Infectious Morbidity After Radical Vulvectomy

Abstract

Objective: This retrospective investigation describes the infectious morbidity of patients following radical vulvectomy with or without inguinal lymph node dissection. Methods: The charts of patients undergoing radical vulvectomy between January 1, 1986, and September 1, 1989, were reviewed for age, weight, cancer type, tumor stage, operative procedure(s), prophylactic antibiotic and its length of use, febrile morbidity, infection site, culture results, significant medical history, and length of use and number of drains or catheters used. Results: The study group was composed of 61 patients, 14 of whom underwent a radical vulvectomy and 47 who also had inguinal lymph node dissection performed. Twenty-nine patients (48%) had at least 1 postoperative infection. Five patients (8%) had 2 or more postoperative infections. The site and incidence of the infections were as follows: urinary tract 23%, wound 23%, lymphocyst 3%, lymphatics (lymphangitis) 5%, and bowel (pseudomembranous colitis) 3%. The most common pathogens isolated from both urine and wound sites were Pseudomonas aeruginosa, enterococcus, and Escherichia coli. A significant decrease in wound infection was demonstrated when separate incisions were made for inguinal lymph node dissection (P <0.05). The mean number of days to onset of postoperative infection for wound, urine, lymphatics, lymphocyst, and bowel were 11, 8, 57, 48, and 5, respectively. Conclusions: We conclude that the clinical appearance of post-radical vulvectomy infections is delayed when compared with other post-surgical wound infections. Second, utilizing separate inguinal surgical incisions may reduce infectious morbidity. Finally, tumor stage and type do not necessarily increase the infectious morbidity of radical vulvar surgery.

Trends in bacterial resistance among perioperative infections in patients with primary ovarian cancer: A retrospective 20-year study at an affiliated hospital in South China

“…24 Many factors contribute to the development of perioperative infections in patients with ovarian cancer after cytoreductive surgery, including the microorganism, the environment, and host defense mechanisms, while ovarian cancer patients frequently undergo extensive, prolonged, and highly invasive surgery, experience significant blood loss, have received preoperative chemoradiotherapy, and have primary or secondary hypoimmunity. 17 In the present study, the rate of perioperative infections in patients with ovarian cancer after primary cytoreductive surgery was higher (18.9%) than previously reported, 3,17,18 suggesting the need to take preventive preoperative and perioperative actions to reduce the rate of perioperative infections in these patients in our hospital.…”

“…Perioperative infections were common in women with ovarian cancer after primary cytoreductive surgery in the present study. The urinary tract and surgical wound were the most common infection sites in both groups, 18 but the percentage of urinary tract infections was higher in the second 10-year group (65.0%) compared with the first 10-year group (60.1%). Numerous factors increase the risk of perioperative urinary tract infections during ovarian cancer surgery, including anatomical features, ascending infection from the lower genital tract, invasive instrumentation such as cystoscopy and catheterization, surgical intervention, chemoradiotherapy, and dysbiosis of vaginal microbiota.…”

“…[25][26][27] The distribution of the causative organisms changed slightly between the two decades in the current study. Some previous studies found that the most common isolated pathogens were Pseudomonas aeruginosa followed by Enterococcus and E. coli, 18 while other studies reported that E. coli was the main causative organism, followed by Enterococcus. 3,17,25 Furthermore, a shift in the vaginal flora may have affected the distribution of causative organisms in perioperative infections.…”

“…Perioperative infection after surgery for primary ovarian cancer, advanced stage ovarian cancer, tumor grade, and culture-positive percentage were defined as reported previously. 3,18,19 The inclusion criterion was patients with primary ovarian cancer who underwent cytoreductive surgery. The exclusion criteria were: (i) patients with metastatic ovarian carcinoma; (ii) patients with synchronous cancer types; (iii) patients with low-grade malignant ovarian tumor; and (iv) patients with incomplete information.…”

Trends and Complications of Vulvar Reconstruction After Vulvectomy: A Study of a Nationwide Cohort

“…Of 225 patients undergoing either radical or modified radical vulvectomy for vulvar cancer at the Mayo Clinic from 1976 to 1990, 4% had a postoperative vulvar infection and 21% had vulvar necrosis. 45 Elg et al 46 reported a 23% wound infection rate associated with radical vulvectomy. The overall rate of wound infection in this database study was low.…”