Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2017

Open Access 01-02-2017 | Melanomas

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

Authors: Marloes Faut, MD, Rianne M. Heidema, MD, Harald J. Hoekstra, MD, PhD, Robert J. van Ginkel, MD, PhD, S. Lukas B. Been, MD, PhD, Schelto Kruijff, MD, PhD, Barbara L. van Leeuwen, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2017

Login to get access

Abstract

Background

Inguinal 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.

Methods

A 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.

Results

One 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.

Conclusion

Changes 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.
Literature
1.
Baas PC, Schraffordt Koops H, Hoekstra HJ, van Bruggen JJ, van der Weele LT, Oldhoff J. Groin dissection in the treatment of lower-extremity melanoma: short-term and long-term morbidity. Arch Surg. 1992:127:281–6CrossRefPubMed
2.
de Vries M, Vonkeman WG, van Ginkel RJ, Hoekstra HJ. Morbidity after inguinal sentinel lymph node biopsy and completion lymph node dissection in patients with cutaneous melanoma. Eur J Surg Oncol. 2006:32:785–9CrossRefPubMed
3.
de Vries M, Hoekstra HJ, Hoekstra-Weebers JE. Quality of life after axillary or groin sentinel lymph node biopsy, with or without completion lymph node dissection, in patients with cutaneous melanoma. Ann Surg Oncol. 2009:16:2840–7CrossRefPubMedPubMedCentral
4.
Poos HP, Kruijff S, Bastiaannet E, van Ginkel RJ, Hoekstra HJ. Therapeutic groin dissection for melanoma: risk factors for short-term morbidity. Eur J Surg Oncol. 2009:35:877–83CrossRefPubMed
5.
van Akkooi AC, Bouwhuis MG, van Geel AN, et al. Morbidity and prognosis after therapeutic lymph node dissections for malignant melanoma. Eur J Surg Oncol. 2007:33:102–8CrossRefPubMed
6.
Sabel MS, Griffith KA, Arora A et. al. Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy. Surgery. 2007:141:728–35CrossRefPubMed
7.
Bartlett EK, Meise C, Bansal N, et al. Sartorius transposition during inguinal lymphadenectomy for melanoma. J Surg Res. 2013:184:209–15CrossRefPubMed
8.
Stuiver MM, Westerduin E, ter Meulen S, Vincent AD, Nieweg OE, Wouters MW. Surgical wound complications after groin dissection in melanoma patients: a historical cohort study and risk factor analysis. Eur J Surg Oncol. 2014:40:1284–90CrossRefPubMed
9.
Henderson MA, Burmeister BH, Ainslie J, et al. Adjuvant lymph-node field radiotherapy versus observation only in patients with melanoma at high risk of further lymph-node field relapse after lymphadenectomy (ANZMTG 01.02/TROG 02.01): 6-year follow-up of a phase 3, randomised controlled trial. Lancet Oncol. 2015:16:1049–60CrossRefPubMed
10.
Wevers KP, Poos HP, van Ginkel RJ, van Etten B, Hoekstra HJ. Early mobilization after ilio-inguinal lymph node dissection for melanoma does not increase the wound complication rate. Eur J Surg Oncol. 2013:39:185–90CrossRefPubMed
11.
Chang SB, Askew RL, Xing Y, et al. Prospective assessment of postoperative complications and associated costs following inguinal lymph node dissection (ILND) in melanoma patients. Ann Surg Oncol. 2010:17:2764–72CrossRefPubMedPubMedCentral
12.
Yu LL, Flotte TJ, Tanabe KK et. al. Detection of microscopic melanoma metastases in sentinel lymph nodes. Cancer. 1999:86:617–27CrossRefPubMed
13.
Faries MB, Thompson JF, Cochran A, et al. The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (I). Ann Surg Oncol. 2010:17:3324–9CrossRefPubMedPubMedCentral
14.
Knobben BA, van Horn JR, van der Mei HC, Busscher HJ. Evaluation of measures to decrease intraoperative bacterial contamination in orthopaedic implant surgery. J Hosp Infect. 2006:62:174–80CrossRefPubMed
15.
Guggenheim MM, Hug U, Jung FJ et. al. Morbidity and recurrence after completion lymph node dissection following sentinel lymph node biopsy in cutaneous malignant melanoma. Ann Surg. 2008:247:687–93CrossRefPubMed
16.
Beitsch P, Balch C. Operative morbidity and risk factor assessment in melanoma patients undergoing inguinal lymph node dissection. Am J Surg. 1992:164:462–5. discussion 465–6CrossRefPubMed
17.
Glarner CE, Greenblatt DY, Rettammel RJ, Neuman HB, Weber SM. Wound complications after inguinal lymph node dissection for melanoma: is ACS NSQIP adequate? Ann Surg Oncol. 2013:20:2049–55CrossRefPubMedPubMedCentral
18.
Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107:I9–6CrossRef
19.
Potretzke AM, Wong KS, Shi F, Christensen W, Downs TM, Abel EJ. Highest risk of symptomatic venous thromboembolic events after radical cystectomy occurs in patients with obesity or nonurothelial cancers. Urol Ann. 2015:7:355–60PubMedPubMedCentral
20.
Safdie FM, Dip F, Ardila-Gatas J, Moon S, Lo Menzo E, Szomstein S, Rosenthal R. Incidence and clinical implications of upper extremity deep vein thrombosis after laparoscopic bariatric procedures. Obes Surg. 2015:25:1098–101CrossRefPubMed
21.
Tran BH, Nguyen TJ, Hwang BH, et al. Risk factors associated with venous thromboembolism in 49,028 mastectomy patients. Breast. 2013:22:444–8CrossRefPubMed
22.
Parkin L, Sweetland S, Balkwill A, Green J, Reeves G, Beral V, Million Women Study Collaborators. Body mass index, surgery, and risk of venous thromboembolism in middle-aged women: a cohort study. Circulation. 2012:125:1897–904CrossRefPubMed
23.
Scalise A, Calamita R, Tartaglione C, et al. Improving wound healing and preventing surgical-site complications of closed surgical incisions: a possible role of Incisional Negative Pressure Wound Therapy. A systematic review of the literature. Int Wound J. 2015. doi:10.​1111/​iwj.​12492
24.
Booth HP, Prevost AT, Gulliford MC. Impact of body mass index on prevalence of multimorbidity in primary care: cohort study. Fam Pract. 2014:31:38–43CrossRefPubMed
25.
Delman KA, Kooby DA, Ogan K, Hsiao W, Master V. Feasibility of a novel approach to inguinal lymphadenectomy: minimally invasive groin dissection for melanoma. Ann Surg Oncol. 2010:17:731–7CrossRefPubMed
26.
Martin BM, Etra JW, Russell MC, et al. Oncologic outcomes of patients undergoing videoscopic inguinal lymphadenectomy for metastatic melanoma. J Am Coll Surg. 2014:218:620–6CrossRefPubMed
27.
Jakub JW, Terando AM, Sarnaik A, et al. Safety and feasibility of minimally invasive inguinal lymph node dissection in patients with melanoma (SAFE-MILND): report of a prospective multi-institutional trial. Ann Surg. 2016. doi:10.​1097/​SLA.​0000000000001670​
Metadata
Title
Morbidity After Inguinal Lymph Node Dissections: It Is Time for a Change
Authors
Marloes Faut, MD
Rianne M. Heidema, MD
Harald J. Hoekstra, MD, PhD
Robert J. van Ginkel, MD, PhD
S. Lukas B. Been, MD, PhD
Schelto Kruijff, MD, PhD
Barbara L. van Leeuwen, MD, PhD
Publication date
01-02-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5461-3

Other articles of this Issue 2/2017

Annals of Surgical Oncology 2/2017 Go to the issue

Gastrointestinal Oncology

Effects of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy and Neoadjuvant Intraperitoneal/Systemic Chemotherapy on Peritoneal Metastases from Gastric Cancer

Melanomas

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

Healthcare Policy and Outcomes

Impact of Location of Readmission on Outcomes After Major Cancer Surgery

Healthcare Policy and Outcomes

Racial and Socioeconomic Treatment Disparities in Adolescents and Young Adults with Stage II–III Rectal Cancer

Hepatobiliary Tumors

Predictive Profile-Nomogram for Liver Resection for Breast Cancer Metastases: An Aggressive Approach with Promising Results

Hepatobiliary Tumors

The Warsaw Proposal for the Use of Extended Selection Criteria in Liver Transplantation for Hepatocellular Cancer