Octreotide in the Treatment of Lymphorrhea After Renal Transplantation: A Preliminary Experience

Capocasale, E.; Busi, N.; Valle, Raffaele Dalla; Mazzoni, M.P.; Bignardi, L; Maggiore, Umberto; Buzio, Carlo; Sianesi, M

doi:10.1016/j.transproceed.2006.03.040

Cited by 26 publications

(22 citation statements)

References 13 publications

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“…In the last decade, several measures have been suggested to prevent lymph leakage: closed suction drain, sclerotherapy, talc poudrage, fibrin sealant, i.m. injection of octeotride, pressure dressings, careful ligation of lymphatic vessels and avoiding the use of electrocautery [21–29]. The use of such measures might be pushed by the consciousness that a CSL and lymphorrhoea should be expected after surgery.…”

Section: Discussionmentioning

confidence: 99%

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How can we predict lymphorrhoea and clinically significant lymphocoeles after radical prostatectomy and pelvic lymphadenectomy? Clinical implications

et al. 2010

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surgeon, pathological T and N stage) and the presence of CSL.• Univariable and multivariable linear regression models were also used to test the association between the available predictors and lymphorrhoea. RESULTS• The median (range) number of LNs removed was 20 (1-63). Both linear and logistic multivariable regression analysis showed that the number of removed LNs and age were the only two statistically significant predictors of total amount of lymphorrhoea and CSL after RRP and PLND (both P < 0.01).• Specifically, the risk of developing a CSL increased by 5% for every LN removed. Similarly, every year of age increased the risk of having CSL by 5%.• The most informative thresholds for predicting CSL were 65 years of age and 20 LNs removed.• External iliac lymphadenectomy resulted in a higher associated risk of lymphorrhoea and CLS relative to obturator LN removal ( P = 0.001 vs P = 0.1, respectively). CONCLUSIONS• There was a positive association between the number of LNs removed and age at RRP with the amount of lymphorrhoea and the risk of developing a CSL.• The most informative thresholds in predicting CSL were 65 years of age and 20 LNs removed. External iliac lymphadenectomy resulted in a higher risk of lymphorrhoea and CLS relative to obturator LN removal. KEYWORDS prostate cancer, lymphadenectomy, lymphocoele, lymphorrhoeaWhat's known on the subject? and What does the study add? Lymphorrhoea is the leakage of lymph out of drains after surgery and may affect the perioperative period after retropubic radical prostatectomy (RRP) and extended pelvic lymphadenectomy (PLND). Similarly, lymphoceles represent a common complication after RRP and PLND, although only in few cases do lymphoceles become symptomatic.In the current study, the amount of lymphorrhoea and the risk of CSL in patients treated with RRP and PLND were prospectively assessed. Moreover, individual factors which can predict lymphorrhoea, CSL and total days of drainage, were identified, in order to improve treatment decision-making in PCa patients. Indeed, to foresee lymphorrhoea and CSL after RRP and PLND may assist clinicians in selecting the most appropriate surgical technique and the most proper management in the post-operative period, when surgery is performed.Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVE

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

How can we predict lymphorrhoea and clinically significant lymphocoeles after radical prostatectomy and pelvic lymphadenectomy? Clinical implications

et al. 2010

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“…Various efforts have been made to treat post‐transplant lymphoceles with percutaneous aspiration or drainage with or without sclerotherapy. Although the use of sclerosants such as ethanol, fibrin sealant, gentamicin, or octreotide reduced the recurrence rate compared to simple aspiration (33–35), the recurrence rate is still high. In their series with 63 symptomatic lymphoceles, Bischof et al.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic lymphoceles after kidney transplantation – multivariate analysis of risk factors and outcome after laparoscopic fenestration

Ulrich

Niedźwiecki

Fikatas

et al. 2010

Clinical Transplantation

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Lymphocele formation is a common complication after kidney transplantation, and laparoscopic surgery has become a widely accepted treatment option. The aim of this retrospective study was to analyze the risk factors of lymphocele development and to assess the treatment outcome after laparoscopic fenestration. We analyzed 426 renal allograft recipients operated between 2002 and 2006 receiving triple immunosuppression with calcineurin inhibitors. The incidence of lymphocele was 9.9%, while 24 (5.6%) patients with symptomatic lymphoceles required laparoscopic surgery. Serum creatinine at diagnosis was significantly higher in patients with lymphoceles treated surgically (3.2 +/- 0.7 vs. 1.7 +/- 0.6 mg/dL; p < 0.001). After successful laparoscopic intervention, creatinine concentrations recovered until discharge and were comparable to other patients (1.6 +/- 0.5 vs. 1.5 +/- 0.5 mg/dL; p = NS). While we observed a significant association of lymphocele formation with diabetes, tacrolimus therapy, and acute rejection in univariate testing, only diabetes remained a significant factor after multivariate analysis. Laparoscopic fenestration proved to be a safe and efficient method without any associated mortality and a low recurrence rate of 8.3% (n = 2). We conclude that diabetes is an independent risk factor for lymphocele development, and laparoscopic fenestration should be the treatment of choice for larger and symptomatic lymphoceles, as it is safe and offers a low recurrence rate.

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“…Beneficial effects of a somatostatin analogue, octreotide, in the treatment of postoperative lymphorrhea have been previously reported [1][2][3]. Here, we report the successful use of a long-acting somatostatin analogue, lanreotide, as a new treatment of lymphorrhea following an aortic valve replacement.…”

Section: Introductionmentioning

confidence: 74%

“…A standard approach involves bed rest, leg elevation, prophylactic antibiotics and simple drainage with or without pressure dressings. However, these methods entail a high recurrence rate and often fail to control the lymphatic leak, leading to prolonged hospital stays, increased risk of infection and thus, increased costs [2,3]. More invasive procedures such as repeated aspiration or injection of sclerosing agents may be painful and further increase the risk of infection.…”

Section: Discussionmentioning

confidence: 99%

The use of lanreotide in the management of lymphorrhea after an aortic valve replacement

Lemaı̂tre

Segers

Lebrun

2012

Interactive CardioVascular and Thoracic Surgery

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Lymphorrhea is a rare but potentially serious complication following various surgical procedures. Uncontrolled lymph drainage may lead to infection and prolonged hospital stay. Currently, there is no standard effective treatment. Early management usually involves bed rest, drainage and pressure dressings. These methods are associated with prolonged recovery and high recurrence rates. We report a case of lymphorrhea from the groin wound after an aortic valve replacement. The patient presented with significant lymph drainage from the postoperative inguinal wound. Lymphorrhea was successfully treated with a long-acting somatostatin analogue, lanreotide. No recurrence was observed after 1 and 6 months of patient follow-up. This case report demonstrates the successful use of lanreotide in the control of lymphorrhea following groin dissection for vascular access.

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Octreotide in the Treatment of Lymphorrhea After Renal Transplantation: A Preliminary Experience

Cited by 26 publications

References 13 publications

How can we predict lymphorrhoea and clinically significant lymphocoeles after radical prostatectomy and pelvic lymphadenectomy? Clinical implications

How can we predict lymphorrhoea and clinically significant lymphocoeles after radical prostatectomy and pelvic lymphadenectomy? Clinical implications

Symptomatic lymphoceles after kidney transplantation – multivariate analysis of risk factors and outcome after laparoscopic fenestration

The use of lanreotide in the management of lymphorrhea after an aortic valve replacement

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