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de Jong A, Baeten IGT, Jansen A, Hoogendam JP, Jürgenliemk-Schulz IM, Zweemer RP, Gerestein CG. Symptomatic Lymphocele After Robot-Assisted Pelvic Lymphadenectomy as Part of the Primary Surgical Treatment for Cervical and Endometrial Cancer: A Retrospective Cohort Study. J Minim Invasive Gynecol 2024; 31:243-249.e2. [PMID: 38171478 DOI: 10.1016/j.jmig.2023.12.010] [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: 09/17/2023] [Revised: 12/08/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
STUDY OBJECTIVES Pelvic lymph node dissection (PLND) is part of the primary treatment for early-stage cervical cancer and high-intermediate risk or high-risk endometrial cancer. Pelvic lymphocele is a postoperative complication of PLND, and when symptomatic, lymphoceles necessitate treatment. The aim of this study was to investigate the incidence and risk factors of symptomatic lymphocele after robot-assisted laparoscopic PLND in cervical and endometrial cancer. DESIGN Retrospective cohort study. SETTING Single-center academic hospital. PATIENTS Two hundred and fifty-eight patients with cervical cancer and 129 patients with endometrial cancer. INTERVENTIONS Pelvic lymphadenectomy by robot-assisted laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS The authors retrospectively included all patients with early-stage cervical cancer and high-intermediate risk or high-risk endometrial cancer who underwent pelvic lymphadenectomy by robot-assisted laparoscopic surgery between 2008 and 2022. Medical records were reviewed for the occurrence of a symptomatic lymphocele. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for developing a symptomatic lymphocele. In total, 387 patients, 258 with cervical cancer and 129 with endometrial cancer, were included in the study. The overall incidence of symptomatic lymphoceles was 9.6% with a median follow-up of 47 months [interquartile range 23-61]. For the entire cohort, smoking was the only significant risk factor for symptomatic lymphoceles identified in univariate (OR 2.47, 95% CI 1.19-5.11) and multivariate analysis (OR 2.42, 95% CI 1.16-5.07). For cervical cancer, body mass index (BMI) (OR 1.09, 95% CI 1.00-1.17) and prior abdominal surgery (OR 2.75, 95% CI 1.22-6.17) were also identified as significant independent risk factors. For endometrial cancer, age was identified as a significant independent risk factor (OR 0.90, 95% CI 0.83-0.97). CONCLUSION This single-center cohort study demonstrated an incidence of almost 10% of symptomatic lymphoceles after robot-assisted laparoscopic PLND for cervical cancer and endometrial cancer, with a higher risk observed among patients who smoke at the time of diagnosis. Furthermore, risk factors differ between the 2 populations, necessitating further studies to establish risk models.
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Affiliation(s)
- Alise de Jong
- Department of Gynecologic Oncology (Jong, Jansen, Drs. Baeten, Hoogendam, Jürgenliemk-Schulz, Zweemer, and Gerestein), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ilse G T Baeten
- Department of Gynecologic Oncology (Jong, Jansen, Drs. Baeten, Hoogendam, Jürgenliemk-Schulz, Zweemer, and Gerestein), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Anna Jansen
- Department of Gynecologic Oncology (Jong, Jansen, Drs. Baeten, Hoogendam, Jürgenliemk-Schulz, Zweemer, and Gerestein), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jacob P Hoogendam
- Department of Gynecologic Oncology (Jong, Jansen, Drs. Baeten, Hoogendam, Jürgenliemk-Schulz, Zweemer, and Gerestein), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ina M Jürgenliemk-Schulz
- Department of Gynecologic Oncology (Jong, Jansen, Drs. Baeten, Hoogendam, Jürgenliemk-Schulz, Zweemer, and Gerestein), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Radiation Oncology (Dr. Jürgenliemk-Schulz), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ronald P Zweemer
- Department of Gynecologic Oncology (Jong, Jansen, Drs. Baeten, Hoogendam, Jürgenliemk-Schulz, Zweemer, and Gerestein), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis G Gerestein
- Department of Gynecologic Oncology (Jong, Jansen, Drs. Baeten, Hoogendam, Jürgenliemk-Schulz, Zweemer, and Gerestein), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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Moussa AM, Aly AK, Maybody M, Camacho JC, Ridouani F, Gonzalez-Aguirre AJ, Santos E. A comparison of lymphatic embolization and sclerotherapy in the management of iatrogenic abdominopelvic lymphoceles following oncological surgery. Diagn Interv Radiol 2023; 29:542-547. [PMID: 37171042 PMCID: PMC10679622 DOI: 10.4274/dir.2023.232135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/10/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE To compare the safety and efficacy of sclerotherapy and lymphatic embolization (LE) in the treatment of symptomatic iatrogenic lymphoceles following the placement of a percutaneous drainage catheter. METHODS This is a retrospective study of 46 patients who underwent sclerotherapy (17 patients) or LE (29 patients) for the management of symptomatic iatrogenic lymphoceles following percutaneous drain placement between January 2017 and December 2021. The demographic characteristics, time between surgery and lymphatic intervention, clinical presentation, number of procedures, drain output pre- and post-intervention, time from intervention to drain removal, and adverse events were collected and compared for both groups. The clinical success rate, defined as the successful removal of the drain after one procedure, was calculated. Adverse events were reported according to the Society of Interventional Radiology classification. A statistical analysis was conducted using SPSS, and the P value for statistical significance was set at 0.05. The Mann-Whitney U test was used to compare differences in the scale variables, and Fisher's exact test was used to compare the categorical and ordinal variables between both groups. RESULTS A total of 46 patients with 49 lymphoceles met the inclusion criteria of the study. Of these patients, 17 patients (19 lymphoceles) underwent sclerotherapy, and 29 patients (30 lymphoceles) underwent LE as their initial procedures. The clinical success after one procedure was significantly higher (83% vs. 47%, P = 0.011), and the median time between the first intervention and drain removal was significantly shorter in the LE group (median duration of 6 vs. 13 days, P = 0.018) compared with the sclerotherapy group. No statistically significant difference in adverse events was noted between both groups (0.26 vs. 0.10, P = 0.11). CONCLUSION This study found that LE had a higher clinical success rate after the first procedure and a shorter time to drain removal compared with sclerotherapy. There was no difference in the rate of adverse events between both groups. Although LE is a safe and promising technique, a prospective study is needed to further compare the efficacy of both treatment modalities.
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Affiliation(s)
- Amgad M. Moussa
- Department of Radiology, Division of Interventional Radiology,Memorial Sloan Kettering Cancer Center, New York, United States
| | - Ahmed K. Aly
- Department of Radiology, Division of Interventional Radiology,Memorial Sloan Kettering Cancer Center, New York, United States
| | - Majid Maybody
- Department of Radiology, Division of Interventional Radiology,Memorial Sloan Kettering Cancer Center, New York, United States
| | - Juan C. Camacho
- Department of Radiology, Division of Interventional Radiology, Florida Atlantic University, Florida, United States
| | - Fourat Ridouani
- Department of Radiology, Division of Interventional Radiology,Memorial Sloan Kettering Cancer Center, New York, United States
| | - Adrian J. Gonzalez-Aguirre
- Department of Radiology, Division of Interventional Radiology,Memorial Sloan Kettering Cancer Center, New York, United States
| | - Ernesto Santos
- Department of Radiology, Division of Interventional Radiology,Memorial Sloan Kettering Cancer Center, New York, United States
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Luzarraga Aznar A, Español Lloret P, Soler Moreno C, Luna Guibourg R, Rovira Negre R. Laparoscopic approach for symptomatic pelvic and para-aortic lymphoceles. J Turk Ger Gynecol Assoc 2021; 23:60-62. [PMID: 34109774 PMCID: PMC8907432 DOI: 10.4274/jtgga.galenos.2021.2021.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Description and demonstration of the feasibility of laparoscopic management of symptomatic pelvic lymphocele after surgical staging in gynecological cancer surgery. Step-by-step description of the surgical procedure using pictures and an educational video. Patient gave informed consent for the use of images and the full video article was approved by the Institutional Review Board of the Hospital of Sant Pau. Lymphocele is one of the most common complications of pelvic or lumbo-aortic lymphadenectomy. Although the incidence is variable at 1-58%, around 5-18% of cases are symptomatic. Only symptomatic lymphocele requires treatment, which can be medical or interventional. Drainage is usuallyperformed by guided radiology although a surgical approach has shown a lower rate of recurrence. A 64-years-old woman diagnosed withendometrial carcinosarcoma was staged laparoscopically by pelvic and para-aortic lymphadenectomy. Para-aortic lymphadenectomy wasperformed using an extraperitoneal approach. Three weeks later she presented with an intense and persistent burning pain, radiating towardsthe left leg. Computed tomography imaging suggested the presence of a 10x7.6 cm lymphocele adjacent to the left external iliac vessels.Laparoscopy was performed with four-port placement configuration, enabling the identification of a large, bilobed lymphocele, adjacent to theleft pelvic wall and left paracolic gutter. Adhesiolysis and identification of main landmarks in the left paracolic gutter and left paravesical fossawas performed as a first step. Peritoneum of each lymphocele was opened in the caudal region and the opening was broadened to facilitatelymph drainage. Owing to the low morbidity and excellent results, we suggest that laparoscopic drainage should be performed as a feasible anduseful treatment for pelvic symptomatic lymphoceles.
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Affiliation(s)
- Ana Luzarraga Aznar
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pia Español Lloret
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Soler Moreno
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rocio Luna Guibourg
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ramon Rovira Negre
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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