Tissue sealants for the prevention of lymphoceles after radical inguinal lymph node dissection in patients with melanoma: A systematic review and individual patient data meta‐analysis

Abstract

Background and Objectives Postoperative lymphoceles and further wound complications occur frequently after radical inguinal lymph node dissection (ILND). In various studies, tissue sealants have shown to reduce the incidence of postoperative morbidity. Methods A systematic review and meta‐analysis of randomized controlled trials (RCTs) investigating the effectiveness of tissue sealants in reducing the incidence of postoperative lymphoceles following ILND in patients with melanoma was conducted. Individual patient data was requested to pool the data for meta‐analysis appropriately. Results Thousand seven hundred twenty‐nine manuscripts were screened for eligibility. Six RCTs published between 1986 and 2012 were identified including 194 patients for ILND. Only four RCTs were included in the meta‐analysis. No study properly defined the term “lymphocele.” Tissue sealants failed to influence the duration of drain placement (mean difference [MD] = −3.05 days; z = 1.18; P = 0.24), total drainage volume (MD = 598.39 mL; z = 1.49; P = 0.14), the incidence of postoperative seroma, wound infection and skin necrosis. Conclusions No improvement was identified with the use of tissue sealants, however, a valid comparison of the results of included trials was difficult owing to the lack of a definition of the term “lymphocele.” Other surgical techniques and trials using validated endpoint definitions are required to reevaluate these findings.

Improved Perioperative Seroma and Complication Rates Following the Application of a 2-Layer Negative Pressure Wound Therapy System After Inguinal Lymphadenectomy for Metastatic Cutaneous Melanoma

“…1,10,11 There have been multiple studies that have investigated interventions designed to either reduce the incidence or reduce the extent of the problem once it has become established. [12][13][14][15] A recent systematic review by the Cochrane Group 11 identified a lack of any useful data and concluded that, ''…there is a need for high quality RCTs to guide clinical practice in this under-researched area.'' Unfortunately, there have been no studies to date that have demonstrated a reliable method to reduce the incidence of seroma.…”

Definition and severity grading of postoperative lymphatic leakage following inguinal lymph node dissection

“…Techniques aiming to reduce complications are for example prophylactic vacuum-sealing therapy [ 20 ], sartorius transposition [ 10 , 21 ], or video-endoscopic minimally invasive inguinal lymphadenectomy (VEIL) [ 22 ] showing inconclusive results concerning the reduction of lymphatic leakage. Several previous RCTs have attempted to reduce lymphatic complications after RILND by employing hemostyptic agents, however, without using a consistent endpoint definition as confirmed by a current systematic review and meta-analysis [ 7 ]. A standardized definition of “postoperative lymphatic leakage after RILND” is necessary for any subsequent step to estimate the effect of prophylactic interventions to provide the patient with the best available operative technique and ultimately to achieve a better oncological outcome.…”

“…Our group reasons that a standardized classification would provide valuable information to guide further treatment. A systematic review and meta-analysis evaluating the benefit of applying tissue sealants to reduce postoperative lymphatic leakage after RILND in melanoma patients that was recently published by our study group points out that it is difficult to conduct a valid comparison of the results of the trials studied due to inhomogeneous endpoint definitions [7]. The studies that were included used different endpoints to describe lymphogenic morbidity.…”

The effect of fibrin glue on the postoperative lymphatic drainage after gastrectomy and D2 dissection: a randomized clinical trial

“…Gerken et al [29] ran a systematic review and meta-analysis to investigate the preventive effect of brincontaining tissue sealants on lymphocele formation after radical inguinal lymph node dissection in patients with melanoma. They used six clinical trials including 194 patients.…”