Morbidity After Inguinal Lymph Node Dissections: It Is Time for a Change

Abstract

BackgroundInguinal lymph node dissection (ILND) for stage 3 melanoma is accompanied by high wound complication rates. During the past decades, several changes in perioperative care have been instituted to decrease the incidence of these complications. This study aimed to evaluate the effect of these different care protocols on wound complications after ILND.MethodsA retrospective analysis of prospectively collected data was performed with 240 patients who underwent an ILND in the University Medical Center Groningen between 1989 and 2014. Four groups with different treatment protocols were analyzed: A (≥10 days of bed rest with a Bohler Braun splint), B (10 days of bed rest without a splint), C (5 days of bed rest), and D (1 day of bed rest). The effect of early mobilization, abolishment of the Bohler Braun splint and postural restrictions, and the introduction of prophylactic antibiotics were analyzed.ResultsOne or more wound complications occurred in 51.2 % of the patients including wound infection (29.8 %), seroma (21.5 %), wound necrosis (13.6 %), and hematoma (5 %). In consecutive periods, respectively 44.4, 60.3, 44.9 and 55.2 % of the patients experienced wound complications. None of the instituted changes in protocols led to a decrease in wound complications.ConclusionChanges in perioperative care protocols did not affect the rate of wound complications. Perhaps a change in the surgical procedure itself can lead to the necessary reduction of wound complications after ILND.

Prevention of seroma following inguinal lymph node dissection with prophylactic, incisional, negative-pressure wound therapy (SEROMA trial): study protocol for a randomized controlled trial

“…While a long-term survival comparison is still pending, complete dissection provides better regional disease control and could be advocated for patients with a greater tumor burden, and the general opinion is that patients with larger metastases should still undergo lymph node dissection if no evidence of distant metastases. Patients undergoing dissection of the groin lymph nodes are particularly prone to postoperative morbidity and previous studies have suggested conservative and minimally invasive ILND protocols [ 22 , 23 ] however, these have yet to achieve broad acceptance due to the risk of compromising oncological safety. In this study, the ILND procedure is performed according to the national guidelines in Denmark, and, therefore, does not vary between study groups.…”

Protection of femoral vessels and vascular grafts after inguinal lymphadenectomy or femoral bypass by using prophylactic routine sartorius muscle flap shield coverage

“…These may be attributed mainly to the potentially contaminated groin area, division of the blood supply to the skin flaps, interruption of collateral lymphatics and the presence of a large dead space in the femoral triangle giving chance for serous or lymphatic collection. 7,[12][13][14][15] In the previous era, the treatment of groin infected grafts was total excision of the graft with massive debridement and extra-anatomical bypass. Limb loss and mortality rates were reported as 10% -79% and 9% -58%, respectively.…”

Recent advances in the management of penile cancer

“…The ability to operatively target the sentinel node allows PC surgeons to reliably diagnose and treat metastatic disease whilst avoiding the significant morbidity of groin dissection in certain patients 19 . Patients undergoing dynamic sentinel node sampling are able to undergo a day surgery procedure through excellent teamwork between nuclear medicine radiologists and surgeons whereas those undergoing groin dissection typically have a much longer length of stay 20 .…”

“…We now know that this could lead to a critical delay in the treatment of PC. Palpable nodes are now rapidly investigated with CT scanning and ultrasound-guided fine-needle aspiration cytology or biopsy 19 .…”