Impact of Surgical Route in Influencing the Risk of Lymphatic Complications After Ovarian Cancer Staging

Bogani, Giorgio; Borghi, Chiara; Ditto, Antonino; Signorelli, Mauro; Martinelli, Fabio; Chiappa, Valentina; Scaffa, Cono; Perotto, Stefania; Maggiore, Umberto Leone Roberti; Montanelli, Luca; Donato, Violante Di; Infantino, Carmelo; Lorusso, Domenica; Raspagliesi, Francesco

doi:10.1016/j.jmig.2017.03.014

Cited by 19 publications

(14 citation statements)

References 28 publications

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“…observed that patients undergoing laparoscopy experienced a longer operative time without statistically significant (weighted mean difference 28.3 min; 95% confidence interval [CI], 2 2.59–59.2). [ 33 ]…”

Section: R Esult and Discussionmentioning

confidence: 99%

“…The systematic reviews and meta-analysis studies supported that laparoscopic technique offers more benefits regarding perioperative morbidity compared with laparotomy [ Table 3 ]. The patients undergoing laparoscopy experienced a significantly lower EBL[ 30 32 33 ] and transfusion requirement. [ 32 ] No statistically significant difference regarding the intraoperative complication.…”

Section: R Esult and Discussionmentioning

confidence: 99%

“…[ 32 ] No statistically significant difference regarding the intraoperative complication. [ 32 33 ] The most impressive benefit of laparoscopic surgery appears to be in postoperative period. All of meta-analysis studies revealed that laparoscopic staging is associated with lower postoperative complication and lower hospital stay as well as shorter interval time to chemotherapy administration.…”

Section: R Esult and Discussionmentioning

confidence: 99%

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Is it the time for laparoscopic management of early-stage ovarian malignancies?

Tantitamit

Lee

2018

Gynecol Minim Invasive Ther

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The laparoscopic management of early-stage ovarian cancer remains controversial. Some surgeons hesitate to perform laparoscopic staging due to concern with the adequacy of staging, the possibility of tumor spillage and risk of port-site metastasis. Previous studies and literature reviews have reinforced the argument and supported the use of laparoscopy. However, the results were drawn with limited sample size obtained from case-series and case–control studies which result in difficult to make definite conclusions. Till date, the list of laparoscopic procedures has grown at a pace consistent with improvements in technology and technical skill of the surgeon. The number of studies with larger sample size, more prospective data, and longer duration of follow-up has been increasing. This review serves as an update on safety, feasibility, surgical, and oncological outcomes in cases of early-stage ovarian cancer treated by laparoscopic surgery of the literature published since 2008. We aim to clarify whether laparoscopy is safe and effective enough to be considered as standard management. Rely on nonrandomize studies, the current clinical evidence supports the role of laparoscopy in the management of early-stage ovarian cancer. Laparoscopy appears to offer several perioperative benefits without compromise of surgical morbidity and oncological outcome.

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Section: R Esult and Discussionmentioning

confidence: 99%

Section: R Esult and Discussionmentioning

confidence: 99%

Section: R Esult and Discussionmentioning

confidence: 99%

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Is it the time for laparoscopic management of early-stage ovarian malignancies?

Tantitamit

Lee

2018

Gynecol Minim Invasive Ther

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“…The permanent existence of a lymphocele allows the trends for the formation of an infected lymphocele. However, the incidence of post-operative lymphocele has been greatly reduced because of laparoscopic approaches and new technologies such as ultracision and ligaclip, which were introduced as prophylactic strategies for preventing lymphatic complications [8, 9]. …”

Section: Discussionmentioning

confidence: 99%

“…While the discovery of lymphocele by physical examination or imaging before infections formation might be earlier in the infected group than non-infected because that most (70%) of the infected lymphoceles were larger in size (diameter > 60 mm). Kim et al [9]. reported that all lymphoceles with a diameter of < 6 cm were asymptomatic, whereas lymphoceles with a diameter exceeding 6 cm were symptomatic and 69% (9/13) were infected.…”

Section: Discussionmentioning

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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