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Jansen A, de Jong A, Hoogendam JP, Baeten IGT, Jürgenliemk-Schulz IM, Zweemer RP, Gerestein CG. Lymphocele following lymph node dissection in cervical and endometrial cancer: A systematic review and meta-analysis. Gynecol Oncol 2023; 170:273-281. [PMID: 36738486 DOI: 10.1016/j.ygyno.2023.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/31/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purpose of this systematic review and meta-analysis was to evaluate the proportion and risk factors of lymphoceles and symptomatic lymphoceles after PLND in early-stage cervical and early-stage high or high-intermediate risk endometrial cancer. METHODS Studies reporting on the proportion of lymphocele after PLND were conducted in PubMed, Embase and Cochrane Library. Retrieved studies were screened on title/abstract and full text by two reviewers independently. Quality assessment was conducted using the Newcastle Ottowa Scale and the Cochrane risk-of-bias tool. Proportion of lymphocele and possible risk factors were pooled through random-effects meta-analyses. RESULTS From the 233 studies retrieved, 24 studies were included. The pooled proportion of lymphocele was 14% and of symptomatic lymphocele was 3%. Routinely performing diagnostics was associated with a significantly higher proportion of lymphocele compared to diagnostics performed on indication (21% versus 4%, p < 0.01). Laparotomic surgical approach led to a significantly higher proportion of lymphoceles than laparoscopic surgical approach (18% versus 7%, p = 0.05). The proportion of lymphocele was significantly higher when >15% of the study population underwent additional paraaortic lymph node dissection (PAOLND) opposed to <15% (15% versus 3%, p < 0.01). A mean number of lymph nodes dissected of <21 resulted in a significantly higher pooled proportion of lymphoceles opposed to when the mean number was 21 or higher (19% versus 5%, p = 0.02). Other risk factors analysed were BMI, lymph node metastasis, adjuvant radiotherapy and follow up. There was no sufficient data to detect significant risk factors for the development of symptomatic lymphoceles. CONCLUSION The pooled proportion of lymphocele was 14% of which symptomatic lymphoceles occurred in 3%. Significant risk factors for the total proportion of lymphoceles were laparotomic approach, decreased number of lymph nodes dissected and additional PAOLND.
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Affiliation(s)
- A Jansen
- Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A de Jong
- Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J P Hoogendam
- Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - I G T Baeten
- Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - I M Jürgenliemk-Schulz
- Department of Radiation Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - R P Zweemer
- Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - C G Gerestein
- Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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2
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Bogani G, Papadia A, Buda A, Casarin J, Di Donato V, Plotti F, Gasparri ML, Cimmino C, Pinelli C, Perrone AM, Barra F, Cromi A, Di Martino G, Palaia I, Ferrero S, Indini A, De Iaco P, Angioli R, Luvero D, Muzii L, Ghezzi F, Landoni F, Mueller MD, Benedetti Panici P, Raspagliesi F. Factors predicting morbidity in surgically-staged high-risk endometrial cancer patients. Eur J Obstet Gynecol Reprod Biol 2021; 266:169-174. [PMID: 34688098 DOI: 10.1016/j.ejogrb.2021.09.029] [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: 07/30/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate factors predicting the risk of developing 90-day postoperative complications and lymphatic-specific morbidity in patients undergoing surgical staging for high-risk endometrial cancer. METHODS This is a multi-institutional retrospective cohort study. Patients affected by apparent early-stage high-risk endometrial cancer (endometrioid FIGO grade 3 with deep myometrial invasion and non-endometrioid endometrial cancer) undergoing surgical staging between 2007 and 2019. Complications were graded according to the Clavien-Dindo classification system. Martin criteria were applied to improve quality of complications reporting. RESULTS Charts of 279 patients were evaluated. Lymphadenectomy, sentinel node mapping (SNM), and SNM followed by back-up lymphadenectomy were performed in 83 (29.7%), 50 (17.9%), and 146 (52.4%) patients, respectively. The former group of patients included 13 patients who had lymphadenectomy after the failure of the SNM technique. Thirteen (4.6%) patients developed severe postoperative events (grade 3 or worse). At multivariate analysis, body mass index (OR: 1.08 (95%CI: 1.01, 1.17)) and open abdominal surgery (OR: 2.27 (95%CI: 1.02, 5.32)) were the two independent factors predictive of surgery-related morbidity. Seven severe lymphatic complications occurred. The adoption of laparoscopic approach (p < 0.001, log-rank test) and SNM (p = 0.038, log-rank test) correlated with a lower risk of developing surgery-related events. Independently, open abdominal surgery was associated with an increased risk of developing lymphatic morbidity (OR: 37.4 (95%CI: 4.38, 319.5); p = 0.001). CONCLUSION The adoption of the laparoscopic approach and SNM technique were associated with lower 90-day complication rates than open surgery in high-risk endometrial cancer undergoing staging surgery.
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Affiliation(s)
- Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Alessandro Buda
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Chiara Cimmino
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy; Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Anna Myriam Perrone
- Department of Obstetrics and Gynecology Sant'Orsola Malpighi University Hospital University of Bologna, 40138 Bologna, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Giampaolo Di Martino
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Alice Indini
- Unit of Medical Oncology, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Varese, Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Daniela Luvero
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | | | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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Abaza R, Henderson SJ, Martinez O. Robotic Vessel Sealer Device for Lymphocele Prevention After Pelvic Lymphadenectomy: Results of a Randomized Trial. J Laparoendosc Adv Surg Tech A 2021; 32:721-726. [PMID: 34677080 DOI: 10.1089/lap.2021.0531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Pelvic lymph node dissection (PLND) during robotic prostatectomy is associated with potential complications. The most common complication of PLND is lymphoceles, occurring in up to 50% of patients in studies with screening imaging but usually asymptomatic. We performed a prospective randomized trial to evaluate whether using advanced bipolar energy for PLND via the robotic vessel sealer can prevent lymphoceles. Methods: A total of 120 patients were enrolled in the trial with each patient serving as their own control. Robotic PLND was randomly performed using the vessel sealer on one side and standard PLND using clips on the other side. All patients underwent screening computed tomography scan 3 months postoperatively with radiologists blinded to the assigned technique. Significant lymphoceles were defined as fluid collections ≥3 cm in any plane. Results: Of those enrolled, 114 completed the study. The mean nodal yield was 6.5 nodes, with 3.1 versus 3.4 nodes for vessel sealer side versus standard technique (P = .35), respectively. The mean operative time for PLND was 11.3 versus 11.1 minutes (P = .62), respectively. Twenty-two lymphoceles were identified. Ten occurred on the vessel sealer side versus 12 on the standard side (8.8% versus 10.5%, P = .412). All lymphoceles were asymptomatic. Conclusions: While the robotic advanced bipolar device did not appear to prevent lymphoceles, the vessel sealer also did not increase the rate of lymphoceles compared with a standard technique using clips. Both techniques were equally efficacious, efficient, and safe for PLND such that surgeons who prefer to avoid clips can reasonably use the vessel sealer, although at increased cost. Clinical Trial Registration number: NCT02035475.
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Affiliation(s)
- Ronney Abaza
- Central Ohio Urology Group, LLC, Columbus, Ohio, USA
| | - Sean Jay Henderson
- Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio, USA
| | - Oscar Martinez
- Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio, USA
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4
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Mahmoodzadeh H, Rahimi-Movaghar E, Omranipour R, Shirkhoda M, Jalaeefar A, Miri SR, Sharifi A. The effect of fibrin glue on the postoperative lymphatic leakage after D2-lymphadenectomy and gastrectomy in patients with gastric cancer. BMC Surg 2021; 21:155. [PMID: 33745452 PMCID: PMC7983227 DOI: 10.1186/s12893-021-01168-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Disturbance in the lymphatic drainage during D2 dissection is associated with significant morbidity. We aimed to assess the effect of fibrin glue on the reduction of postoperative lymphatic leakage. Methods Prospective double-blinded randomized clinical trial with forty patients in each study arm was conducted. All patients diagnosed, staged, and became a candidate for D2 dissection based on NCCN 2019 guideline for gastric cancer. The intervention group received 1 cc of IFABOND® applied to the surgical bed. Results The difference between study groups regarding age, gender, tumor stage was insignificant. (All p-values > 0.05). The median daily drainage volume was 120 ml with the first and the third interquartile being 75 and 210 ml, respectively for the intervention group. The control group had median, the first, and the third interquartile of 350, 290, and 420 ml. The difference between daily drainage volumes was statistically significant (p-value < 0.001). The length of hospital stay was significantly different between the two groups. Notably, the intervention group was discharged sooner (median of 7 Vs 9 days, p-value: 0.001). Conclusion This study showed the possible role of fibrin glue in reducing postoperative lymphatic leakage after gastrectomy and D2 dissection. Registration trial number: IRCT20200710048071N1, 2020.08.16
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Affiliation(s)
- Habibollah Mahmoodzadeh
- Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ramesh Omranipour
- Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.,Breast Disease Research Center, Tehran university of Medical Sciences, Tehran, Iran
| | - Mohammad Shirkhoda
- Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohsen Jalaeefar
- Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Rouhollah Miri
- Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirsina Sharifi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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5
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Gezer Ş, Pulur A, Yücesoy İ. Application of thrombin gel matrix for the prevention of lymphocele in patients with endometrial cancer: A prospective randomized trial. J Gynecol Obstet Hum Reprod 2020; 50:101994. [PMID: 33217600 DOI: 10.1016/j.jogoh.2020.101994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate a thrombin gel matrix (TGM), Floseal, for the prevention of lymphocele in patients with endometrial cancer who underwent pelvic lymphadenectomy. METHODS A total of 79 consecutive patients with endometrial cancer were randomly allocated to one of two groups: the TGM group and control group. After completion of the lymphadenectomy, 5 mL of Floseal was applied to the bilateral pelvic sidewalls, especially the femoral canal, obturator, and common iliac vessels areas. Computed tomography scans were obtained for lymphocele evaluation 2 months after the surgery. RESULTS Three patients from the TGM group, and four patients from the control group were lost during follow-up, and data from 36 participants from each group were analyzed. As the primary outcome, lymphocele developed in 12 patients in both groups (33 %). There was no significant difference between the groups in terms of lymphocele and symptomatic lymphocele development. Lymphocele localization was also not different between the two groups, but the diameter of the lymphoceles detected in the TGM group was significantly greater (p = 0.021). The mean drainage days was significantly shorter in the TGM group (p = 0.015). The amount of drainage was also less in the TGM group, but the difference was not statistically significant. CONCLUSION Thrombin gel matrix applied to the pelvic sidewalls does not reduce the incidence of symptomatic or asymptomatic lymphoceles after pelvic lymphadenectomy in endometrial cancer. However, it can reduce the amount of drainage and the number of drainage days so it can help to shorten hospitalization.
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Affiliation(s)
- Şener Gezer
- Kocaeli University School of Medicine, Department of Gynecologic Oncology, Turkey.
| | - Alparslan Pulur
- Kocaeli University School of Medicine, Department of Gynecologic Oncology, Turkey
| | - İzzet Yücesoy
- Kocaeli University School of Medicine, Department of Gynecologic Oncology, Turkey
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6
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Distribution of lymphocele following lymphadenectomy in patients with gynecological malignancies. Obstet Gynecol Sci 2020; 63:700-708. [PMID: 32814372 PMCID: PMC7677060 DOI: 10.5468/ogs.20110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/20/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study identified the distribution of lymphocele, as well as the factors associated with lymphocele formation, in patients undergoing pelvic and/or para-aortic lymph node dissection (PLND and/or PALND) for gynecologic malignancies. METHODS This study was retrospective, and data were collected from patients who underwent surgical procedures including lymphadenectomy due to gynecologic malignancies from March 2013 to May 2016. Lymphocele was defined by postoperative computer tomography within 2 weeks after surgery. RESULTS A total of 116 patients underwent lymphadenectomy, of whom, 47 (42.0%) developed lymphocele and 14 (12.1%) had symptomatic lymphocele formation. The affecting factors of lymphocele formation were PLND concomitant with PALND and a large amount of blood loss ≥600 mL (P=0.030 and P=0.006, respectively). All clinical factors were not significantly different between patients with symptomatic and asymptomatic lymphocele. Lymphocele developed more frequently in the left side (67.1%) of the body compared to the right side (48.7%), and in the pelvic area (75.9%) compared to the para-aortic area (24.1%, P<0.001, both). CONCLUSION Lymphocele formation is more prevalent in the left and pelvic area of the body compared to the right and paraaortic side. PLND concurrent with PALND and large amounts of blood loss were significant risk factors for lymphocele formation.
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7
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Decreasing Lymphoid Fluid Accumulation During Lymph-Node Dissection. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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8
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Saner FA, Schötzau A, Mackay G, Heinzelmann-Schwarz V, Montavon Sartorius C. Fibrin-thrombin sealant does not reduce lymphocele formation in patients with inguinofemoral lymphadenectomy for vulvar cancer. Cancer Manag Res 2019; 11:3575-3582. [PMID: 31118780 PMCID: PMC6503303 DOI: 10.2147/cmar.s197143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/19/2019] [Indexed: 01/07/2023] Open
Abstract
Purpose: Inguinofemoral lymphadenectomy (IFLD) is associated with very high morbidity. Fibrin sealant patches are used in various surgical procedures to prevent hematomas and lymphoceles. Here, we report a single-institution experience of fibrin sealants after IFLD in vulvar cancer and give an overview of the current literature. Patients and methods: We retrospectively analyzed outcome data on vulvar cancer patients who underwent bilateral IFLD between November 2014 and June 2016 at the University Hospital Basel. A fibrin sealant patch (Tachosil®) was placed in one groin only. Postsurgical fluid collection and complications were compared between both groins; time courses of lymphocele formation were analyzed using a linear mixed-effects regression model. Results: Postsurgical outcome of 11 consecutive patients with bilateral IFLD for vulvar cancer was assessed for a median follow-up of 32 days (range 12–77). Significantly larger lymphoceles were detected over time in the groin with the fibrin sealant patch (median 20 mL vs 5 mL without patch, p=0.002), and more punctures for symptomatic lymphocele were required on this side. The infection rate did not differ between sides. Conclusion: Fibrin sealant patches should not routinely be used for prevention of lymphoceles after IFLD for vulvar cancer. They do not seem to reduce lymph collection, the need for puncture or the infection risk after lymphadenectomy in our experience and according to a general literature review.
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Affiliation(s)
- Flurina Am Saner
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas Schötzau
- Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gillian Mackay
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland.,Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Céline Montavon Sartorius
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland
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Prodromidou A, Iavazzo C, Fotiou A, Psomiadou V, Drakou M, Vorgias G, Kalinoglou N. The application of fibrin sealant for the prevention of lymphocele after lymphadenectomy in patients with gynecological malignancies: A systematic review and meta-analysis of randomized controlled trials. Gynecol Oncol 2019; 153:201-208. [DOI: 10.1016/j.ygyno.2019.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
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10
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Efficacy of a collagen-fibrin sealant patch (TachoSil®) as adjuvant treatment in the inguinofemoral lymphadenectomy for vulvar cancer: a double-blind randomized-controlled trial. Arch Gynecol Obstet 2019; 299:1467-1474. [DOI: 10.1007/s00404-019-05113-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/04/2019] [Indexed: 11/26/2022]
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11
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Qualified Rehabilitation After Radical Treatment for Bladder Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Jaunarena I, Ruiz R, Gorostidi M, Cobas P, Avila M, Valle DD, Cespedes J, Lekuona A. Efficacy of a Fibrin Sealant (Tissucol Duo) for the Preventionof Lymphocele after Laparoscopic Pelvic Lymphadenectomy:A Randomized Controlled Trial. J Minim Invasive Gynecol 2018; 26:954-959. [PMID: 30296475 DOI: 10.1016/j.jmig.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/29/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE To assess the efficacy of Tissucol Duo (Baxter AG, Vienna, Austria) fibrin sealant in decreasing the incidence of lymphocele (LC) after pelvic laparoscopic lymph node dissection using harmonic shears. DESIGN Randomized controlled trial (Canadian Task Force classification level I). SETTING Tertiary referral and educational center. PATIENTS Seventy-four patients randomized to the use of sealant per hemipelvis. INTERVENTION Fibrin sealant. MEASUREMENTS AND MAIN RESULTS After bilateral pelvic lymphadenectomy a fibrin sealant was used in 1 hemipelvis but not the other, applied in 41 patients (55.4%) to the left and 33 patients (44.6%) to the right hemipelvis. The primary outcome was the incidence of LC after surgery in symptomatic and asymptomatic patients. Imaging (ultrasound, computed tomography, and magnetic resonance) was performed to detect LC at 3, 6, and 12 months after surgery. Overall, 26 patients (35.1%) developed LC, and 4 were symptomatic (5.4%). Allowing patients to serve as their own treatment group and control, the hemipelvis treated with Tissucol Duo corresponding to the treatment group and that not treated to the control group, LCs were found in 17 (23%) and 14 (19%) cases, respectively, but the difference was not significant. The mean initial LC maximum diameter was 27.1 mm (standard deviaiotn, 35.2), and LCs tended to decrease in size during the first year to a mean of 8.7 mm. CONCLUSION Application of Tissucol Duo fibrin sealant after laparoscopic pelvic lymphadenectomy using ultrasonic shears does not decrease the occurrence of symptomatic or asymptomatic LC.
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Affiliation(s)
- Ibon Jaunarena
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)..
| | - Ruben Ruiz
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - Mikel Gorostidi
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - Paloma Cobas
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - Marisa Avila
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - David Del Valle
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - Juan Cespedes
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - Arantza Lekuona
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
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Liu J, Zhang H, Du Q, Yao S. Successful Laparoscopic Treatment of Chylous Ascites after Pelvic Lymphadenectomy: A Case Report and Peanut Oil Application. J Minim Invasive Gynecol 2018; 25:923-926. [DOI: 10.1016/j.jmig.2017.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/24/2017] [Accepted: 12/28/2017] [Indexed: 01/03/2023]
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14
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Grimm C, Polterauer S, Helmy-Bader S, Zikan M, Cibula D, Heitz F, Harter P, Giese A, Reinthaller A, Tempfer C. A collagen-fibrin patch for the prevention of symptomatic lymphoceles after pelvic lymphadenectomy in women with gynecologic malignancies: A randomized clinical trial. Gynecol Oncol 2018; 149:140-145. [PMID: 29395308 DOI: 10.1016/j.ygyno.2018.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/08/2018] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a collagen-fibrin patch for the prevention of symptomatic lymphoceles after pelvic lymphadenectomy in women with gynecologic malignancies. METHODS In a multicenter, randomized, clinical trial, 164 women with pelvic lymphadenectomy were allocated either to bilateral pelvic application of two collagen-fibrin patches or no intervention. Main outcome was efficacy, defined as reduction of symptomatic lymphocele rate diagnosed within four weeks after surgery. Secondary outcomes were asymptomatic lymphoceles and subsequent interventions. Sample size was based on the assumption that application of a collagen-fibrin patch reduces the prevalence of symptomatic lymphoceles by at least 66%. The study was single-blinded, i.e., patients and primary outcome assessors, but not surgeons, were blinded to the treatment allocation. RESULTS A total of 75 women were randomized to the intervention and 89 to the control group. All women received the allocated intervention. In total, 42 (27.4%) lymphoceles and 8 (5.2%) symptomatic lymphoceles were observed. Symptomatic lymphoceles were observed in 5/68 (7.4%) women in the intervention group and 3/85 (3.5%) women in the control group (p = 0.47). Asymptomatic lymphoceles were observed in 16 (23.5%) women in the intervention group compared to 18 (21.2%) in the control group (p = 0.85). In a multivariate logistic regression model, no independent risk factor for the development of a symptomatic lymphocele was ascertained. DISCUSSION Intraoperative application of collagen-fibrin patches to the pelvic side walls does not reduce the incidence of symptomatic lymphoceles in women with gynecologic malignancies undergoing pelvic lymphadenectomy.
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Affiliation(s)
- Christoph Grimm
- Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria
| | - Stephan Polterauer
- Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria
| | - Samir Helmy-Bader
- Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria
| | - Michal Zikan
- Department of Obstetrics and Gynecology, Gynecologic Oncology Center, Charles University Prague, Prague, Czech Republic
| | - David Cibula
- Department of Obstetrics and Gynecology, Gynecologic Oncology Center, Charles University Prague, Prague, Czech Republic
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Arnd Giese
- Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany; Department of Gastroenterology, St. Josef Hospital, Bochum, Germany
| | - Alexander Reinthaller
- Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria
| | - Clemens Tempfer
- Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany.
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The Efficacy of Fibrin Sealant Patches in Reducing the Incidence of Lymphatic Morbidity After Radical Lymphadenectomy: A Meta-Analysis. Int J Gynecol Cancer 2018. [PMID: 28640177 DOI: 10.1097/igc.0000000000001051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although pivotal in the oncological management of most tumors, radical lymphadenectomy is associated with a significant number of lymphatic complications. The aim of this meta-analysis is to evaluate the efficacy of fibrinogen sealant patches in reducing lymphadenectomy-related postoperative complications. METHODS/MATERIALS The electronic databases PubMed, Medline, and Scopus were searched using the terms "lymphadenectomy" or "lymph node dissection" and "TachoSil," "TachoComb," or "fibrin sealant patch." Series evaluating the efficacy of fibrin-thrombin collagen sealant patches were included in the meta-analysis. RESULTS Overall, 26 studies were retrieved through the literature search. Ten studies including 720 patients met selection criteria. The use of fibrin-thrombin sealant patches to the sole scope of reducing lymphadenectomy-related complications significantly reduced the incidence of lymphocele, symptomatic lymphocele, the need of percutaneous drainage procedures, the volume of lymph drained, and the duration of the drainage. No effect on wound and/or lymphocele infection was noted. CONCLUSIONS This meta-analysis demonstrates that the use of fibrin-thrombin sealant patches significantly reduces the total volume of lymph drained, the duration of the drainage, the incidence of lymphocele and symptomatic lymphocele, and the need for postoperative percutaneous drainage procedures. Its use does not affect the incidence of wound or lymphocele infections.
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16
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Zellner M, Ridderskamp D, Fawzy M. Qualified Rehabilitation After Radical Treatment for Bladder Cancer. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_30-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Effectiveness of Fibrin Sealant Patch in Reducing Drain Volume after Pelvic Lymph Node Dissection in Women with Gynecologic Malignancy. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3086857. [PMID: 29279844 PMCID: PMC5723939 DOI: 10.1155/2017/3086857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/08/2017] [Indexed: 11/24/2022]
Abstract
Background The goal of this study was to evaluate the effectiveness of fibrin sealant in decreasing postoperative lymphatic drainage in women after pelvic lymphadenectomy and/or para-aortic lymphadenectomy during gynecologic cancer surgery. Methods This study is a retrospective case-control study. Forty-five patients who underwent staging surgery were enrolled. Twenty-seven patients were in the fibrin sealant group (group A) and 18 in the control group (group B). The two groups were compared for the total volume of drain, hospital stay, harvested lymph node, and incidence of asymptomatic lymphocele. Lymphocele formation was evaluated by computed tomography (CT) on 3 months after surgery. Results There were no significant differences in patient demographics between group A and B with respect to age, BMI, and harvested lymph nodes. Patients who received fibrin sealants had reduced total volume of drainage from postoperative days 2 to 5 compared to the control group (group A versus group B: 994.819 ± 745.85 ml versus 1847.89 ± 1241.41 ml; P = 0.015). However no differences were observed in hospital stay (P = 0.282), duration of drain (P = 0.207), and incidence of asymptomatic lymphocele at 3 months (P = 0.126). Conclusion The results of this study indicate that the application of fibrin sealants after pelvic and/or para-aortic lymphadenectomy may reduce lymphatic drainage in gynecologic malignancy.
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18
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Lv S, Wang Q, Zhao W, Han L, Wang Q, Batchu N, Ulain Q, Zou J, Sun C, Du J, Song Q, Li Q. A review of the postoperative lymphatic leakage. Oncotarget 2017; 8:69062-69075. [PMID: 28978181 PMCID: PMC5620321 DOI: 10.18632/oncotarget.17297] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022] Open
Abstract
Lymphatic complications are rare, but well-known phenomena, and have been described by many researchers. However, many diagnoses of lymphatic complications are found confusing due to different definition. A literature search in Pubmed was performed for studies postoperative lympatic complications. These complications divided into two parts: lymphatic leakage and lymphatic stasis. This review is about lymphatic leakage, especially, postoperative lymphatic leakage due to the injury of lymphatic channels in surgical procedures. According to polytrophic consequences, many types of postoperative lymphatic leakage have been presented, including lymph ascites, lymphocele, lymphorrhea, lymphatic fistula, chylous ascites, chylothorax, chyloretroperitoneum and chylorrhea. In this review, we focus on the definition, incidence and treatment about most of these forms of lymphatic complications to depict a comprehensive view of postoperative lymphatic leakage. We hold the idea that the method of treatment should be individual and personal according to manifestation and tolerance of patient. Meanwhile, conservative treatment is suitable and should be considered first.
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Affiliation(s)
- Shulan Lv
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qing Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wanqiu Zhao
- Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Lu Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qi Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nasra Batchu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qurat Ulain
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Junkai Zou
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chao Sun
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiang Du
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qing Song
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, USA.,Center of Big Data and Bioinformatics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qiling Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center of Big Data and Bioinformatics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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19
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Gilbert DR, Angell J, Abaza R. Evaluation of Absorbable Hemostatic Powder for Prevention of Lymphoceles Following Robotic Prostatectomy With Lymphadenectomy. Urology 2016; 98:75-80. [DOI: 10.1016/j.urology.2016.06.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/17/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
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20
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Chan ESY, Yee CH, Chiu PKF, Chan CK, Tam MHM, Ng CF. Effects of an autologous fibrin sealant on lymphatic leakage after radical cystectomy: A matched case-control study. SURGICAL PRACTICE 2016. [DOI: 10.1111/1744-1633.12189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Eddie Shu-Yin Chan
- Division of Urology, Department of Surgery; Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong China
| | - Chi-Hang Yee
- Division of Urology, Department of Surgery; Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong China
| | - Peter Ka-Fung Chiu
- Division of Urology, Department of Surgery; Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong China
| | - Chi-Kwok Chan
- Division of Urology, Department of Surgery; Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong China
| | - Mandy Ho-Man Tam
- Division of Urology, Department of Surgery; Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong China
| | - Chi-Fai Ng
- Division of Urology, Department of Surgery; Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong China
- S.H. Ho Urology Centre; Department of Surgery, The Chinese University of Hong Kong; Hong Kong China
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21
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Buda A, Ghelardi A, Fruscio R, Guelfi F, La Manna M, Dell'Orto F, Milani R. The contribution of a collagen-fibrin patch (Tachosil) to prevent the postoperative lymphatic complications after groin lymphadenectomy: a double institution observational study. Eur J Obstet Gynecol Reprod Biol 2015; 197:156-8. [PMID: 26765122 DOI: 10.1016/j.ejogrb.2015.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/10/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Postoperative morbidity associated with groin lymphadenectomy remain high and still represents a major concern for this patients. The aim of this study was to confirm the efficacy of TachoSil(®) in preventing postoperative complications after inguinofemoral lymphadenectomy for gynecological malignancy. STUDY DESIGN An observational study was conducted to evaluate the incidence of postoperative complications among 49 patients (TachoSil(®) group=24; control group=25) underwent groin dissection enrolled in two Italian Department of Gynecology Oncology from 2011 to 2014. RESULTS A total of 74 inguinal dissections were performed. Bilateral groin dissection was performed in 25 patients (Tachosil group=10; group 2=15). Patients in TachoSil(®) group showed a lower daily drainage volume with a mean volume of 84 ml (range 30-465) vs. 143 ml (range -72 to 413) in the control group (p=.004), and a lower total drainage volume with a mean of 540 ml (range 90-930) vs. 900 ml (range 200-3270) for Tachosil and control group, respectively. A lower incidence of lymphocyst required drainage, cellulitis, wound infection and late lymphedema was observed in TachoSil group even without reaching statistical significance. CONCLUSIONS This observational study confirmed that the use of TachoSil(®) seems to be highly effective in reducing the rate of postoperative lymphorrea and postoperative complications after groin dissection in case of gynecological malignancies. Larger multicenter prospective study is advisable to validate our preliminary results.
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Affiliation(s)
- Alessandro Buda
- Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, Italy; University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
| | - Alessandro Ghelardi
- Obstetrics and Gynecology Unit, Division of Gynecologic Oncology, Usl 1 of Massa and Carrara, Italy
| | - Robert Fruscio
- Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, Italy; University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Fernando Guelfi
- Obstetrics and Gynecology Unit, Division of Gynecologic Oncology, Usl 1 of Massa and Carrara, Italy
| | - Maria La Manna
- Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, Italy; University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Federica Dell'Orto
- Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, Italy; University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Rodolfo Milani
- Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, Italy; University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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22
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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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Symptomatic Lymphocele Formation After Sentinel Lymph Node Biopsy for Early Stage Cervical Cancer. J Minim Invasive Gynecol 2015; 23:442-5. [PMID: 26260297 DOI: 10.1016/j.jmig.2015.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 11/20/2022]
Abstract
In early stage cervical cancer, nodal status is the most important prognostic factor, and execution of retroperitoneal lymphadenectomy is currently an integral part of surgical therapy. Sentinel lymph node biopsy has been progressively incorporated with surgical therapy and could reduce morbidity. However, the current incidence of complications exclusively related to the procedure is unknown. We report on a 29-year-old woman affected by cervical cancer (Fédération Internationale de Gynécologie et d'Obstétrique Stage 1b1), who underwent sentinel lymph node biopsy in combination with radical vaginal trachelectomy, and who later developed a symptomatic pelvic lymphocele that required surgical therapy. Conservative procedures in the pelvic lymph nodes are not free of complications, especially with regard to the formation of symptomatic lymphoceles. This report brings to light an important discussion about the exact magnitude of the complications associated with the procedure.
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24
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Weniger M, D'Haese JG, Angele MK, Kleespies A, Werner J, Hartwig W. Treatment options for chylous ascites after major abdominal surgery: a systematic review. Am J Surg 2015; 211:206-13. [PMID: 26117431 DOI: 10.1016/j.amjsurg.2015.04.012] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/01/2015] [Accepted: 04/17/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chylous leakage is a relevant clinical problem after major abdominal surgery leading to an increased length of stay. DATA SOURCES A systematic search of MEDLINE/PubMed and the Cochrane Library was performed according to the PRISMA statement. The search for the MeSH terms "chylous ascites" and/or "lymphatic fistula" retrieved a total of 2,348 articles, of which 36 full-text articles were reviewed by 2 independent investigators. RESULTS Chylous ascites is described with an incidence of up to 11%, especially after pancreatic surgery. The incidence is increasing with the number of lymph nodes harvested. In patients treated with total parenteral nutrition, conservative treatment is demonstrated to be effective in up to 100% of cases. CONCLUSIONS The extent of abdominal surgery mainly predicts the risk of chylous ascites. Conservative treatment has been shown to be effective in almost all cases and is the treatment of choice.
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Affiliation(s)
- Maximilian Weniger
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany
| | - Jan G D'Haese
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany
| | - Martin K Angele
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany.
| | - Axel Kleespies
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany
| | - Jens Werner
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany
| | - Werner Hartwig
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany
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Sarmento S, Costa F, Pereira A, Lencart J, Dias A, Cunha L, Sousa O, Silva JP, Santos L. Attenuation measurements show that the presence of a TachoSil surgical patch will not compromise target irradiation in intra-operative electron radiation therapy or high-dose-rate brachytherapy. Radiat Oncol 2015; 10:7. [PMID: 25572977 PMCID: PMC4293105 DOI: 10.1186/s13014-014-0316-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/18/2014] [Indexed: 11/27/2022] Open
Abstract
Background Surgery of locally advanced and/or recurrent rectal cancer can be complemented with intra-operative electron radiation therapy (IOERT) to deliver a single dose of radiation directly to the unresectable margins, while sparing nearby sensitive organs/structures. Haemorrhages may occur and can affect the dose distribution, leading to an incorrect target irradiation. The TachoSil (TS) surgical patch, when activated, creates a fibrin clot at the surgical site to achieve haemostasis. The aim of this work was to determine the effect of TS on the dose distribution, and ascertain whether it could be used in combination with IOERT. This characterization was extended to include high dose rate (HDR) intraoperative brachytherapy, which is sometimes used at other institutions instead of IOERT. Methods CT images of the TS patch were acquired for initial characterization. Dosimetric measurements were performed in a water tank phantom, using a conventional LINAC with a hard-docking system of cylindrical applicators. Percentage Depth Dose (PDD) curves were obtained, and measurements made at the depth of dose maximum for the three clinically used electron energies (6, 9 and 12MeV), first without any attenuator and then with the activated patch of TS completely covering the tip of the IOERT applicator. For HDR brachytherapy, a measurement setup was improvised using a solid water phantom and a Farmer ionization chamber. Results Our measurements show that the attenuation of a TachoSil patch is negligible, both for high energy electron beams (6 to 12MeV), and for a HDR 192Ir brachytherapy source. Our results cannot be extrapolated to lower beam energies such as 50 kVp X-rays, which are sometimes used for breast IORT. Conclusion The TachoSil surgical patch can be used in IORT procedures using 6MeV electron energies or higher, or HDR 192Ir brachytherapy.
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Affiliation(s)
- Sandra Sarmento
- Medical Physics Department, Portuguese Institute of Oncology, Porto, Portugal. .,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal.
| | - Filipa Costa
- Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal.
| | - Alexandre Pereira
- Medical Physics Department, Portuguese Institute of Oncology, Porto, Portugal. .,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal.
| | - Joana Lencart
- Medical Physics Department, Portuguese Institute of Oncology, Porto, Portugal. .,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal.
| | - Anabela Dias
- Medical Physics Department, Portuguese Institute of Oncology, Porto, Portugal. .,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal.
| | - Luís Cunha
- Medical Physics Department, Portuguese Institute of Oncology, Porto, Portugal. .,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal.
| | - Olga Sousa
- Radiation Oncology Department, Portuguese Institute of Oncology, Porto, Portugal.
| | - José Pedro Silva
- Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal.
| | - Lúcio Santos
- Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal. .,Experimental Pathology and Therapeutics Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal.
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Köhler C, Kyeyamwa S, Marnitz S, Tsunoda A, Vercelino F, Schneider A, Favero G. Prevention of lymphoceles using FloSeal and CoSeal after laparoscopic lymphadenectomy in patients with gynecologic malignancies. J Minim Invasive Gynecol 2014; 22:451-5. [PMID: 25499774 DOI: 10.1016/j.jmig.2014.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pelvic ± para-aortic lymphadenectomy (LAE) is an essential element of staging and treatment of different gynecologic malignancies. However, LAE can induce asymptomatic and symptomatic pelvic lymphoceles (LCs) in a considerable percentage of patients. Therapy of symptomatic LCs may cause additional morbidity. The best strategy to reduce the rate of LCs has not established yet. MATERIALS AND METHODS Between January 2011 and May 2012, transperitoneal laparoscopic pelvic ± para-aortic LAE was performed at the Department of Gynecology at Charité University Hospital Berlin in 238 patients with cervical, endometrial, ovarian, or groin-positive vulvar cancer. The application of FloSeal (Baxter, Deerfield, IL) and CoSeal (Baxter) was used in 25 patients (group A) as an alternative to routine pelvic drainage after LAE. A case-control comparison was performed on 25 patients (group B) with bilateral drainage after complete LAE. The primary objective of this pilot study was to evaluate the feasibility and safety of the method. As a secondary objective, we evaluated the incidence of LCs and symptomatic LCs in both groups. The detection of LCs was performed during oncologic follow-up by sonography, computed tomographic imaging, or magnetic resonance imaging. MEASUREMENTS AND MAIN RESULTS Pelvic (n = 50) or pelvic + para-aortic (n = 42) LAE was performed in 44 patients with cervical, 2 with endometrial, 1 with ovarian, and 2 with groin-positive vulvar cancer, respectively. In group B (n = 25), systematic bilateral pelvic drainage was placed after finishing LAE, whereas in group A (n = 25) LAE areas were sealed with 5 mL FloSeal on each side and sprayed with CoSeal afterward without placing drains. In 14 of 50 patients (28%), LCs were detected. In a subgroup of patients with cervical cancer (88% of the cohort), symptomatic LCs occurred in 11% in group A and 18% in group B. Operative revision of symptomatic LCs was necessary in 5% and 18% in groups A and B, respectively (p = .66). Mean Hospital stay was significant shorter in group A (6 days) versus B (8 days) (p = .027). CONCLUSION The results of this case-controlled pilot study indicate that the application of FloSeal and CoSeal after transperitoneal LAE is feasible and safe, may reduce hospital stay, and may potentially decrease the rate of symptomatic LCs in patients with gynecologic malignancies.
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Affiliation(s)
- Christhardt Köhler
- Department of Operative and Oncologic Gynecology, Asklepios Clinic, Hamburg, Germany
| | - Sarah Kyeyamwa
- Department of Gynecology, Charité Universitt of Gynec, Berlin, Germany
| | - Simone Marnitz
- Department of Radiooncology, Charité Universitt of Radio, Berlin, Germany
| | - Audrey Tsunoda
- Department of Gynecologic Oncology, Cancer Centre Barretos, Barretos, Brazil
| | | | - Achim Schneider
- Institute for Cytologie and Dyplasia, Füytologie and Dyp, Berlin, Germany
| | - Giovanni Favero
- Department of Operative and Oncologic Gynecology, Asklepios Clinic, Hamburg, Germany.
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Grimm C, Polterauer S, Helmy S, Cibula D, Zikan M, Reinthaller A, Tempfer C. A collagen-fibrin patch (Tachosil®) for the prevention of symptomatic lymphoceles after pelvic lymphadenectomy in women with gynecologic malignancies: a randomized clinical trial. BMC Cancer 2014; 14:635. [PMID: 25175029 PMCID: PMC4156659 DOI: 10.1186/1471-2407-14-635] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 08/22/2014] [Indexed: 11/10/2022] Open
Abstract
Background Lymphoceles are a common complication after pelvic lymphadenectomy in women with gynecologic malignancies. Although typically asymptomatic, lymphoceles can superinfect requiring medical or surgical intervention. A single center randomized controlled trial provided first evidence, that a collagen-fibrin patch (Tachosil®) is effective in the prevention of symptomatic lymphoceles after pelvic lymphadenectomy. Methods/Design We will perform a multicentre, blinded, randomized, controlled trial comprising 140 women with gynecologic malignancies undergoing pelvic lymphadenectomy. Women will be randomly allocated to Tachosil® application or no application. Primary outcome is efficacy, defined as lymphocele CTCAE 4.03 grade ≥2 within four weeks after surgery. Secondary outcomes are asymptomatic lymphocele verified by ultrasound, medical or surgical intervention. Assuming a two-sided 5% significance level, a power of 80%, and a drop out rate of 10%, a sample size of 68 patients per group was calculated to detect a 66% absolute decrease in symptomatic lymphoceles. Discussion We aim to provide further evidence for the efficacy of a collagen-fibrin patch in the prevention of symptomatic lymphoceles in women with gynecological malignancies undergoing pelvic lymphadenectomy. Trial registration This study is registered at ClinicalTrials.gov (NCT01470677, protocol ID: TACHO-1). This study is registered at the EudraCT database (EudraCT number: 2011-003115-34).
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Affiliation(s)
- Christoph Grimm
- Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center - Gynecologic Cancer Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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28
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Horvath S, George E, Herzog TJ. Unintended consequences: surgical complications in gynecologic cancer. ACTA ACUST UNITED AC 2014; 9:595-604. [PMID: 24161311 DOI: 10.2217/whe.13.60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
More than 91,000 women in the USA will be diagnosed with a gynecologic malignancy in 2013. Most will undergo surgery for staging, treatment or both. No therapeutic intervention is without consequence, therefore, it is imperative to understand the possible complications associated with the perioperative period before undertaking surgery. Complication rates are affected by a patient population that is increasingly older, more obese and more medically complicated. Surgical modalities consist of abdominal, vaginal, laparoscopic and robotic-assisted approaches, and also affect rates of complications. An understanding of the various approaches, patient characteristics and surgeon experience allow for individualized decision-making to minimize the complications after surgery for gynecologic cancer.
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Affiliation(s)
- Sarah Horvath
- Columbia University, New York Presbyterian Hospital, NY, USA
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29
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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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