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Currie RV, Durand CJ, Bond J. Reducing the incidence of problematic seroma formation and skin necrosis post-lymphadenectomy: Triple action of topical tranexamic acid, negative pressure wound therapy, and prolonged drainage. J Plast Reconstr Aesthet Surg 2024; 94:54-61. [PMID: 38759512 DOI: 10.1016/j.bjps.2024.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Axillary and inguinal lymph node dissections are commonly associated with complications that often require additional interventions. METHODS Patients who underwent axillary or inguinal lymphadenectomy via standard procedures were compared to an intervention cohort of patients who underwent axillary or inguinal lymphadenectomy with the use of topical tranexamic acid (TXA) to the wound cavity, a PICO (Smith&Nephew UK) closed-incision negative pressure dressing, and discharged early with a drain in-situ. RESULTS Seventy-six patients in the control group (mean age 65.8 years, mean BMI 28.4 kg/m2) underwent open lymphadenectomy without topical TXA and a simple dressing. Seventy-eight patients were included in the intervention group (mean age 67.1 years, mean BMI 28.5 kg/m2). Patients in the intervention group had an inpatient stay of mean 5.6 days fewer than those in the control group (CI 3.09-5.31; p < .0001), an estimated saving to the healthcare trust of £ 3046.40 (US$3723.61) per patient in "bed days." They had longer drain duration (mean 15 days vs. 8.3 days); however, they had a statistically significant lower risk of seroma formation requiring drainage (6.4% vs. 21%; p = .009), and skin necrosis (0% vs. 6.6%; p = .027). They also had a lower risk of infection (17% vs. 29%), wound dehiscence (15% vs. 25%), and readmission (7.7% vs. 14%), although they were not statistically significant. Patients in the control group were more likely to receive antibiotics as inpatients (51% vs. 7.7%; p < .00001) and on discharge (24% vs. 5%; p < .0011) than those in the intervention group. CONCLUSIONS Topical TXA, PICO dressing, and early discharge with a drain following lymphadenectomy results in a reduced rate of complications.
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Affiliation(s)
- Rachel V Currie
- Regional Department of Maxillofacial and Plastic Surgery, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, Northern Ireland.
| | - Ciaran J Durand
- Regional Department of Maxillofacial and Plastic Surgery, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, Northern Ireland
| | - Jeremy Bond
- Regional Department of Maxillofacial and Plastic Surgery, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, Northern Ireland
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Falcone M, Gül M, Peretti F, Preto M, Cirigliano L, Scavone M, Sedigh O, Oderda M, Gontero P. Inguinal Lymphadenectomy for Penile Cancer: An Interim Report from a Trial Comparing Open Versus Videoendoscopic Surgery Using a Within-patient Design. EUR UROL SUPPL 2024; 63:31-37. [PMID: 38558767 PMCID: PMC10980994 DOI: 10.1016/j.euros.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
Background and objective Nodal metastasis is a major survival and prognostic factor in penile cancer (PeCa). Thus, accurate staging, prognosis, and treatment selection require adequate inguinal lymphadenectomy (ILND). ILND surgery should balance oncologic rigor with morbidity and postoperative complications. Our aim was to compare the feasibility and safety of open ILND (OILND) and videoendoscopic ILND (VEILND) in patients with PeCa. Methods We conducted a single-center randomized trial with a within-patient design between October 2019 and April 2023. Patients who were undergoing either staging or radical ILND for PeCa were included and randomized to receive either OILND or VEILND on one side, with the other technique then used on the contralateral side. The trial was approved by the local ethics committee and was registered on ClinicalTrials.gov (NCT05887921). The primary outcome was the safety of VEILND. Secondary outcomes included intraoperative and postoperative morbidity rates and surgical outcomes for the two procedures, as well as oncological outcomes according to survival estimates. Key findings and limitations We included 14 patients in the study. Median follow-up was 12 mo (interquartile range [IQR] 12-17). There were no significant differences in operative time and the number of lymph nodes removed between OILND and VEILND. However, the median time to drain removal was significantly shorter in the VEILND group (15 d, IQR 13-17, 95% confidence interval [CI] 12-17) than in the OILND group (27 d, IQR 20-41, 95% CI 24-31; p = 0.025). No intraoperative complications were observed, but postoperative complications occurred in three cases (21.4%, 95% CI 8.4-37.8%) in the VEILND group and eight (57.1%, 95% CI 18.6-54.3%) in the OILND group (p = 0.032). Conclusions and clinical implications VEILND represents a safe technique to consider for either staging or curative intent in PeCa and seems to have an advantage over OILND in terms of morbidity. Further high-powered studies are warranted to confirm these preliminary results. Patient summary We compared the outcomes of two different surgical techniques to remove lymph nodes in patients with penile cancer. We found that a video-assisted keyhole surgery approach seems to result in a lower rate of complications than after open surgery.
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Affiliation(s)
- Marco Falcone
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
- Neurourology Clinic, Unità Spinale Unipolare, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Murat Gül
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
| | - Federica Peretti
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Mirko Preto
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Lorenzo Cirigliano
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Martina Scavone
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Omid Sedigh
- Urological Department, Gradenigo Hospital, Turin, Italy
| | - Marco Oderda
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
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Tang S, Akers C, Alnajjar H, Ayres B, Baldini C, Embleton-Thirsk A, Gurusamy K, Hadway P, Kumar V, Lau M, Nigam R, Pang K, Parnham A, Pizzo E, Ranieri V, Rees R, Sangar V, Wadke A, Williams N, Muneer A. A study protocol for a feasibility randomised controlled trial investigating videoendoscopic radical inguinal lymphadenectomy versus open radical inguinal lymphadenectomy in patients with penile cancer (VELRAD). Pilot Feasibility Stud 2024; 10:61. [PMID: 38600541 PMCID: PMC11005199 DOI: 10.1186/s40814-024-01474-8] [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: 07/03/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Penile cancer is a rare male genital malignancy. Surgical excision of the primary tumour is followed by radical inguinal lymphadenectomy if there is metastatic disease detected by biopsy, fine needle aspiration cytology (FNAC) or following sentinel lymph node biopsy in patients with impalpable disease. However, radical inguinal lymphadenectomy is associated with a high morbidity rate, and there is increasing usage of a videoendoscopic approach as an alternative. METHODS A pragmatic, UK-wide multicentre feasibility randomised controlled trial (RCT), comparing videoendoscopic radical inguinal lymphadenectomy versus open radical inguinal lymphadenectomy. Patients will be identified and recruited from supraregional multi-disciplinary team meetings (sMDT) and must be aged 18 or over requiring inguinal lymphadenectomy, with no contraindications to surgical intervention for their cancer. Participants will be followed up for 6 months following randomisation. The primary outcome is the ability to recruit patients for randomisation across all selected sites and the rate of loss to follow-up. Other outcomes include acceptability of the trial and intervention to patients and healthcare professionals assessed by qualitative research and obtaining resource utilisation information for health economic analysis. DISCUSSION There are currently no other published RCTs comparing videoendoscopic versus open radical inguinal lymphadenectomy. Ongoing study is required to determine whether randomising patients to either procedure is feasible and acceptable to patients. The results of this study may determine the design of a subsequent trial. TRIAL REGISTRATION Clinicaltrials.gov PRS registry, registration number NCT05592639. Date of registration: 13th October 2022, retrospectively registered.
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Affiliation(s)
- Stanley Tang
- University College London Hospitals NHS Trust, London, UK
| | - Clare Akers
- University College London Hospitals NHS Trust, London, UK
| | | | - Ben Ayres
- St George's University Hospitals NHS Trust, London, UK
| | | | | | | | - Paul Hadway
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Vivekanandan Kumar
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Maurice Lau
- The Christie NHS Foundation Trust, Manchester, UK
| | - Raj Nigam
- Royal Surrey County Hospital, Surrey, UK
| | - Karl Pang
- University College London Hospitals NHS Trust, London, UK
| | - Arie Parnham
- The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Rowland Rees
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Vijay Sangar
- The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Asif Muneer
- University College London Hospitals NHS Trust, London, UK.
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4
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Bada M, Crocetto F, Nyirady P, Pagliarulo V, Rapisarda S, Aliberti A, Boccasile S, Ferro M, Barone B, Celia A. Inguinal lymphadenectomy in penile cancer patients: a comparison between open and video endoscopic approach in a multicenter setting. J Basic Clin Physiol Pharmacol 2023; 34:383-389. [PMID: 36933235 DOI: 10.1515/jbcpp-2023-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/25/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES To compare differences of operative outcomes, post-operative complications and survival outcomes between open and laparoscopic cases in a multicenter study. METHODS This was a retrospective cohort study performed at three European centers from September 2011 to January 2019. The surgeon decision to perform open inguinal lymphadenectomy (OIL) or video endoscopic inguinal lymphadenectomy (VEIL) was done in each hospital after patient counselling. Inclusion criteria regarded a minimum follow-up of 9 months since the inguinal lymphadenectomy. RESULTS A total of 55 patients with proven squamous cell penile cancer underwent inguinal lymphadenectomy. 26 of them underwent OIL, while 29 patients underwent VEIL. For the OIL and VEIL groups, the mean operative time was 2.5 vs. 3.4 h (p=0.129), respectively. Hospital stays were lower in the VEIL group with 4 vs. 8 days in OIL patients (p=0.053) while number of days requiring drains to remain in situ was 3 vs. 6 days (p=0.024). The VEIL group reported a lower incidence of major complications compared to the OIL group (2 vs. 17%, p=0.0067) while minor complications were comparable in both groups. In a median follow-up period of 60 months, the overall survival was 65.5 and 84.6% in OIL and VEIL groups, respectively (p=0.105). CONCLUSIONS VEIL is comparable to OIL regarding safety, overall survival and post-operative outcomes.
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Affiliation(s)
- Maida Bada
- Department of Urology, San Bassanino Hospital, Bassano del Grappa, Vicenza, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology - Federico II University of Naples, Naples, Italy
| | - Peter Nyirady
- Department of Urology, Semmelweis University, Budapest, Budapest, Italy
| | - Vincenzo Pagliarulo
- Department of Urology, Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Sebastiano Rapisarda
- Department of Urology, Pederzoli Hospital Private Clinic SpA, Peschiera del Garda, Veneto, Italy
| | - Antonio Aliberti
- Urology, ASL 3 Napoli Castellammare di Stabia, Castellammare di Stabia, Italy
| | - Stefano Boccasile
- Department of Urology, Cima Barcelona Hospital, Barcelona, Catalogna, Spain
| | - Matteo Ferro
- Istituto Europeo di Oncologia, Milano, Lombardia, Italy
| | - Biagio Barone
- Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Campania, Italy
| | - Antonio Celia
- Department of Urology, San Bassanino Hospital, Bassano del Grappa, Veneto, Italy
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5
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Yang M, Liu Z, Tan Q, Hu X, Liu Y, Wei L, Deng C, Zhou S, Yang N, Duan G, Zheng Y, Li X, Chen Z, Zhou Z, Zheng J. Comparison of antegrade robotic assisted VS laparoscopic inguinal lymphadenectomy for penile cancer. BMC Surg 2023; 23:55. [PMID: 36915083 PMCID: PMC10012593 DOI: 10.1186/s12893-023-01935-6] [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: 05/10/2022] [Accepted: 02/08/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Minimally invasive modifications of inguinal lymphadenectomy (IL), including laparoscopic IL (LIL) and robotic-assisted IL (RAIL), have been utilized for penile cancer. Comparative study is necessary to guide the decision about which minimally invasive technique to select for IL. Therefore we compared RAIL with LIL performed via an antegrade approach in terms of perioperative outcomes. METHODS We conducted a retrospective study of 43 patients who underwent RAIL (n = 20) or LIL (n = 23) for penile cancer from 2016 to 2020. The key surgical procedures and techniques are described. Complications were graded by the Clavien-Dindo classification, and operative time, estimated blood loss (EBL), lymph nodal yield, nodal positivity, postoperative drain duration, and disease recurrence during follow-up were assessed. Categorical variables were compared using chi-squared whereas continuous variables were compared by t-tests. RESULTS The operative time for RAIL was significantly shorter than that of LIL (median 83 vs 95 min). Significantly less blood loss was reported with RAIL than with LIL (median 10 vs 35 ml). Lymph node yield, pathological positive nodes, the hospital stay, postoperative drain duration, postoperative complications and recurrence were similar for RAIL and LIL. CONCLUSIONS For patients with penile cancer, perioperative outcomes of RAIL and LIL were similar, but there was less blood loss, a shorter operative time for robotic cases.
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Affiliation(s)
- Mengjun Yang
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.,Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Zhicheng Liu
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.,Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Qi Tan
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.,Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Xiaofei Hu
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China.,Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang Liu
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Ling Wei
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Chunyan Deng
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Shikai Zhou
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Nengrui Yang
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.,Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Guangjie Duan
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yiming Zheng
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Xuemei Li
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Zhiwen Chen
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Zhansong Zhou
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Ji Zheng
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China. .,Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China.
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6
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Tang S, Pang KH, Alnajjar HM, Ayres B, Kumar V, Parnham A, Muneer A. Videoendoscopic Inguinal Lymphadenectomy Versus Radical Open Dissection (VELRAD) in Patients with Male Genital Cancer: A Clinical Trial Update. Eur Urol Focus 2023:S2405-4569(23)00034-2. [PMID: 36797170 DOI: 10.1016/j.euf.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/04/2023] [Accepted: 01/28/2023] [Indexed: 02/16/2023]
Abstract
VELRAD is the first multicentre feasibility randomised controlled trial comparing videoendoscopic radical inguinal lymphadenectomy versus open dissection for male genital cancer. We have randomised nine patients so far in our attempt to identify the best approach to inguinal lymph node dissection.
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Affiliation(s)
- Stanley Tang
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Karl H Pang
- University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Hussain M Alnajjar
- University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Ben Ayres
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Vivekanandan Kumar
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Arie Parnham
- The Christie NHS Foundation Trust, Manchester, UK
| | - Asif Muneer
- University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospital, London, UK; Department of Surgical Biotechnology, University College London, London, UK.
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7
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Vlasenko D. [Surgical technique of axillary, inguinal and iliac lymph node dissection]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:121-129. [PMID: 36449037 DOI: 10.1007/s00104-022-01768-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Systematic lymph node dissection (SLND) plays an important role in the surgical treatment of many tumors. Despite continuous developments in surgical techniques, the morbidity in axillary, inguinal and iliac SLND remains high. OBJECTIVE Description of the currently existing surgical techniques of axillary, inguinal and iliac SLND with presentation of the possible advantages and disadvantages, also with respect to the oncological results. MATERIAL AND METHODS Based on the currently available literature reports, study results and own experience, the techniques of SLND and treatment results are presented. RESULTS SLND in the axillary, inguinal and iliac regions is still a challenging procedure for surgeons and patients. This problem exists due to the complex anatomy and the high morbidity. Modifications of open surgical techniques led to a reduction of postoperative complications only in rare exceptions. Minimally invasive iliac SLND is possible and can be performed both by laparoscopy and retroperitoneoscopy. The application of videoscopic techniques in axillary and inguinal SLND is also possible and the feasibility has been confirmed in different studies. Using minimally invasive approaches a significant reduction in wound complications could be achieved. Nevertheless, up to now the oncological results of minimally invasive surgery are still unclear, especially for malignant melanoma. CONCLUSION By using minimally invasive SLND in the axillary, inguinal and iliac regions, a significant reduction of wound complications can be achieved. Further prospective studies are needed to confirm the initially promising results, especially with respect to the oncological outcome.
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Affiliation(s)
- Dmytro Vlasenko
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
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8
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Gómez-Ferrer A, Collado A, Ramírez M, Domínguez J, Casanova J, Mir C, Wong A, Marenco JL, Nagore E, Soriano V, Rubio-Briones J. A single-center comparison of our initial experiences in treating penile and urethral cancer with video-endoscopic inguinal lymphadenectomy (VEIL) and later experiences in melanoma cases. Front Surg 2022; 9:870857. [PMID: 36225221 PMCID: PMC9548630 DOI: 10.3389/fsurg.2022.870857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/08/2022] [Indexed: 12/01/2022] Open
Abstract
Background Video-endoscopic inguinal lymphadenectomy (VEIL) is a minimally invasive approach that is increasingly indicated in oncological settings, with mounting evidence for its long-term oncological safety. Objectives To present our single-center experience of treating penile and urethral cancer with VEIL, as well as its more recent application in melanoma patients. Methods We prospectively recorded our experiences with VEIL from September 2010 to July 2018, registering the patient primary indication, surgical details, complications, and follow-up. Results Twenty-nine patients were operated in one (24) or both (5) groins; 18 had penile cancer, 1 had urethral cancer, and 10 had melanoma. A mean 8.62 ± 4.45 lymph nodes were removed using VEIL and of these, an average of 1.00 ± 2.87 were metastatic; 16 patients developed lymphocele and 10 presented some degree of lymphedema; there were no skin or other major complications. The median follow-up was 19.35 months; there were 3 penile cancer patient recurrences in the VEIL-operated side. None of the melanoma patients presented a lymphatic inguinal recurrence. Conclusions VEIL is a minimally invasive technique which appears to be oncologically safe showing fewer complications than open surgery. However, complications such as lymphorrhea, lymphocele, or lymphedema were not diminished by using VEIL.
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Affiliation(s)
- A. Gómez-Ferrer
- Urology Department, Valencian Institute of Oncology Foundation, Valencia, Spain
- Correspondence: Álvaro Gómez-Ferrer
| | - A. Collado
- Urology Department, Valencian Institute of Oncology Foundation, Valencia, Spain
| | - M. Ramírez
- Urology Department, Valencian Institute of Oncology Foundation, Valencia, Spain
| | - J. Domínguez
- Urology Department, Valencian Institute of Oncology Foundation, Valencia, Spain
| | - J. Casanova
- Urology Department, Valencian Institute of Oncology Foundation, Valencia, Spain
| | - C. Mir
- Urology Department, Valencian Institute of Oncology Foundation, Valencia, Spain
| | - A. Wong
- Urology Department, Valencian Institute of Oncology Foundation, Valencia, Spain
| | - J. L. Marenco
- Urology Department, Valencian Institute of Oncology Foundation, Valencia, Spain
| | - E. Nagore
- Dermatology Department, Valencian Institute of Oncology Foundation, Valencia, Spain
| | - V. Soriano
- Medical Oncology Department, Valencian Institute of Oncology Foundation, Valencia, Spain
| | - J. Rubio-Briones
- Urology Department, Valencian Institute of Oncology Foundation, Valencia, Spain
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9
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Nursing of Vulvar Cancer Radical Operation Combined with Laparoscopic Inguinal Lymph Node Dissection. Emerg Med Int 2022; 2022:8091114. [PMID: 36105671 PMCID: PMC9467793 DOI: 10.1155/2022/8091114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/23/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose. The application, development, and care of radical surgery combined with laparoscopic inguinal lymph node dissection for vulvar cancer. Methods. We searched the PubMed, Web of Science, the Cochrane Library, and EMBASE databases for published literature on the care of radical surgery combined with laparoscopic inguinal lymph node dissection for vulvar cancer up to June 2022. We used the following search terms and terms: “vulvar cancer,” “injury,” “radical vulvar cancer surgery,” “laparoscopic inguinal lymph node dissection,” and “care.” Results. Laparoscopic inguinal lymph node dissection has become a new surgical method for the treatment of vulvar cancer, and it effectively avoids all the problems associated with traditional surgery. In addition, radical vulvar cancer surgery and laparoscopic inguinal lymph node dissection combined with high-quality nursing interventions can promote patients’ recovery and reduce the occurrence of complications, which has important clinical significance. Conclusion. This article reviews the application, development, and nursing care of radical vulvar cancer surgery combined with laparoscopic inguinal lymph node dissection.
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Jakub JW, Lowe M, Howard JH, Farma JM, Sarnaik A, Tuttle T, Neuman HB, Ariyan CE, Uppal A, Trocha S, Beasley GM, Wasif N, Bilimoria KY, Thomay AA, Allred JB, Chen L, Terando AM, Wayne JD, Thompson JF, Cochran AJ, Sim MS, Elashoff DE, Delman KA, Faries MB. Oncologic Outcomes of Multi-Institutional Minimally Invasive Inguinal Lymph Node Dissection for Melanoma Compared with Open Inguinal Dissection in the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II). Ann Surg Oncol 2022; 29:5910-5920. [PMID: 35499783 DOI: 10.1245/s10434-022-11758-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/28/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Minimally invasive inguinal lymphadenectomy (MILND) is safe and feasible, but limited data exist regarding oncologic outcomes. METHODS This study performed a multi-institutional retrospective cohort analysis of consecutive MILND performed for melanoma between January 2009 and June 2016. The open ILND (OILND) comparative cohort comprised patients enrolled in the second Multicenter Selective Lymphadenectomy Trial (MSLT-II) between December 2004 and March 2014.The pre-defined primary end point was the same-basin regional nodal recurrence, calculated using properties of binomial distribution. Time to events was calculated using the Kaplan-Meier method. The secondary end points were overall survival, progression-free survival, melanoma-specific survival (MSS), and distant metastasis-free survival (DMFS). RESULTS For all the patients undergoing MILND, the same-basin regional recurrence rate was 4.4 % (10/228; 95 % confidence interval [CI], 2.1-7.9 %): 8.2 % (4/49) for clinical nodal disease and 3.4 % (6/179) for patients with a positive sentinel lymph node (SLN) as the indication. For the 288 patients enrolled in MSLT-II who underwent OILND for a positive SLN, 17 (5.9 %) had regional node recurrence as their first event. After controlling for ulceration, positive LN count and positive non-SLNs at the time of lymphadenectomy, no difference in OS, PFS, MSS or DMFS was observed for patients with a positive SLN who underwent MILND versus OILND. CONCLUSION This large multi-institutional experience supports the oncologic safety of MILND for melanoma. The outcomes in this large multi-institutional experience of MILND compared favorably with those for an OILND population during similar periods, supporting the oncologic safety of MILND for melanoma.
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Affiliation(s)
- James W Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Michael Lowe
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - J Harrison Howard
- Department of Surgery, University of South Alabama Health, Mobile, AL, USA
| | - Jeffrey M Farma
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Amod Sarnaik
- Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Todd Tuttle
- Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Heather B Neuman
- Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Abhineet Uppal
- Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Steve Trocha
- Department of Surgery, Greenville Health System, Greenville, SC, USA
| | - Georgia M Beasley
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Nabil Wasif
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Karl Y Bilimoria
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alan A Thomay
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Jacob B Allred
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Lucia Chen
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - Alicia M Terando
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jeffrey D Wayne
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Alistair J Cochran
- Department of Anatomic Pathology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Myung-Shin Sim
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - David E Elashoff
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - Keith A Delman
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark B Faries
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Lymphatic Function of the Lower Limb after Groin Dissection for Vulvar Cancer and Reconstruction with Lymphatic SCIP Flap. Cancers (Basel) 2022; 14:cancers14041076. [PMID: 35205824 PMCID: PMC8870617 DOI: 10.3390/cancers14041076] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/27/2023] Open
Abstract
Inguinofemoral lymphadenectomy, frequently performed for vulvar cancer, is burdened with substantial immediate and long-term morbidity. One of the most disabling treatment-related sequelae is lower limb lymphedema (LLL). The present study aims to describe the wound complications and the severity of LLL in patients who have undergone groin dissection for vulvar cancer and immediate inguinal reconstruction with the Lymphatic Superficial Circumflex Iliac Perforator flap (L-SCIP). We retrospectively reviewed the data of patients who underwent bilateral groin dissection and unilateral inguinal reconstruction with the L-SCIP. The presence and severity of postoperative LLL during the follow-up period were assessed by lymphoscintigraphy and limbs' volume measurement. In addition, immediate complications at the level of the inguinal area were registered. The changes between preoperative and postoperative limb volumes were analyzed by Student's t test. p values < 0.05 were considered significant. Thirty-one patients were included. The mean variation of volume was 479 ± 330 cc3 in the side where groin reconstruction had been performed, and 683 ± 425 cc3 in the contralateral side, showing smaller variation in the treated side (p = 0.022). Lymphoscintigraphy confirmed the clinical findings. Based on our results, inguinal reconstruction with L-SCIP performed at the same time of groin dissection in patients treated for vulvar cancer can provide a significant protective effect on LLL.
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12
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Mosehle SD, Guidozzi F. Laparoscopic inguinal lymph node dissection in carcinoma of the vulva: experience and intermediate results at one institution. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2021. [DOI: 10.1080/20742835.2021.1912274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Setheme Daniel Mosehle
- Department of Obstetrics and Gynaecology, Gynecologic Oncology Unit, Sefako Makgatho Health Sciences University/Dr George Mukhari Academic Hospital, Pretoria, South Africa
| | - Franco Guidozzi
- Department of Obstetrics and Gynecology, University of the Witwatersrand, Johannesburg, South Africa
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13
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Gerken ALH, Herrle F, Jakob J, Weiß C, Rahbari NN, Nowak K, Karthein C, Hohenberger P, Weitz J, Reißfelder C, Dobroschke JC. Definition and severity grading of postoperative lymphatic leakage following inguinal lymph node dissection. Langenbecks Arch Surg 2020; 405:697-704. [PMID: 32816115 PMCID: PMC7449944 DOI: 10.1007/s00423-020-01927-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
Purpose Lymphatic complications occur frequently after radical inguinal lymph node dissection (RILND). The incidence of lymphatic leakage varies considerably among different studies due to the lack of a consistent definition. The aim of the present study is to propose a standardized definition and grading of different types of lymphatic leakage after groin dissection. Methods A bicentric retrospective analysis of 82 patients who had undergone RILND was conducted. A classification of postoperative lymphatic leakage was developed on the basis of the daily drainage output, any necessary postoperative interventions and reoperations, and any delay in adjuvant treatment. Results In the majority of cases, RILND was performed in patients with inguinal metastases of malignant melanoma (n = 71). Reinterventions were necessary in 15% of the patients and reoperations in 32%. A new classification of postoperative lymphatic leakage was developed. According to this definition, grade A lymphatic leakage (continued secretion of lymphatic fluid from the surgical drains without further complications) occurred in 13% of the patients, grade B lymphatic leakage (persistent drainage for more than 10 postoperative days or the occurrence of a seroma after the initial removal of the drain that requires an intervention) in 28%, and grade C lymphatic leakage (causing a reoperation or a subsequent conflict with medical measures) in 33%. The drainage volume on the second postoperative day was a suitable predictor for a complicated lymphatic leakage (grades B and C) with a cutoff of 110 ml. Conclusion The proposed definition is clinically relevant, is easy to employ, and may serve as the definition of a standardized endpoint for the assessment of lymphatic morbidity after RILND in future studies.
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Affiliation(s)
- Andreas Lutz Heinrich Gerken
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Florian Herrle
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jens Jakob
- Department of General, Visceral and Pediatric Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Christel Weiß
- Department of Biometry and Statistics, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nuh N Rahbari
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kai Nowak
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Department of General Vascular and Thoracic Surgery, RoMed Hospital Rosenheim, Pettenkoferstraße 10, 83022, Rosenheim, Germany
| | - Constantin Karthein
- Department of Visceral Surgery, University Hospital, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Peter Hohenberger
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jürgen Weitz
- Department of Visceral Surgery, University Hospital, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jakob C Dobroschke
- Department of Visceral Surgery, University Hospital, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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14
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Sommariva A, Cona C, Tonello M, Pilati P, Rossi CR. Oncological outcome of videoscopic groin dissection for lymph node metastasis from melanoma. Surg Endosc 2020; 35:2576-2582. [PMID: 32483695 DOI: 10.1007/s00464-020-07675-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/23/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Videoscopic inguinal lymphadenectomy (VIL) represents an innovative approach for patients with melanoma lymph node (LN) metastases, mainly aimed at lowering wound-related morbidity. However, long-term data on oncologic safety are still lacking. The aim of this study is to review the oncologic outcome of videoscopic groin dissection in a single institution caseload. METHODS Data were prospectively gathered on patients with inguinal melanoma metastasis who underwent VIL. Clinical data included age, race, sex, tumor histology, node counts and number of metastatic nodes. Disease-free survival and overall survival were monitored based on an institutional follow-up schedule. The study was approved by the local ethics committee (Video-SIIO II study). RESULTS We analyzed 48 videoscopic groin dissections performed in 50 patients (2 patients underwent bilateral VIL). Median age was 54.5 years. Female/male ratio was 15/33. Indication for surgery was positive inguinal sentinel biopsy and cytological confirmed clinical disease in 40 and 10 cases, respectively. Median LN retrieval count was 19. After a median follow-up of 28 months, groin recurrence (lymphatic basin) was observed in one single case. CONCLUSIONS VIL for melanoma LN metastases is associated with a favorable oncologic outcome. In particular, LN yield and locoregional recurrence rate obtained with videoscopic dissection are comparable to those reported with the open technique. Prospective studies are needed to confirm these results in a larger cohort of patients.
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Affiliation(s)
- Antonio Sommariva
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy. .,Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco, Veneto, TV, Italy.
| | - Camilla Cona
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marco Tonello
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Pierluigi Pilati
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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15
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Elbalka SS, Taha A, Srinivas C, Hegazy MA, Kotb SZ, Elnahas W, Farouk O, Metwally IH, Elzahaby IA, Abdelwahab K, Fathi A, Tobias-Machado M, Nayak SP. Short-Term Surgical Outcomes of Standard and Lateral Video Endoscopic Inguinal Lymphadenectomy: A Multinational Retrospective Study. J Laparoendosc Adv Surg Tech A 2020; 30:373-377. [DOI: 10.1089/lap.2019.0733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Anis Taha
- Faculdade de Medicina do ABC, Santo Andre, Brazil
| | | | | | - Sherif Z. Kotb
- Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Waleed Elnahas
- Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Omar Farouk
- Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | | | | | | | - Adel Fathi
- Oncology Center Mansoura University (OCMU), Mansoura, Egypt
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16
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Nayak SP, Pokharkar H, Gurawalia J, Dev K, Chanduri S, Vijayakumar M. Efficacy and Safety of Lateral Approach-Video Endoscopic Inguinal Lymphadenectomy (L-VEIL) over Open Inguinal Block Dissection: a Retrospective Study. Indian J Surg Oncol 2019; 10:555-562. [PMID: 31496610 DOI: 10.1007/s13193-019-00951-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022] Open
Abstract
This retrospective study compared the immediate post-operative short-term outcomes of Lateral Approach-Video Endoscopic Inguinal Lymphadenectomy (L-VEIL) and open surgery approach in patients with TNM stage N0 and N1 tumors. Inguinal lymphadenectomies performed for various TNM stage N0 and N1 cancers between January 2011 and December 2015 at a single center were analyzed by collecting data from operation theater records and case files. Mean blood loss, operative time, drain output, nodal yield, nodal positivity, and complications were analyzed as post-procedural outcomes. Among the 116 surgeries performed, 92 were open surgery and 24 were L-VEIL. Compared with open surgery, L-VEIL led to significantly lower blood loss (64.8 mL vs. 23.3 mL; p = 0.002), mean nodal yield (11.04 vs. 8.38; p = 0.001), and mean hospital stay (3.08 vs. 8 days; p < 0.001). However, the operative time was similar for both the groups (94.5 vs. 68.1 min; p = 0.08). Complications that were significantly low in L-VEIL were flap necrosis [RR 1.29; 95% CI (1.03-1.72); p < 0.001], wound dehiscence [RR 1.25; 95% CI (1.19-1.51); p = 0.005), wound infection [RR 1.34; 95% CI (1.19-1.51); p = 0.003], readmission [RR 1.3; 95% CI (1.17-1.44); p = 0.005], and re-surgery [p = 0.014]. Occurrence of complications such as lymphocele [RR 1.25; 95% CI (0.33-4.78); p = 0.5], lymphorrhea [RR 1.27; 95% CI (1.15-1.40); p = 0.5], and pedal edema [p = 0.2] were similar for both the approaches. L-VEIL was effective and safe compared with open inguinal block dissection in treatment of various TNM stage N0 and N1 urogenital and skin cancers.
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Affiliation(s)
- Sandeep P Nayak
- 1Department of Surgical Oncology, Fortis Hospital and MACS Clinic, Jayanagar 4th Block West, Bangalore, 560 011 India
| | | | - Jaiprakash Gurawalia
- Department of Surgical Oncology, Kidwai Cancer Institute, Bangalore, Karnataka India
| | - Kapil Dev
- Department of Surgical Oncology, Kidwai Cancer Institute, Bangalore, Karnataka India
| | - Srinivas Chanduri
- Department of Surgical Oncology, Kidwai Cancer Institute, Bangalore, Karnataka India
| | - M Vijayakumar
- 3Vice Chancellor, Yenepoya University, Mangalore, Karnataka India
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17
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Zuhdy M, Elbalka SS, Hamdy O, Raafat S, Saleh GA, Abdelazez MA, Roshdy S. A Totally Laparoendoscopic Approach for Low Rectal Cancer with Inguinal Nodal Metastasis. J Laparoendosc Adv Surg Tech A 2019; 29:60-64. [PMID: 30130134 DOI: 10.1089/lap.2018.0442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Isolated inguinal nodal metastasis from rectal cancer is rare with better oncological outcome in case of surgical resection. METHODS We report a rectal cancer case with inguinal nodal metastasis that was operated using a totally endoscopic approach. Laparoscopic intersphincteric resection was done for rectal cancer and video endoscopic inguinal lymphadenectomy (VEIL) for inguinal lymph nodes. The patient was presented to and managed in the Oncology Center, Mansoura University, Egypt. RESULTS The patient had an uneventful postoperative course with better outcome than open surgery. CONCLUSIONS Incorporation of minimally invasive approaches such as laparoscopy and VEIL in the management of inguinal nodal metastasis from rectal cancer can have a great impact on the patient's quality of life without affecting the oncologic outcome.
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Affiliation(s)
- Mohammed Zuhdy
- 1 Surgical Oncology Unit, Oncology Center Mansoura University, Mansoura, Egypt
| | - Saleh Saleh Elbalka
- 1 Surgical Oncology Unit, Oncology Center Mansoura University, Mansoura, Egypt
| | - Omar Hamdy
- 1 Surgical Oncology Unit, Oncology Center Mansoura University, Mansoura, Egypt
| | - Sara Raafat
- 2 Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gehad A Saleh
- 3 Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mai AbdAllah Abdelazez
- 4 Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sameh Roshdy
- 1 Surgical Oncology Unit, Oncology Center Mansoura University, Mansoura, Egypt
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18
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Ye YL, Guo SJ, Li ZS, Yao K, Chen D, Wang YJ, Chen P, Han H, Zhou FJ. Radical Videoscopic Inguinal Lymphadenectomies: A Matched Pair Analysis. J Endourol 2018; 32:955-960. [PMID: 30062905 DOI: 10.1089/end.2018.0356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the modifications and feasibility of radical videoscopic inguinal lymphadenectomy (VIL). PATIENTS AND METHODS From January 2010 to December 2017, more than 200 patients who have underwent bilateral radical inguinal lymphadenectomy for penile cancer in Sun Yat-Sen University Cancer Center. And there were 33 patients who received radical VIL and 174 patients who received open inguinal lymphadenectomy (OIL). According to similar factors of age, body mass index, T stage, and N stage, two matched groups were created with a rate of 1:2, one group received VIL, and another group received OIL. The numbers of harvested lymph nodes, operating times, and complications were compared between the two groups. Descriptive statistical analyses, t tests, chi-square tests, and rank sum tests were performed. RESULTS In total, 93 patients were selected, including 31 patients who underwent bilateral VIL and 62 who underwent OIL. The numbers of harvested lymph nodes did not differ significantly (p = 0.983), the operating time was longer for the VIL than the open lymphadenectomy (p < 0.01), and the morbidity was lower among the VIL than the open lymphadenectomy. CONCLUSIONS Modified radical VIL is feasible, practical, and results in reduced morbidity. The dissecting field and the defined plane were critical to these modifications.
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Affiliation(s)
- Yun-Lin Ye
- 1 Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center , Guangzhou, China
| | - Sheng-Jie Guo
- 1 Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center , Guangzhou, China
| | - Zai-Shang Li
- 2 Department of Urology, Shenzhen People's Hospital, The Second Clinical College of Jinan University , Shenzhen, China
| | - Kai Yao
- 1 Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center , Guangzhou, China
| | - Dong Chen
- 1 Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center , Guangzhou, China
| | - Yan-Jun Wang
- 1 Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center , Guangzhou, China
| | - Peng Chen
- 3 Department of Urology, Cancer Center of Xinjiang Medical University , Urumchi, China
| | - Hui Han
- 1 Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center , Guangzhou, China
| | - Fang-Jian Zhou
- 1 Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center , Guangzhou, China
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Video Endoscopic Inguinal Lymphadenectomy via 3-Incision Lateral Approach for Vulvar Cancers: Our Preliminary Outcome of 37 Cases. Int J Gynecol Cancer 2018; 26:1706-1711. [PMID: 27575632 DOI: 10.1097/igc.0000000000000816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to build a video endoscopic inguinal lymphadenectomy (VEIL) via the 3-incision superolateral inguinal approach and explore the feasibility and significance of this method for vulvar cancer. METHODS Thirty-seven patients with vulvar cancer who underwent VEIL via the 3-incision superolateral inguinal approach were enrolled and followed up. The number of excised lymph nodes, intraoperative complications, inguinal wound healing, and the prognosis were retrospectively analyzed. RESULTS The average number of excised lymph nodes per side is 8.8 ± 3.7 (4-18) among the 37 patients and after the new method was more mature, is 9.6 ± 3.6 among the 34 patients treated. Primary healing was found in 36 cases, whereas delayed healing occurred in 1 case complicated with diabetes. The lymph node-positive patients (6 cases) were supplemented with postoperative radiochemotherapy (RCT). All patients survived during the follow-up. Of the 2 recurrent patients, one patient who received surgery again and RCT survived without tumor. The other patient undergoing RCT survived with tumor. CONCLUSIONS Compared with open lymphadenectomy, VEIL via the 3-incision lateral approach provides a feasible, but more cosmetic, and promising minimally invasive modality in clinic for treating patients with vulvar cancer.
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20
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Postlewait LM, Farley CR, Diller ML, Martin B, Hart Squires M, Russell MC, Rizzo M, Ogan K, Master V, Delman K. A Minimally Invasive Approach for Inguinal Lymphadenectomy in Melanoma and Genitourinary Malignancy: Long-Term Outcomes in an Attempted Randomized Control Trial. Ann Surg Oncol 2017; 24:3237-3244. [DOI: 10.1245/s10434-017-5971-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 12/15/2022]
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Pouwer AFW, Arts HJ, van der Velden J, de Hullu JA. Limiting the morbidity of inguinofemoral lymphadenectomy in vulvar cancer patients; a review. Expert Rev Anticancer Ther 2017; 17:615-624. [PMID: 28608762 DOI: 10.1080/14737140.2017.1337513] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inguinofemoral lymphadenectomy (IFL) is performed in the treatment for vulvar cancer. One or more complications after IFL is reported in up to 85% of the patients. This review presents an overview of surgical techniques and peri- and post-operative care that has been studied in order to reduce the morbidity associated with IFL in vulvar cancer patients. Areas covered: Current knowledge on post-operative complications after different surgical techniques and peri- and post-operative protocols were discussed. A systematic literature review was conducted using MEDLINE, EMBASE and the Cochrane library on 20 February 2017. In order to be eligible for inclusion, studies must report the associated post-operative morbidity per surgical technique, or peri- or post-operative care given after IFL in vulvar cancer patients. Expert commentary: After the implementation of several new surgical techniques, the morbidity after IFL decreased but remains high and clinically meaningful. More research is needed on surgical techniques and peri-or post-operative care to further reduce the complication rates after IFL in vulvar cancer patients.
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Affiliation(s)
- Anne-Floor W Pouwer
- a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands
| | - Henriette J Arts
- b Department of Obstetrics and Gynaecology , University Medical Center Groningen , Groningen , The Netherlands
| | - Jacobus van der Velden
- c Department of Obstetrics and Gynaecology , Center for Gynaecologic Oncology Amsterdam (location: Academic Medical Center) , Amsterdam , The Netherlands
| | - Joanne A de Hullu
- a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands
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Leone A, Diorio GJ, Pettaway C, Master V, Spiess PE. Contemporary management of patients with penile cancer and lymph node metastasis. Nat Rev Urol 2017; 14:335-347. [PMID: 28401957 DOI: 10.1038/nrurol.2017.47] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Penile cancer is a rare disease that causes considerable physical and psychological patient morbidity, especially at advanced stages. Patients with low-stage nodal metastasis can achieve durable survival with surgery alone, but those with extensive locoregional metastasis have overall low survival. Contemporary management strategies for lymph node involvement in penile cancer aim to minimize the morbidity associated with traditional radical inguinal lymphadenectomy through appropriate risk stratification while optimizing oncological outcomes. Modified (or superficial) inguinal lymph node dissection and dynamic sentinel lymph node biopsy are diagnostic modalities that have been recommended in patients with high-risk primary penile tumours and nonpalpable inguinal lymph nodes. In addition, advances in minimally invasive and robot-assisted lymphadenectomy techniques are being investigated in patients with penile cancer and might further decrease lymphadenectomy-related adverse effects. The management of patients with advanced disease has evolved to include multimodal treatment with systemic chemotherapy before surgical intervention and can include adjuvant chemotherapy after pelvic lymphadenectomy. The role of radiotherapy in the neoadjuvant or adjuvant setting remains largely unclear, owing to a lack of high-level evidence of possible benefits. New targeted therapies have shown efficacy in squamous cell carcinomas of other sites and might also prove effective in patients with penile cancer.
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Affiliation(s)
- Andrew Leone
- H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA
| | - Gregory J Diorio
- H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA
| | - Curtis Pettaway
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit Number: 1373, Houston, Texas 77030, USA
| | - Viraj Master
- Emory University School of Medicine, 1365 Clifton Road NE, Building B, Room 1485, Atlanta, Georgia 30030, USA
| | - Philippe E Spiess
- H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA
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23
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Sommariva A, Pasquali S, Cona C, Ciccarese AA, Saadeh L, Campana LG, Meroni M, Rossi CR. Videoscopic ilioinguinal lymphadenectomy for groin lymph node metastases from melanoma. Br J Surg 2016; 103:1026-32. [PMID: 27146356 DOI: 10.1002/bjs.10140] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/02/2015] [Accepted: 02/03/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Groin lymph node dissection for melanoma is burdened by high postoperative morbidity. Videoscopic lymphadenectomy may lower the incidence of complications, including infection, dehiscence and lymphoedema. This pilot study aimed to investigate the feasibility and postoperative outcomes of videoscopic ilioinguinal lymphadenectomy in patients with inguinal nodal melanoma metastases. METHODS Patients with inguinal nodal metastases, with either a positive sentinel lymph node biopsy or clinically positive nodes from melanoma, were enrolled. Inguinal dissection was performed via three ports. Iliac dissection was obtained through a preperitoneal access. Intraoperative and postoperative data were collected. RESULTS Of 23 patients selected for 24 procedures, four needed conversion to an open procedure. Median duration of surgery was 270 (i.q.r. 245-300) min. Wound-related postoperative complications occurred in four patients, although only one needed further intervention. The median number of excised lymph nodes was 21 (i.q.r. 15-25). After a median follow-up of 18 months, regional lymph node recurrence was observed in two patients. CONCLUSION Videoscopic ilioinguinal lymphadenectomy for melanoma groin lymph node metastases is technically feasible, safe, and associated with acceptable morbidity and oncological outcome.
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Affiliation(s)
- A Sommariva
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - S Pasquali
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - C Cona
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - A A Ciccarese
- Anaesthesiology Units, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - L Saadeh
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - L G Campana
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - M Meroni
- Anaesthesiology Units, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - C R Rossi
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
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24
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Jakub JW, Terando AM, Sarnaik A, Ariyan CE, Faries MB, Zani S, Neuman HB, Wasif N, Farma JM, Averbook BJ, Bilimoria KY, Allred JBJ, Suman VJ, Grotz TE, Zendejas B, Wayne JD, Tyler DS. Training High-Volume Melanoma Surgeons to Perform a Novel Minimally Invasive Inguinal Lymphadenectomy: Report of a Prospective Multi-Institutional Trial. J Am Coll Surg 2015; 222:253-60. [PMID: 26711792 DOI: 10.1016/j.jamcollsurg.2015.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/07/2015] [Accepted: 11/07/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Minimally invasive inguinal lymphadenectomy (MILND) is a novel procedure with the potential to decrease surgical morbidity compared with the traditional open approach. The current study examined the feasibility of a combined didactic and hands-on training program to prepare high-volume melanoma surgeons to perform this procedure safely and proficiently. STUDY DESIGN A select group of melanoma surgeons with no MILND experience were recruited. After completing a structured training program, surgeons enrolled patients with melanoma who required inguinal lymphadenectomy and performed the procedure in the minimally invasive fashion. A proficiency score composed of lymph node yield, operative time, and blood loss (or adverse events) was assigned for each case. After performing six cases, surgeons meeting a threshold score were considered proficient in the procedure. RESULTS Twelve surgeons from 10 institutions enrolled 88 patients. The majority of surgeons were deemed proficient within 6 cases (83%). No differences in operative time or lymph node yield were noted during the course of the study. The rate of conversion was higher during an individual surgeon's early experience (9 of 49 [18%]), and only 1 procedure was converted in the 39 cases performed after a surgeon had performed 5 cases (late conversion rate, 3%; p = 0.038); however, this did not remain significant after controlling for surgeon. CONCLUSIONS After a structured training program, experienced melanoma surgeons adopted a novel surgical technique with acceptable operative times, conversions, and lymph node yield. Eighty-four percent of the surgeons who completed at least 6 MILND procedures were considered proficient based on our predetermined definition.
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Affiliation(s)
| | - Alicia M Terando
- Department of Surgery, Ohio State University Medical Center, Columbus, OH
| | - Amod Sarnaik
- Department of Surgery, H Lee Moffitt Cancer Center, Tampa, FL
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark B Faries
- Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, CA
| | - Sabino Zani
- Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Heather B Neuman
- Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nabil Wasif
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - Jeffrey M Farma
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA
| | - Bruce J Averbook
- Department of Surgery, MetroHealth Medical Center, Cleveland, OH
| | - Karl Y Bilimoria
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jacob B Jake Allred
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Vera J Suman
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | | | - Jeffrey D Wayne
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Douglas S Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
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25
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Zoras O, Lasithiotakis K, Balch C. Uncertainties in the management of melanoma nodal metastasis. Eur J Surg Oncol 2015; 41:811-3. [PMID: 25980747 DOI: 10.1016/j.ejso.2015.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022] Open
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