Postoperative administration of octreotide to reduce lymphorrhea, lymphocele, lymphedema and lymphatic ascites after lymphadenectomy in gynecological malignancies
Authors:
V. Weinberger 1
; L. Minář 1
; M. Felsinger 1
; D. Seidlová 2; P. Ovesná 3; M. Bednaříková 4
; E. Jandáková 5; I. Rovný 6
Authors‘ workplace:
Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA
1; Anesteziologicko-resuscitační klinika LF MU a FN, Brno, přednosta prof. MUDr. R. Gál, Ph. D.
2; Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty MU, Brno, přednosta doc. RNDr. L. Dušek, Ph. D.
3; Interní hematologická a onkologická klinika LF MU a FN, Brno, přednosta prof. MUDr. J. Mayer, CSc.
4; Ústav patologie LF MU a FN, Brno, přednosta doc. MUDr. L. Křen, Ph. D.
5; Chirurgická klinika LF MU a FN, Brno, přednosta prof. MUDr. Z. Kala, CSc.
6
Published in:
Ceska Gynekol 2017; 82(2): 92-99
Overview
Introduction:
Octreotide is a synthetic analogue of natural somatostatin. Octreotide effect on lymphorrhea reduction in gynecological malignancies has only been assessed in case studies.
Design:
Original work.
Setting:
Gynecologic Oncology Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno.
Methods:
In 2014 there was a prospective, randomized, one-institution study. Patients underwent surgery including pelvic or pelvic and paraaortic lymphadenectomy for cervical, uterine and ovarian cancer. The informed consent was signed. Octreotide was evaluated in relation to diagnosis, surgery (laparoscopy versus laparotomy), pelvic and/or paraaortic lymphadenectomy, number of removed lymph nodes and their positivity, neoadjuvant chemotherapy, adjuvant chemotherapy, adjuvant radiotherapy, albumin, BMI, number of days with drains postoperatively, number of days in hospital, blood loss during surgery, time of surgery, total number of drains placed into abdominal cavity. In follow up period, within 1 year after surgery, we searched for lymphocele, lymphedema of lower extremities and lymphatic ascites in relation to lymphorrhea.
Results:
44 patients (9 cervical, 19 endometrial and 16 ovarian cancer) were enrolled in two statistically comparable randomized groups. „Octreotide group“, which paradoxically showed lymphorrhea of 4082 ml on average, (without 1992 ml, p = 0.001), needed drainage for more days (p = 0.001). The diagnosis had no influence on lymphorrhea in both groups (p = 0.966). The neoadjuvant chemotherapy was administered (p = 0.026), the more lymph nodes were removed (p = 0.018), the more days the drainage was in place (p < 0.001), the bigger the lymphorrhea; no relationship between lymphorrhea and age (p = 0.631), albumin level (p = 0.584), BMI ( p= 0.966) or number of positive nodes (p = 0.259), length of surgery (p = 0.206), blood loss (p = 0.494). Nor lymphedema (p = 0.404), nor lymphocele (p = 0.086), correlated with postoperative lymphorrhea. Lymphatic ascites was associated with lymphorrhea (p = 0.048).
Conclusion:
Octreotide did not reduce lymphorrhea and the incidence of lymphocele, lymphedema of lower extremities and lymphatic ascites within one year of follow-up period after surgery. According to our results, we do not recommend to administer the octreotide in oncogynecological patients after pelvic and/or paraaortic lymphadenectomy.
Keywords:
lymphadenectomy, lymphatic ascites, lymphedema, lymphocele, octreotide
Sources
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