynecological aspects of retroperitoneal diseases (author's transl)]. ARCHIV FUR GYNAKOLOGIE 1976; 220:257-73. [PMID: 946750 DOI: 10.1007/bf00667752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Current literature was reviewed for gynecological aspects of retroperitoneal diseases. Taking into account the original histological findings retroperitoneal diseases were divided into the following groups from a gynecological point of view: 1. Malignant and benign primary retroperitoneal tumors 2. retroperitoneal organs 3. malignant and benign tumors of retroperitoneal organs 4. retroperitoneal gynecological structures 5. retroperitoneal metastases 6. other retroperitoneal diseases.
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Abstract
Three cases of lymphocysts occurred in a series of 97 patients undergoing extension pelvic urological operations, an incidence rate of 3.1 per cent. This is the first report of this complication after urological lymphadenectomy. Awareness of the entity is important to urologists since lymphatic staging operations for prostate and bladder carcinoma are widely used to help plan definitive therapy. Athough this complication is rare after renal transplantation it may cause significant interference with graft function. The etiology, symptoms, findings, diagnosis and treatment of this condition are reviewed. Echography is presented as an ideal technique to diagnose the condition and to guide in its management.
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46
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Braun WE, Banowsky LH, Straffon RA, Nakamoto S, Kiser WS, Popowniak KL, Hewitt CB, Stewart BH, Zelch JV, Magalhaes RL, Lachance JG, Manning RF. Lymphocytes associated with renal transplantation. Report of 15 cases and review of the literature. Am J Med 1974; 57:714-29. [PMID: 4613172 DOI: 10.1016/0002-9343(74)90845-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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47
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Steinberg AO, Madayag MA, Bosniak MA, Morales PA. Demonstration of 2 unusually large pelvic lymphocysts by lymphangiography. J Urol 1973; 109:477-8. [PMID: 4692384 DOI: 10.1016/s0022-5347(17)60456-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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