A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer

Zikán, Michal; Fischerová, D.; Pinkavova, I.; Sláma, Jiří; Weinberger, Vít; Dušek, Ladislav; Cibula, David

doi:10.1016/j.ygyno.2015.02.016

Cited by 107 publications

(101 citation statements)

References 26 publications

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“…A total of 40% of patients without TachoSil® had SLC in our study; which is in agreement with other research in a similar setting of patients with comparable extensive surgical procedures [7]. It is interesting to note that the incidence of SLC can decrease up to 5.7% if all types of gynecological cancers with less radical procedures are included [12]. Several factors such as higher BMI, the extension of lymphadenectomy, the number of lymph node removed, the presence of lymph node metastases, and the absence of lymphatic vessels' ligation have been proposed to be associated with SLC formation [9,11]; however, the only independent risk factor for the occurrence of SLC is higher surgical complexity [9].…”

Section: Discussionsupporting

confidence: 91%

Use of TachoSil® to Prevent Symptomatic Lymphocele after an Aggressive Tumor Debulking with Lymphadenectomy for Advanced Stage Ovarian Cancer. A Pilot Study

Minig

Patrono

Cárdenas-Rebollo

et al. 2016

Gynecol Obstet Invest

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Objective: To describe the incidence of symptomatic lymphocele (SLC) after an aggressive tumor debulking surgery and lymphadenectomy in patients with ovarian cancer and peritoneal carcinomatosis with or without TachoSil®. Material and Methods: A pilot retrospective comparative observational study was performed between patients with advanced ovarian cancer International Federation of Gynecology and Obstetrics stages III-IV who underwent complete debulking surgery and radical retroperitoneal lymphadenectomy. In 18 patients, 4 TachoSil® patches were placed in the retroperitoneal area, since January 2014-October 2014. This group was compared with other 18 consecutive patients matched by age, International Federation of Gynecology and Obstetrics stage, surgical complexity, American Society of Anesthesiologists score, comorbidity, and BMI without the use of TachoSil®. Results: Baseline characteristics were similar between groups. There were no statistically significant differences in terms of surgical complexity, surgical time, estimated blood loss, node removed, length of hospital stay, and complications between groups. SLC was diagnosed in 7 patients (38.8%) without TachoSil®, and in 2 patients (11.1%) with TachoSil® (p = 0.121). The use of TachoSil® was associated with a statistically significant lower re-admission rate (p = 0.041) and with a significantly shorter time to adjuvant chemotherapy (p = 0.02). Conclusions: Using TachoSil® in women with advanced stage ovarian cancer who underwent radical debulking with retroperitoneal lymph node dissection is associated with a non-statistically significant reduction in the incidence of SLC. A larger-scale randomized controlled study should be conducted to confirm our preliminary results.

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Section: Discussionsupporting

confidence: 91%

Use of TachoSil® to Prevent Symptomatic Lymphocele after an Aggressive Tumor Debulking with Lymphadenectomy for Advanced Stage Ovarian Cancer. A Pilot Study

Minig

Patrono

Cárdenas-Rebollo

et al. 2016

Gynecol Obstet Invest

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“…Performing lymph node dissection for every patient with endometrial cancer has met considerable resistance because of the risk of lower extremity lymphedema (80), cost, increased operative time, need for a gynecologic oncologist instead of a generalist, and the number of blocks and slides generated. The sentinel lymph node mapping procedure therefore appears most attractive.…”

Section: Frozen Sectionmentioning

confidence: 99%

Practical issues related to uterine pathology: staging, frozen section, artifacts, and Lynch syndrome

Soslow

2016

Modern Pathology

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“…The majority of lymphoceles were asymptomatic and found by ultrasonic or computed tomography imaging during routine postoperative follow-up. About 5–34.5% of lymphoceles are in large size and symptomatic causing excessive pressure to adjacent tissues or because of infection complications [4]. …”

Section: Introductionmentioning

confidence: 99%

Risk factors, microbiology and management of infected lymphocyst after lymphadenectomy for gynecologic malignancies

Wang

Fan

et al. 2018

Arch Gynecol Obstet

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ObjectiveTo evaluate risk factors, microbiology and management of infected lymphocysts in patients undergoing systemic lymphadenectomy for gynecological cancer.MethodsPatients with gynecological cancer who developed postoperative lymphocysts after lymphadenectomy were enrolled between January 2009 and June 2017. The clinical data of infected lymphocysts were analyzed and compared with non-infected lymphocysts. Multivariate analysis of risk factors, the microbiology and therapeutic strategies for infected lymphocysts were also evaluated.ResultsA total of 115 patients out of 619 developed postoperative lymphocysts, the incidence of infected lymphocysts was 4.36%. Infected lymphocysts were more frequently found in patients with combined pelvic and para aortic lymphadenectomy, higher number of resected pelvic lymph nodes, lower level of postoperative serum hemoglobin and higher proportion of neutropenia. The median diameter of infected lymphocysts was significantly larger than non-infected (71.89 vs 38.47 mm, P < 0.001) and a large size (diameter over 60 mm) was identified as an independent risk factor for infected lymphocysts (OR = 3.933, P = 0.017). The microbiology of infected lymphocysts includes gram-positive cocci, gram-negative bacillus and anaerobic bacteria. Percutaneous catheter drainage was successfully performed in 20 patients with infected lymphocysts. 16 of 19 patients with large lymphoceles received combined antibiobics and PCD therapy and showed clinical remission in all cases. Patients with large size infected lymphocysts who received combined therapy experienced a significantly shorter treatment period and lower recurrent rate than those with only antibiotics (P = 0.046, P = 0.018).ConclusionsThe current study demonstrated that a diameter over 60 mm was an independent risk factor for infected lymphocysts. The predominant bacteria originated from the urogenital or skin flora. The combination of PCD with appropriate antibiotics was a convenient and effective therapeutic strategy resulting in a high success rate.

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A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer

Cited by 107 publications

References 26 publications

Use of TachoSil® to Prevent Symptomatic Lymphocele after an Aggressive Tumor Debulking with Lymphadenectomy for Advanced Stage Ovarian Cancer. A Pilot Study

Use of TachoSil® to Prevent Symptomatic Lymphocele after an Aggressive Tumor Debulking with Lymphadenectomy for Advanced Stage Ovarian Cancer. A Pilot Study

Practical issues related to uterine pathology: staging, frozen section, artifacts, and Lynch syndrome

Risk factors, microbiology and management of infected lymphocyst after lymphadenectomy for gynecologic malignancies

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