Prospective Randomized Study to Compare Lymphocele and Lymphorrhea Control Following Inguinal and Axillary Therapeutic Lymph Node Dissection With or Without the Use of an Ultrasonic Scalpel

Matthey-Giè, Marie-Laure; Gié, Olivier; Deretti, Sona; Demartines, Nicolas; Matter, Maurice

doi:10.1245/s10434-015-5025-y

Cited by 23 publications

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“…Adwani et al, and several subsequent studies report no statistically significant reduction in the drainage volume and rate of seroma development [10, 25–30]. Furthermore, a recent trial [19] has shown a higher rate of lymphoedema after lymphatic dissection conducted with ultrasonic scalpels. The higher rate of lymphoedema in the ultrasonic scalpel group was thought to be explained by an oversealing of the lymphatic vessels.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the Ultrasonic scalpel on the amount of drained lymph after axillary or inguinal lymphadenectomy

et al. 2017

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BackgroundSeroma formation and lymphoedema are frequently encountered complications after radical lymph node dissection (RLND). Attempts to reduce the lymphatic morbidity include the use of Ultrasonic Scalpel. The aim of the present analysis was to assess the impact of the ultrasonic scalpel on the amount of drained lymph after lymph node dissection.MethodsPatients listed for a RLND or completion lymph node dissection (CLND) were enrolled in a prospective randomized trial to compare the impact of two surgical dissection techniques (USS versus control) on the amount of drained lymph. The lymph drained in 24 h was collected. Our primary endpoint was to compare the daily amount of drained lymph between the two groups. Secondary endpoints were the comparison of drained lymph with the BMI of the patients, the gender and the surgical site (axilla, groin).ResultsEighty patients were randomly assigned to the USS group or the Control (C) group. No difference was measured in the total amount of lymph drained (USS: 2908 ± 2453 ml vs. C: 3898 ± 5791 ml; p-value = 0.382). The result was also similar after adjusting for gender, age, and BMI. A significant higher amount of lymph was measured after inguinal dissection with USS compared to axillary (p < 0.001).ConclusionThe study suggests that the use of Harmonic scalpel did not influence the amount of lymph drained after RLND and not support the theory that USS induces oversealing of lymphatics.Trial registrationClinical Trial NCT02476357. Registered 20 of February 2015.

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Section: Discussionmentioning

confidence: 99%

“…Consenting patients were randomised into two treatment arms, a USS group and a control group. Details of the study design have been published previously [19]. The study protocol was accepted by the local ethics committee and registered under ClinicalTrials.gov (trial no.…”

Section: Methodsmentioning

confidence: 99%

Impact of the Ultrasonic scalpel on the amount of drained lymph after axillary or inguinal lymphadenectomy

et al. 2017

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“…Nem ismert az sem, hogy a blokkdisszekció kiterjesztése az indikációnak megfelelően biztonságosan módosítható-e (blokkdisszekció pozitív SLN után, tapintható nyirokcsomó/k miatt, vagy palliatív célból a tumor lokális kontrolljára távoli metsztázisok mellett) a beavatkozás szövődményeinek csökkentése céljából. Ezt a kérdést többen is vizsgálták (55)(56)(57).…”

Section: Regionális Blokkdisszekcióunclassified

Progress in the surgical treatment of cutaneous melanoma

Kis¹,

Kádár²,

Juhász³

2017

BVSZ

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A melanoma malignum kezelésében a korábbi mechanikus szemléletet felváltotta az ún. biológiai szemlélet, melynek során a szervezet tumorellenes mechanizmusait igyek szünk támogatni. Ez a szemléletváltás a melanoma sebészeti kezelésben a primer tumor körüli biztonsági zóna lecsökkentéséhez és az őrszem (sentinel) nyirokcsomó biopszia bevezetéséhez vezetett. A melanoma terápiájában manapság a sebészre négy meghatározó feladat hárul: a primer tumor eltávolítása, sentinel nyirokcsomó biopszia valamint blokkdisszekció elvégzése és a bőrmetasztázisok sebészi ellátása. Jelen összefoglaló közleményben a szerzők a legfrissebb nemzetközi irányelvek, tudományos eredmények és saját gyakorlatuk alapján részletes áttekintést nyújtanak a melanoma műtéti ellátásáról, beszámolnak a nem rezekábilis bőráttétek kezelésében hasz nálatos új eljárásról, a hazánkban is elérhető elektrokemoterápiáról. Kulcsszavak: melanoma malignum-biztonsági zónasentinel nyirokcsomó-blokkdisszekció-elektrokemoterápia SUMMARY Recently the biological approach dominates in the treatment of malignant melanoma, which means the support of the antitumor defense of the organism. This view has led to diminished safety margins at the removal of the primary tumor and introduction of sentinel lymph node biopsy. Nowadays surgeons have four main tasks in the treatment of melanoma: excision of primary tumor, sentinel lymph node biopsy, regional lymph node dissection, and surgical treatment of the metastases. Based on the latest international guidelines, published data, and best practices authors summarize the current surgical therapies of cutaneous malignant melanoma, and also account on electrochemotherapy, which is a new, effective treatment of the irresecable cutaneous metastases.

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“…[1][2][3][4][5][6][7][8][9] arguably, inguinal lymphadenectomy has been a lightning rod for this debate because of the high morbidity that has repeatedly been reported from this procedure. The authors of this editorial admittedly have contributed to the ongoing rhetoric by developing and reporting a novel approach to inguinal lymphadenectomy.…”

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confidence: 99%

“…[3][4][5][6][7][8][9] Arguably, the optimal way to reduce complications is to avoid surgery altogether. Two trials, the Multicenter Selective Lymphadenectomy Trial-II and the EORTC's MiniTub registry trial, prospectively are analyzing the outcome of patients who do not undergo completion lymphadenectomy after a positive sentinel lymph node biopsy (SLNB).…”

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confidence: 99%

Revisiting the Strait of Messina: The Balance Between Optimal Oncologic Outcomes and Complications From Surgery

Delman

Lowe

2016

Ann Surg Oncol

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Prospective Randomized Study to Compare Lymphocele and Lymphorrhea Control Following Inguinal and Axillary Therapeutic Lymph Node Dissection With or Without the Use of an Ultrasonic Scalpel

Abstract: The use of USS failed to offer any significant reduction in length of drain usage and operative complication, but it seems to increase the rate of lymphedema formation.

Cited by 23 publications

References 20 publications

Impact of the Ultrasonic scalpel on the amount of drained lymph after axillary or inguinal lymphadenectomy

Impact of the Ultrasonic scalpel on the amount of drained lymph after axillary or inguinal lymphadenectomy

Progress in the surgical treatment of cutaneous melanoma

Revisiting the Strait of Messina: The Balance Between Optimal Oncologic Outcomes and Complications From Surgery

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