Incidence and therapy of lymphoceles after pelvic and paraaortic lymph node dissection – our file
Authors:
Z. Felsingerová; L. Minář
; V. Weinberger
Authors‘ workplace:
Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA
Published in:
Ceska Gynekol 2014; 79(5): 388-392
Overview
Objective:
Analysis of lymphocele´s incidence and therapy among the patients, who underwent systematic pelvic and paraaortic lymphadenectomy during the years 2010–2012 in Oncogynecological centre of Department of Gynecology and Obstetrics in Brno.
Design:
Retrospective study.
Setting:
Department of Gynecology and Obstetrics, Masaryk University Hospital Brno.
Methods:
We retrospectively evaluated the file of 111 patients, who underwent pelvic and/or paraaortic lymphadenectomy during the years 2010–2012 in our clinic. These patients were observed for the incidence of lymphoceles proved by ultrasonography. We focused on the incidence of symptomatic lymphoceles from all detected lymphoceles in the file of patients and we searched for relation between their presence and the type of systematic lymphadenectomy (pelvic or paraaortic) and the type of gynecological tumor and we report their management.
Results:
During the years 2010–2012 we provided 111 lymphadenectomies consisting of: 78 pelvic and 33 pelvic and paraaortic lymphadenectomies in our clinic. These patients were rewied for retrospective study. We reported 37 cases of lymphoceles (33.3%) detected by vaginal or transabdominal ultrasonography. Among all patients with lymphoceles, we observed 24 asymptomatic patients and 13 patients with clinical features. There were 11.7% symptomatic lymphoceles from overall count. Only these symptomatic patients underwent therapy including simple punction or surgery management.
Among all patients with lymphoceles, we reported the presence of lymfoceles by 19 patients with ovarian cancer (51.4%), 12 patients with cancer of cervix (32.4%), 4 patients with cancer of uterus (10.8%), one patient with cancer of salpinx and one patient with cancer of peritoneum (both 2.7%). We did not register statistically important dependence of lymphocele´s incidence on the type of lymphadenectomy (pelvic and/or paraaortic) – difference of 4.31%.
Conclusion:
Asymptomatic lymphoceles do not represent such a risk for patients after lymphadenectomy such as lymphoceles with clinical symptoms, which need to be followed by therapy. We proved incidence of lymphoceles 33.3%. There were 11.7% symptomatic lymphoceles among all patients after systematic lymph-adenectomy.
In the future, it is necessary to standardize the condi-tions, used to indicate systematic lymphadenectomy to ensure safety of the oncological procedure and at the same time not to increase postoperative morbidity of patients. Going forward the topic of lymphocel´s prevention and detection of their valid risk and protective factors requires further prospective studies divided into single types of gynecological malignant tumors.
Keywords:
pelvic and paraaortic lymphadenectomy, lymphoceles, incidence
Sources
1. Achouri, A., Huchon, C., Bats, AS., et al. Complications of lymphadenectomy for gynecological cancer. Eur J Surg Oncol, 2013, 39(1), p. 81–88.
2. Benedetti-Panici, P., Maneschi, F., Cutillo, G., et al. A randomized study comparing retroperitoneal drainage with no drainage after lymphadenectomy in gynecologic malignancies. Gynecol Oncol, 1997, 65(3), p. 478–482.
3. Franchi, M., Trimbos, JB., Zanaboni, F., et al. Randomised trial of drains versus no drains following radical hysterectomy and pelvic lymph node dissection: A European Organisation for Research and Treatment of Cancer Group (EORTCC- GCG) study in 234 patients. Eur J Cancer, 2007, 43(8), p. 1265–1268.
4. Gallotta, V., Fanfani, F., Rossitto, C., et al. A randomized study comparing the use of the Ligaclip with bipolar energy to prevent lymphocele during laparoscopic pelvic lymphadenectomy for gynecologic cancer. Am J Obstet Gynecol, 2010, 203(5), 483, e481–e486
5. Ghezzi, F., Uccella, S., Cromi, A., et al. Lymphoceles, lymphorrhoea, and lymphedema after laparoscopic and open endometrial cancer staging. Ann Surg Oncol, 2012, 19(1), p. 259–267.
6. Kim, HY., Kim, JW., Kim, SH., et al. An analysis of the risk factors and management of lymphocele after pelvic lymphadenectomy in patients with gynecologic malignancies. Cancer Res Treatment, 2004, 36(6), p. 377–383.
7. Ilancheran, A., Monaghan, JM. Pelvic lymphocyst – a 10 year experience. Gynecol Oncol, 1988, 29, p. 333–336.
8. Kim, HY., Kim, JW., Kim, SH., et al. An analysis of the risk factors and management of lymphocele after pelvic lymphadenectomy in patients with gynecologic malignancies. Cancer Res Treatment: official journal of Korean Cancer Association 2004, 36(6), p. 377–383.
9. Logmans, A., Kruyt, RH., De Bruin, HG., et al. Lymphedema and lymphocysts following lymphadenectomy may be prevented by omentoplasty: A pilot study. Gynecol Oncol, 1999, 75(3), p. 323–327.
10. Lucewicz, A., Wong, G., Lam, VW., et al. Management of primary symptomatic lymphocele after kidney transplantation: a systematic review. Transplantation, 2011, 92(6), p. 663–673.
11. Petru, E., Tamussino, K., Lahousen, M., et al. Pelvic and paraaortic lymphocysts after radical surgery because of cervical and ovarian cancer. Am J Obstet Gynecol, 1989, 161(4), p. 937–941.
12. SimonatoHYPERLINK „http://www.ncbi.nlm.nih.gov/pubmed?term=Simonato%20A%5BAuthor%5D&cauthor=true&cauthor_uid=19762048“ A, Varca V, Esposito M, Venzano F, Carmignani G. The use of a surgical patch in the preventionof lymphoceles after extraperitoneal pelvic lymphadenec-tomy for prostate cancer: a randomized prospective pilot study. J HYPERLINK „http://www.ncbi.nlm.nih.gov/pubmed/19762048“Urol 2009, 182(5), p. 2285–2290.
13. Tinelli, A., Mynbaev, OA., Tsin, DA., et al. Lymphocele prevention after pelvic laparoscopic lymphadenectomy by a collagen patch coated with human coagulation factors: a matched case-control study. Int J Gynecol Cancer, 2013, 23(5), p. 956–963.
14. Varga, Z., Hegele, A., Olbert, P., et al. Laparoscopic peritoneal drainage of symptomatic lymphoceles after pelvic lymph node dissection using methylene blue installation. Urol Int, 2006, 76, p. 335–338.
15. Weinberger, V., Zikán, M., Cibula, D. Lymphocele: prevalence and management in gynecological malignancies: Expert Rev Anticancer Ther, 2014, 3, p. 307–317.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2014 Issue 5
Most read in this issue
- Condylomata acuminata (genital warts)
- Preeclampsia in pregnancy – prediction, prevention and further management
- Vaginal breech delivery after 36 week of pregnancy in a selected group of pregnancy – analysis of perinatal results in years 2008–2011
- Extramammary Paget´s disease of the vulva – a case report