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McMillan AT, Ho NX, Izard C, Matteucci PL, Totty JP. The incidence and cost implications of surgical site infection following lymph node surgery for skin malignancy. J Plast Reconstr Aesthet Surg 2023; 87:341-348. [PMID: 37925925 DOI: 10.1016/j.bjps.2023.10.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/23/2023] [Accepted: 10/07/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Lymph node surgery is commonly performed in the staging and treatment of metastatic skin cancer. Previous studies have demonstrated sentinel lymph node biopsy (SLNB) and, particularly, lymph node dissection (LND) to be plagued by high rates of wound complications, including surgical site infection (SSI) and seroma formation. This study evaluated the incidence of wound complications following lymph node surgery and provided the first published cost estimate of SSI associated with lymph node surgery in the UK. PATIENTS AND METHODS A retrospective cohort study of 169 patients with a histological diagnosis of primary skin malignancy who underwent SLNB or LND of the axilla and/or inguinal region at a single tertiary centre over a 2 year period was conducted. Demographic, patient risk factor, and operation characteristics data were collected and effect on SSI and seroma formation was analysed. Cost-per-infection was estimated using National Health Service (NHS) reference and antibiotic costs. RESULTS A total of 146 patients underwent SLNB with a SSI rate of 4.1% and a seroma incidence of 12.3%. Twenty-three patients underwent LND with a SSI rate of 39.1% and a seroma incidence of 39.1%. Seroma formation was strongly associated with the development of SSI in both the SLNB (odds ratio (OR) = 18.0, p < 0.001) and LND (OR = 21.0, p = 0.007) group. The median additional cost of care events and treatment of SSI in the SLNB and LND groups was £199.46 and £5187.04, respectively. CONCLUSION SSI remains a troublesome and costly event following SLNB and LND. Further research into perioperative care protocols and methods of reducing lymph node surgery morbidity is required and could result in significant cost savings to the NHS.
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Affiliation(s)
- Angus T McMillan
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, United Kingdom.
| | - Ning Xuan Ho
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, United Kingdom
| | - Charlie Izard
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, United Kingdom
| | - Paolo L Matteucci
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, United Kingdom
| | - Joshua P Totty
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, United Kingdom; Centre for Clinical Sciences, Hull York Medical School, Hull HU6 7RX, United Kingdom
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2
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Does Preventive Negative Pressure Wound Therapy (NPWT) reduce local complications following Lymph Node Dissection (LND) in the management of metastatic skin tumors? J Plast Reconstr Aesthet Surg 2022; 75:4403-4409. [PMID: 36283927 DOI: 10.1016/j.bjps.2022.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/15/2022] [Accepted: 08/16/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Axillary and inguinal lymph node dissection (LND) are performed in metastatic skin tumors with several local complications, such as lymphorrhea, lymphoceles, and lymphedema. The purpose of this study is to determine whether negative pressure wound therapy (NPWT) applied as a preventive measure could improve outcomes. MATERIALS AND METHODS A monocentric study included patients who underwent axillary or inguinal LND from May 2010 to March 2020, with a retrospective evaluation of prospectively collected data. Patients were divided into two groups: the conventional wound care (CWC) and the NPWT groups. Patients were systematically reviewed at D7, D30, and at 1 year postoperative, and data regarding lymphorrhea, lymphoceles, and lymphedema were collected. RESULTS A total of 109 axillary and inguinal LND were performed. NPWT was applied on 68 LND and CWC on 41 LND. The variables, diabetes, smoking, gender, associated treatments, and primary pathology (melanoma, squamous cell carcinoma, or Merkel tumors) were similar in both groups. Analyses have shown a significant difference in the rate of scar disunion during the first month between the two groups (p=0.045 between D1 and D7; p=0.011 between D8 and D30), as well as the presence of lymphorrhea (p=0.000 between D1 and D7; p=0.002 between D8 and D30). The rate of lymphoedema was significantly reduced in the NPWT group versus CWC (p=0.000 between D8 and D30; p=0.034 between D31 and 1 year). CONCLUSION NPWT reduces local complications (scar disunion, lymphorrhea, and lymphedema) during the first year following LND in the management of node metastatic skin tumors.
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3
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Savoie PH, Murez T, Neuville P, Ferretti L, Rocher L, Van Hove A, Camparo P, Fléchon A, Branger N, Rouprêt M. French AFU Cancer Committee Guidelines - Update 2022-2024: penile cancer. Prog Urol 2022; 32:1010-1039. [PMID: 36400476 DOI: 10.1016/j.purol.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/24/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To update French oncology guidelines concerning penile cancer. METHODS Comprehensive Medline search between 2020 and 2022 upon diagnosis, treatment and follow-up of testicular germ cell cancer to update previous guidelines. Level of evidence was evaluated according to AGREE-II. RESULTS Epidermoid carcinoma is the most common penile cancer histology. Physical examination is mandatory to define local and inguinal nodal cancer stage. MRI with artificial erection can help to assess deep infiltration in cases of organsparing intention. Node negative patients (defined by palpation and imaging) will present micro nodal metastases in up to 25% of cases. Invasive lymph node assessment is thus advocated except for low risk patients. Sentinel node dynamic biopsy is the first line technique. Modified bilateral inguinal lymphadenectomy is an option with higher morbidity. 18-FDG-PET is recommended in patients with palpable nodes. Chest, abdominal and pelvis computerized tomography is an option. Fine needle aspiration (when positive) is an easy way to assess inguinal palpable node pathological involvement. Its results determine the type of lymphadenectomy to be performed (for diagnostic or curative purposes). Treatment is mostly surgical. Free margins status is essential, but it also has to be organ-sparing when possible. Brachytherapy and topic agents can cure in selected cases. Lymph node assessment should be synchronous to the removal of the tumour when possible. Limited inguinal lymph node involvement (pN1 stage) can be cured with the only lymphadenectomy. In case of larger lymph node stage, one should consider multidisciplinary treatment including chemotherapy and inclusion in a trial. CONCLUSIONS Penile cancer needs demanding surgery to be cured, surrounded by chemotherapy in node positive patients. Lymph nodes involvement is a major prognostic factor. Thus, inguinal node assessment cannot be neglected.
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Affiliation(s)
- P H Savoie
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon Cedex 09, France.
| | - T Murez
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier Cedex 5, France
| | - P Neuville
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - L Ferretti
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - L Rocher
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, APHP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Van Hove
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Hôpital Européen, 6, rue Désirée-Clary, 13003 Marseille, France
| | - P Camparo
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - A Fléchon
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - N Branger
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut Paoli-Calmettes, 232, Boulevard Sainte Marguerite, 13273 Marseille, France
| | - M Rouprêt
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Nonoperative Management of a Recurrent Postoperative Inguinal Lymphatic Leak via Negative-Pressure Wound Therapy: A Case Report. Adv Skin Wound Care 2021; 34:1-3. [PMID: 34546209 DOI: 10.1097/01.asw.0000775928.63723.3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Lymphatic leaks are common following common femoral vessel exposure for cardiac surgical procedures. The management of this complication can be difficult and is often uncomfortable for the patient. This case report describes the successful nonoperative treatment of a recurrent lymphatic leak from an inguinal surgical wound via negative-pressure wound therapy. Negative pressure may be considered a minimally invasive, effective, and acceptable way to treat postoperative lymphatic leaks at the groin.
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5
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Ravisankar P, Malik K, Raja A, Narayanaswamy K. Clipping inguinal lymphatics decreases lymphorrhoea after lymphadenectomy following cancer treatment: results from a randomized clinical trial. Scand J Urol 2021; 55:480-485. [PMID: 34553670 DOI: 10.1080/21681805.2021.1980096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Post-operative lymphorrhea is a well-known complication of inguinal lymph node dissection. However, the interventions to reduce the duration of drain in situ have not been sufficiently elaborated. OBJECTIVES We evaluated the potential role of intra-operative mapping of lymphatic leakage with peri-incisional methylene blue injection and clipping of lymphatics after inguinal block dissection in reducing postoperative lymphorrhea. METHODS We randomized 39 inguinal dissections done for various malignancies such as for carcinoma penis, urethra, malignant melanoma, rectum into 19 dissections (Interventional group) and 20 dissections (Control group). In the interventional group, after the completion of inguinal dissection, two ml of methylene blue dye was injected 4-8cm from the incision to identify the leaking lymphatics and they were clipped. RESULTS The primary outcome was the decrease in duration of days of drain in situ and was found to have significant reduction of 3.07 days in the interventional arm. (p value-0.02). The secondary outcome was the reduction of 21 ml of mean drain output in the interventional group (p = 0.09). The number of lymphatics clipped was not found to have statistical correlation with the duration of drain in situ and the mean drain output. CONCLUSION The intraoperative mapping of lymphatic channels using methylene blue after inguinal dissection reduces the number of days of drain in situ.
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Affiliation(s)
| | - Kanuj Malik
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
| | - Anand Raja
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
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Silverman RP, Apostolides J, Chatterjee A, Dardano AN, Fearmonti RM, Gabriel A, Grant RT, Johnson ON, Koneru S, Kuang AA, Moreira AA, Sigalove SR. The use of closed incision negative pressure therapy for incision and surrounding soft tissue management: Expert panel consensus recommendations. Int Wound J 2021; 19:643-655. [PMID: 34382335 PMCID: PMC8874075 DOI: 10.1111/iwj.13662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022] Open
Abstract
As the use of closed incision negative pressure therapy (ciNPT) becomes more widespread, dressing designs have evolved to address implementation challenges and meet surgeon demand. While traditional application of ciNPT was limited to the immediate suture line, a novel dressing that covers the incision and additional surrounding tissues has become available. To expand upon previous ciNPT recommendations and provide guidance on this new dressing, an expert panel of plastic surgeons convened to review the current literature, identify challenges to the implementation and sustainability of ciNPT, and use a modified Delphi technique to form a consensus on the appropriate use of ciNPT with full‐coverage dressings. After three rounds of collecting expert opinion via the Delphi method, consensus was reached if 80% of the panel agreed upon a statement. This manuscript establishes 10 consensus statements regarding when ciNPT with full‐coverage foam dressings should be considered or recommended in the presence of patient or incision risk factors, effective therapeutic settings and duration, precautions for use, and tools and techniques to support application. The panel also discussed areas of interest for future study of ciNPT with full‐coverage dressings. High‐quality, controlled studies are needed to expand the understanding of the benefits of ciNPT over the incision and surrounding tissues.
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Affiliation(s)
- Ronald P Silverman
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.,3M Company, St. Paul, Minnesota, USA
| | - John Apostolides
- Defy Plastic & Reconstructive Surgery, San Diego, California, USA
| | | | - Anthony N Dardano
- Department of Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | | | | | - Robert T Grant
- Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital-Columbia and Weill Cornell, New York, New York, USA
| | | | - Suresh Koneru
- Advanced Concepts in Plastic Surgery, San Antonio, Texas, USA
| | | | - Andrea A Moreira
- Department of Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Steven R Sigalove
- Scottsdale Center for Plastic Surgery, Paradise Valley, Arizona, USA
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7
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Wang YJ, Yao XF, Lin YS, Wang JY, Chang CC. Oncologic feasibility for negative pressure wound therapy application in surgical wounds: A meta-analysis. Int Wound J 2021; 19:573-582. [PMID: 34184411 PMCID: PMC8874112 DOI: 10.1111/iwj.13654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 12/25/2022] Open
Abstract
Negative pressure wound therapy (NPWT) decreases postoperative complications of various surgeries. However, the use of NPWT for oncological surgical wounds remains controversial. To evaluate the association of NPWT with oncologic recurrence in surgical wounds without residual malignancy, we analysed studies that compared NPWT with conventional non‐pressure dressings for cancer surgical wounds without residual tumour by August 12, 2020. We compared tumour recurrence rates and postoperative complications between the two procedures. The six studies included 118 patients who received NPWT, and 149 patients who received conventional non‐pressure wound care. The overall quality of the included studies was high based on the Newcastle–Ottawa scale score of 7.5. Tumour recurrence after NPWT was not significantly different compared with conventional non‐negative pressure wound care (9.3% versus 11.4%, P = 0.40). There was no significant heterogeneity between the studies (I2 = 3%). Although NTWT was associated with a lower complication rate compared with the control group, the result was non‐significant (P = 0.15). Application of NPWT in oncologic resection wounds without residual malignancy revealed no difference in local recurrence and may reduce the risk of postoperative complications compared with conventional non‐negative pressure dressings. NPWT can be considered an alternative method for reconstruction in challenging cases.
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Affiliation(s)
- Yen-Jen Wang
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Xiao-Feng Yao
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yang-Sheng Lin
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Evidence-Based Medicine Center, MacKay Memorial Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jen-Yu Wang
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chang-Cheng Chang
- Department of Cosmeceutics, China Medical University, Taichung, Taiwan.,Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan, Taiwan.,Aesthetic Medical Center, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, China Medical University Hospital, Taichung, Taiwan
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8
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Savoie PH, Morel-Journel N, Murez T, Ferretti L, Rocher L, Fléchon A, Camparo P, Méjean A. [French ccAFU guidelines - update 2020-2022: penile cancer]. Prog Urol 2021; 30:S252-S279. [PMID: 33349426 DOI: 10.1016/s1166-7087(20)30753-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE - To update French oncology guidelines concerning penile cancer. METHODS - Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer to update previous guidelines. Level of evidence was evaluated according to AGREE-II. RESULTS - Epidermoid carcinoma is the most common penile cancer histology. Physical examination is mandatory to define local and inguinal nodal cancer stage. MRI with artificial erection can help to assess deep infiltration in cases of organ-sparing intention. Node negative patients (defined by palpation and imaging) will present micro nodal metastases in up to 25% of cases. Invasive lymph node assessment is thus advocated except for low risk patients. Sentinel node dynamic biopsy is the first line technique. Modified bilateral inguinal lymphadenectomy is an option with higher morbidity. 18-FDG-PET is recommended in patients with palpable nodes. Chest, abdominal and pelvis computerized tomography is an option. Fine needle aspiration (when positive) is an easy way to assess inguinal palpable node pathological involvement. Its results determine the type of lymphadenectomy to be performed (for diagnostic or curative purposes). Treatment is mostly surgical. Free margins status is essential, but it also has to be organ-sparing when possible. Brachytherapy and topic agents can cure in selected cases. Lymph node assessment should be synchronous to the removal of the tumour when possible. Limited inguinal lymph node involvement (pN1 stage) can be cured with the only lymphadenectomy. In case of larger lymph node stage, one should consider multidisciplinary treatment including chemotherapy and inclusion in a trial. CONCLUSIONS - Penile cancer needs demanding surgery to be cured, surrounded by chemotherapy in node positive patients. Lymph nodes involvement is a major prognostic factor. Thus, inguinal node assessment cannot be neglected.
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Affiliation(s)
- P-H Savoie
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon, Cedex 09, France.
| | - N Morel-Journel
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165 chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - T Murez
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier, Cedex 5, France
| | - L Ferretti
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - L Rocher
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, APHP, 157 rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Fléchon
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P Camparo
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - A Méjean
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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9
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Miura T, Yamamoto Y, Murao N, Maeda T, Osawa M, Hayashi T, Funayama E. Combined internal and external negative pressure wound therapy: breakthrough treatment for lymphocutaneous intractable fistula. Surg Today 2021; 51:1630-1637. [PMID: 33993364 DOI: 10.1007/s00595-021-02283-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/31/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Lymphocutaneous fistula after lymph node dissection is intractable, yet there is no established treatment strategy. This study demonstrates the wound closure time achieved by a new method of combined internal and external negative pressure wound therapy (CIEN) in patients with lymphocutaneous fistula. METHODS The subjects of this study were six consecutive patients with lymphocutaneous fistula after lymphatic surgery, who were treated with CIEN between 2018 and 2020. The CIEN technique can be summarized as follows: first, internal foam is inserted into the fistula from the opening of the fenestration. Next, a slightly larger area of external foam is applied above the fistula flap outside the external margin of the foam-filled fistula. After bridging the internal foam and external foam, negative-pressure wound therapy is carried out on this bridging foam block. RESULTS CIEN led to rapid and complete wound healing in all six patients. Fistula flap margin ischemia developed in one patient, but adjusting the mode and pressure settings resulted in improvement. Three patients suffered contact dermatitis. There were no signs of tumor or fistula recurrence in any patients after at least 3 months of follow-up. CONCLUSION CIEN is an effective and less invasive treatment modality than the conventional method of managing lymphocutaneous fistula.
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Affiliation(s)
- Takahiro Miura
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Naoki Murao
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Masayuki Osawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Emi Funayama
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
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10
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Marilin N, Master VA, Pettaway CA, Spiess PE. Current practice patterns of society of urologic oncology members in performing inguinal lymph node staging/therapy for penile cancer: A survey study. Urol Oncol 2021; 39:439.e9-439.e15. [PMID: 33775532 DOI: 10.1016/j.urolonc.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Inguinal lymph node (ILN) staging and therapeutic procedures are important for the diagnosis and management of suspected Inguinal lymph node metastasis in the setting of penile cancer. Morbidity associated with inguinal lymph node dissection (ILND) and the lack of standardization in its perioperative management are both significant. In this study, we aimed to define current management approaches and potential opportunities for improving outcomes. METHODS AND MATERIALS A questionnaire was developed with 16 questions regarding pre, peri, and postoperative management of patients undergoing ILND. The questionnaire was approved by the Society of Urologic Oncology (SUO) Questionnaire Committee, which facilitated its dissemination through an initial email and a follow-up reminder to 1,003 members. The study was conducted from July to August, 2020. RESULTS Of the 1,003 SUO members invited to participate, 93 responded (9.3% response rate); 49% performed 1 to 2 ILNDs annually, and 60% chose open ILND for high-risk primary cancer cN0. For suspicious lymph nodes > 2 cm, 69% preferred ILND, 86% preoperative systemic neoadjuvant chemotherapy, followed by surgery for bulky inguinal metastasis, and 84% used perioperative antibiotics (ABX), 53% of whom discontinued ABX 24 hours after surgery. Prophylactic anticoagulation was used by 78% of respondents, and 60% stopped it after ambulation. Specific ligation of lymphatics (versus none) was used by 82% of respondents, 55% obtained frozen sections, and 94% used inguinal drains. A saphenous sparing technique was used by 75% of respondents. An incisional wound vacuum device was used by 17% of respondents. Compression stockings and/or referral to a lymphedema specialist were used to manage postoperative lymphedema by 61% of respondents. CONCLUSIONS Responses to a penile lymphadenectomy survey were relatively low and were primarily from the academic surgeon subset of the SUO. Significant consensus ( ≥ 70%) was noted for neoadjuvant chemotherapy for bulky nodal metastasis prior to surgery, perioperative antibiotic use, ligation of lymphatics, drain placement, and saphenous sparing dissection techniques. Other evidenced-based strategies that could decrease morbidity were rarely used, including dynamic sentinel node biopsy, incisional wound vacuums, and lymphedema prevention. Prospective trials are needed to validate and resolve existing treatment paradigms and to optimize perioperative pathways to reduce complications in penile cancer management.
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Affiliation(s)
- Nicholson Marilin
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, FL.
| | - Viraj A Master
- Department of Urology, and Winship Cancer Institute, Emory University, Atlanta, GA
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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11
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Schmid SC, Seitz AK, Haller B, Fritsche HM, Huber T, Burger M, Gschwend JE, Maurer T. Final results of the PräVAC trial: prevention of wound complications following inguinal lymph node dissection in patients with penile cancer using epidermal vacuum-assisted wound closure. World J Urol 2021; 39:613-620. [PMID: 32372159 PMCID: PMC7910363 DOI: 10.1007/s00345-020-03221-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/21/2020] [Indexed: 10/29/2022] Open
Abstract
PURPOSE Inguinal lymphadenectomy in penile cancer is associated with a high rate of wound complications. The aim of this trial was to prospectively analyze the effect of an epidermal vacuum wound dressing on lymphorrhea, complications and reintervention in patients with inguinal lymphadenectomy for penile cancer. PATIENTS AND METHODS Prospective, multicenter, randomized, investigator-initiated study in two German university hospitals (2013-2017). Thirty-one patients with penile cancer and indication for bilateral inguinal lymph node dissection were included and randomized to conventional wound care on one side (CONV) versus epidermal vacuum wound dressing (VAC) on the other side. RESULTS A smaller cumulative drainage fluid volume until day 14 (CDF) compared to contralateral side was observed in 15 patients (CONV) vs. 16 patients (VAC), with a median CDF 230 ml (CONV) vs. 415 ml (VAC) and a median maximum daily fluid volume (MDFV) of 80 ml (CONV) vs. 110 ml (VAC). Median time of indwelling drainage: 7 days (CONV) vs. 8 days (VAC). All grade surgery-related complications were seen in 74% patients (CONV) vs. 74% patients (VAC); grade 3 complications in 3 patients (CONV) vs. 6 patients (VAC). Prolonged hospital stay occurred in 32% patients (CONV) vs. 48% patients (VAC); median hospital stay was 11.5 days. Reintervention due to complications occurred in 45% patients (CONV) vs. 42% patients (VAC). CONCLUSIONS In this prospective, randomized trial we could not observe a significant difference between epidermal vacuum treatment and conventional wound care.
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Affiliation(s)
- Sebastian C Schmid
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Ismaningerstr. 22, 81375, Munich, Germany.
| | - Anna K Seitz
- Department of Urology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | | | - Toni Huber
- Department of Urology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Jürgen E Gschwend
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Ismaningerstr. 22, 81375, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Ismaningerstr. 22, 81375, Munich, Germany
- Department of Urology and Martini-Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Altman AD, Robert M, Armbrust R, Fawcett WJ, Nihira M, Jones CN, Tamussino K, Sehouli J, Dowdy SC, Nelson G. Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations. Am J Obstet Gynecol 2020; 223:475-485. [PMID: 32717257 DOI: 10.1016/j.ajog.2020.07.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
This is the first collaborative Enhanced Recovery After Surgery Society guideline for optimal perioperative care for vulvar and vaginal surgeries. An Embase and PubMed database search of publications was performed. Studies on each topic within the Enhanced Recovery After Surgery vulvar and vaginal outline were selected, with emphasis on meta-analyses, randomized controlled trials, and prospective cohort studies. All studies were reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. All recommendations on the Enhanced Recovery After Surgery topics are based on the best available evidence. The level of evidence for each item is presented.
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Affiliation(s)
- Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Magali Robert
- Department of Obstetrics and Gynecology, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Robert Armbrust
- Department of Gynecology with Center for Oncological Surgery, Charité University Medicine of Berlin, European Competence Center for Ovarian Cancer, Berlin, Germany
| | - William J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - Mikio Nihira
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California, Riverside, Riverside, CA
| | - Chris N Jones
- Department of Anaesthesia, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - Karl Tamussino
- Division of Gynecology, Medical University of Graz, Graz, Austria
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité University Medicine of Berlin, European Competence Center for Ovarian Cancer, Berlin, Germany
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN
| | - Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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13
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Minimally invasive inguinal lymph node dissection: initial experience and reproducibility in a limited resource setting-with technique video. Surg Endosc 2020; 34:4669-4676. [PMID: 32681375 DOI: 10.1007/s00464-020-07813-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/10/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Conventional inguinal lymph node dissection comes with a high wound complication rate which increases hospital stay and may delay adjuvant treatment. Minimally invasive lymph node dissection (MILND) is a novel endoscopic technique which aims to minimize complications of lymphadenectomy. Herein we present our technique and experience with MILND to examine safety, feasibility and reproducibility in a setting of limited resources. METHODS All patients undergoing MILND in the National Cancer Institute, Cairo were prospectively included following informed consent, IRB and ethical committee approval. Demographics, clinical, pathological data and postoperative complications according to Clavien-Dindo classification were recorded. Footage collected was used to create a step-by-step video demonstrating the technique. RESULTS Twenty-seven procedures were included in the study. The most common indications were vulval cancer (44%) and skin melanoma (19%). There were 5 (18%) conversions to open procedure, all of them in the first 10 cases of the learning curve. The median (range) operative time was 120 (45-240) min and there was a trend towards shorter operative time after the first 5 cases. Wound dehiscence occurred in 4 cases (15%). Three of them (11%) required reoperation (grade III). Grade I/II complications in the form of seroma and wound infection occurred in 34%. The median (range) postoperative hospital stay was 2 (1-14). The median (range) number of retrieved lymph nodes was 12 (3-19). No grade III/IV lymphedema was recorded at 90 days after surgery. CONCLUSION MILND is a safe, feasible technique associated with relatively low postoperative wound complications even when performed in a centre with relatively limited resources.
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14
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Abstract
Summary
Background
Wound healing deficits and subsequent surgical site infections are potential complications after surgical procedures, resulting in increased morbidity and treatment costs. Closed-incision negative-pressure wound therapy (ciNPWT) systems seem to reduce postoperative wound complications by sealing the wound and reducing tensile forces.
Materials and methods
We conducted a collaborative English literature review in the PubMed database including publications from 2009 to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and trauma, general surgery, plastic surgery, cardiac surgery and vascular surgery). With literature reviews, case reports and expert opinions excluded, the remaining 59 studies were critically summarized and evaluated with regard to their level of evidence.
Results
Of nine studies analysed in orthopaedics and trauma, positive results of ciNPWT were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10 (100%) of studies analysed in plastic, vascular and general surgery, respectively, a positive effect of ciNPWT was observed. On the contrary, only 4 of 12 studies from cardiac surgery discovered positive effects of ciNPWT (33.3%).
Conclusion
ciNPWT is a promising treatment modality to improve postoperative wound healing, notably when facing increased tensile forces. To optimise ciNPWT benefits, indications for its use should be based on patient- and procedure-related risk factors.
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15
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Gerken ALH, Herrle F, Jakob J, Weiß C, Rahbari NN, Nowak K, Karthein C, Hohenberger P, Weitz J, Reißfelder C, Dobroschke JC. Definition and severity grading of postoperative lymphatic leakage following inguinal lymph node dissection. Langenbecks Arch Surg 2020; 405:697-704. [PMID: 32816115 PMCID: PMC7449944 DOI: 10.1007/s00423-020-01927-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
Purpose Lymphatic complications occur frequently after radical inguinal lymph node dissection (RILND). The incidence of lymphatic leakage varies considerably among different studies due to the lack of a consistent definition. The aim of the present study is to propose a standardized definition and grading of different types of lymphatic leakage after groin dissection. Methods A bicentric retrospective analysis of 82 patients who had undergone RILND was conducted. A classification of postoperative lymphatic leakage was developed on the basis of the daily drainage output, any necessary postoperative interventions and reoperations, and any delay in adjuvant treatment. Results In the majority of cases, RILND was performed in patients with inguinal metastases of malignant melanoma (n = 71). Reinterventions were necessary in 15% of the patients and reoperations in 32%. A new classification of postoperative lymphatic leakage was developed. According to this definition, grade A lymphatic leakage (continued secretion of lymphatic fluid from the surgical drains without further complications) occurred in 13% of the patients, grade B lymphatic leakage (persistent drainage for more than 10 postoperative days or the occurrence of a seroma after the initial removal of the drain that requires an intervention) in 28%, and grade C lymphatic leakage (causing a reoperation or a subsequent conflict with medical measures) in 33%. The drainage volume on the second postoperative day was a suitable predictor for a complicated lymphatic leakage (grades B and C) with a cutoff of 110 ml. Conclusion The proposed definition is clinically relevant, is easy to employ, and may serve as the definition of a standardized endpoint for the assessment of lymphatic morbidity after RILND in future studies.
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Affiliation(s)
- Andreas Lutz Heinrich Gerken
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Florian Herrle
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jens Jakob
- Department of General, Visceral and Pediatric Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Christel Weiß
- Department of Biometry and Statistics, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nuh N Rahbari
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kai Nowak
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Department of General Vascular and Thoracic Surgery, RoMed Hospital Rosenheim, Pettenkoferstraße 10, 83022, Rosenheim, Germany
| | - Constantin Karthein
- Department of Visceral Surgery, University Hospital, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Peter Hohenberger
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jürgen Weitz
- Department of Visceral Surgery, University Hospital, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jakob C Dobroschke
- Department of Visceral Surgery, University Hospital, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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16
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Current management and future perspectives of penile cancer: An updated review. Cancer Treat Rev 2020; 90:102087. [PMID: 32799062 DOI: 10.1016/j.ctrv.2020.102087] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
Penile cancer (PeCa) is a rare disease worldwide, accounting for less than one percent of all malignancies in men. It usually presents as a painless ulcer or lump on the head of the penis. Squamous cell carcinoma represents the most common histological subtype of PeCa, with pathogenesis intimately linked to chronic Human Papilloma Virus (HPV) infection. Surgery is the cornerstone for the treatment of primary PeCa with potential mutilating outcome depending on the nodal extension of the disease. However, in case of extensive lymph node involvement, multidisciplinary treatment including perioperative chemotherapy and inclusion in clinical trial should be considered. To date, advanced or metastatic disease still have poor prognosis and are a therapeutic challenge with limited options, highlighting the need of new treatments and further investigations. Growing efforts to identify molecular alterations, understand the role of HPV and characterize immune contexture have expanded over the past years, providing further perspectives in prognostication, predictive biomarkers and therapeutic intervention. In this review, we provide an updated overview of current management of PeCa focusing on perioperative strategy. We discuss about new insights of the biology of PeCa and comment future directions in the field.
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17
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Joice GA, Tema G, Semerjian A, Gupta M, Bell M, Walker J, Kates M, Bivalacqua TJ. Evaluation of Incisional Negative Pressure Wound Therapy in the Prevention of Surgical Site Occurrences After Radical Cystectomy: A New Addition to Enhanced Recovery After Surgery Protocol. Eur Urol Focus 2020; 6:698-703. [PMID: 31704281 DOI: 10.1016/j.euf.2019.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/16/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical site infection (SSI) remains a significant complication after radical cystectomy (RC). Enhanced recovery after surgery (ERAS) focuses on interventions to decrease length of stay, but few address wound-related complications directly. OBJECTIVE To determine the impact that prophylactic incisional negative pressure wound therapy (iNPWT) will have to reduce the rate of surgical site occurrences (SSOs = SSI + seroma + superficial dehiscence) after RC. DESIGN, SETTINGS, AND PARTICIPANTS We retrospectively reviewed patients undergoing RC by a single surgeon from 2012 to 2017. As part of our ERAS pathway, we employed prophylactic iNPWT during abdominal closure and compared it with a contemporary cohort of standard wound closure. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We compared 90-d SSIs, SSOs, and readmissions between iNPWT and standard skin staple closure. Univariate and multivariate regressions were used to compare the two groups. RESULTS AND LIMITATIONS We identified 158 (104 iNPWT, 54 standard) patients from 2012 to 2017. The rates of SSIs and SSOs were 9.7% and 19.0%, respectively. The overall readmission rate for the cohort was 21.5%, with 4.4% of patients requiring readmission for SSI. The iNPWT group had lower rates of SSIs (5.8% vs 16.7%, p = 0.03) and SSOs (11.5% vs 33.3%, p < 0.01). There was no difference between the groups for readmission (21.1% vs 22.2%, p = 0.5). The iNPWT protected against both SSI (odds ratio [OR] 0.89, 95% confidence interval [CI]: 0.81-0.98) and 90-d SSO (OR 0.77, 95% CI: 0.68-0.87). CONCLUSIONS Prophylactic iNPWT is feasible after RC with a modest decrease in both 90-d SSIs and 90-d SSOs, but not readmissions. Wound closure assisted by iNPWT should be considered in RC ERAS pathways. PATIENT SUMMARY In this report, we looked at the impact of new vacuum suction dressing on the prevention of surgical infections after radical cystectomy (RC). We found that this wound dressing can decrease the impact of surgical infections and aid in recovery after RC.
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Affiliation(s)
- Gregory A Joice
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Giorgia Tema
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy
| | - Alice Semerjian
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Mohit Gupta
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Michael Bell
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Joanne Walker
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Max Kates
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA
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18
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Shimono A, Sakuma H, Watanabe S, Kono H. Effective combination of lymphatico-venous anastomosis and negative pressure wound therapy for lymphocyst: A Case Study. J Obstet Gynaecol Res 2020; 46:1224-1228. [PMID: 32464690 PMCID: PMC7383887 DOI: 10.1111/jog.14300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/06/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022]
Abstract
Lymphorrhea and lymphocysts are complications that occur after lymph node dissection or biopsy and are difficult to treat. Conventional treatments for lymphocysts are not always effective. For instance, lymphatico‐venous anastomosis has a limited treatment efficacy when the cyst wall is thickened, and negative pressure wound therapy is limited by the installation site and longer treatment times. To overcome these individual shortcomings, we aimed to assess whether a combination of both interventions would be effective. In this study, we report the application of a lymphatico‐venous anastomosis combined with negative pressure wound therapy for treating bilateral inguinal lymph nodes and pelvic lymph node dissection following treatment of vaginal cancer. Short‐term improvements were observed with no recurrence of lymphocysts at 1‐year follow‐up.
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Affiliation(s)
- Ayano Shimono
- Department of Plastic and Reconstructive Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Hisashi Sakuma
- Department of Plastic and Reconstructive Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Shiho Watanabe
- Department of Plastic and Reconstructive Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Hikaru Kono
- Department of Plastic and Reconstructive Surgery, National Center for Child Health and Development, Tokyo, Japan
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19
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Flynn J, Choy A, Leavy K, Connolly L, Alards K, Ranasinha S, Tan PY. Negative Pressure Dressings (PICOTM) on Laparotomy Wounds Do Not Reduce Risk of Surgical Site Infection. Surg Infect (Larchmt) 2020; 21:231-238. [DOI: 10.1089/sur.2019.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Julie Flynn
- Department of Surgery, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Audrey Choy
- Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Kylie Leavy
- Stomal Therapy Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Lisa Connolly
- Stomal Therapy Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Kelly Alards
- Stomal Therapy Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Sanjeeva Ranasinha
- School of Public Health and Preventive Medicine, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Pee Yau Tan
- Department of Surgery, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
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20
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Maciel CVDM, Machado RD, Morini MA, Mattos PAL, Dos Reis R, Dos Reis RB, Guimarães GC, da Cunha IW, Faria EF. External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes. Int Braz J Urol 2019; 45:671-678. [PMID: 31136111 PMCID: PMC6837607 DOI: 10.1590/s1677-5538.ibju.2018.0756] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/24/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Penile cancer (PC) occurs less frequently in Europe and in the United States than in South America and parts of Africa. Lymph node (LN) involvement is the most important prognostic factor, and inguinal LN (ILN) dissection can be curative; however, ILN dissection has high morbidity. A nomogram was previously developed based on clinicopathological features of PC to predict ILN metastases. Our objective was to conduct an external validation of the previously developed nomogram based on our population. MATERIALS AND METHODS We included men with cN0 ILNs who underwent ILN dissection for penile carcinoma between 2000 and 2014. We performed external validation of the nomogram considering three different external validation methods: k-fold, leave-oneout, and bootstrap. We also analyzed prognostic variables. Performance was quantified in terms of calibration and discrimination (receiver operator characteristic curve). A logistic regression model for positive ILNs was developed based on clinicopathological features of PC. RESULTS We analyzed 65 men who underwent ILN dissection (cN0). The mean age was 56.8 years. Of 65 men, 24 (36.9%) presented with positive LNs. A median 21 ILNs were removed. Considering the three different methods used, we concluded that the previously developed nomogram was not suitable for our sample. CONCLUSIONS In our study, the previously developed nomogram that was applied to our population had low accuracy and low precision for correctly identifying patients with PC who have positive ILNs.
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Affiliation(s)
| | | | | | | | - Ricardo Dos Reis
- Departamento de Urologia, Hospital do Câncer de Barretos, Barretos, SP, Brasil
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21
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Abstract
Use of negative-pressure therapy (NPT) is a well-established therapy for chronic, open, contaminated wounds, promoting formation of granulation tissue and healing. The application of NPT after primary closure (ie, incisional NPT) has also been shown to reduce surgical site infection and surgical site occurrence in high-risk procedures across multiple disciplines. Incisional NPT is believed to decrease edema and shear stress, promote angiogenesis and lymphatic drainage, and increase vascular flow and scar formation. Incisional NPT may be considered when there is a high risk of surgical site occurrence or surgical site infection, particularly in procedures with nonautologous implants, such as hernia mesh or other permanent prosthetics. Here we discuss the proposed physiologic mechanism as demonstrated in animal models and review clinical outcomes across multiple specialties.
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22
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Dräger DL, Schmidt S. [Wound drainage after inguinal lymphadenectomy in malignant diseases]. Urologe A 2019; 58:555-558. [PMID: 30968174 DOI: 10.1007/s00120-019-0920-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D L Dräger
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland. .,UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland.
| | - S Schmidt
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland
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23
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Prophylactic incisional negative pressure wound therapy shows promising results in prevention of wound complications following inguinal lymph node dissection for Melanoma: A retrospective case-control series. J Plast Reconstr Aesthet Surg 2019; 72:1178-1183. [PMID: 30898502 DOI: 10.1016/j.bjps.2019.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/25/2019] [Accepted: 02/12/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inguinal lymphadenectomy (ILND) for melanoma is associated with a number of complications including seroma, surgical site infection (SSI), and lymphedema. Incisional negative pressure wound therapy (iNPWT) has shown promising results in preventing postoperative morbidity across a wide variety of surgical procedures, but these results are yet to be investigated in patients undergoing ILND for melanoma. METHODS In this study, we reviewed the data of 55 melanoma patients treated with ILND between January 2015 and January 2017 at Odense University Hospital. Patients were followed up until April 2018 for the occurrence of seroma, SSI, and lymphedema. We used prophylactic iNPWT after ILND in 14 patients and compared their morbidity outcomes with the 41 patients receiving standard postoperative wound care in the same period. RESULTS The iNPWT intervention significantly reduced seroma compared to the control group (28.6% vs. 90.3%, p < 0.001) and had a trending impact on wound infection (42.9% vs. 65.9%, p = 0.13). The effect was not significant for the prevention of lymphedema (35.7% vs. 51.2%, p = 0.33). Because the iNPWT group had relatively fewer incidences of seroma, SSI, and lymphedema, the iNPWT intervention was more cost-effective than conventional wound care (US$911.2 vs. US$2542.7, p < 0.05). CONCLUSION The use of prophylactic iNPWT significantly reduced seroma formation following ILND. These promising results, however, need to be confirmed in a future prospective randomized trial.
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Savoie PH, Fléchon A, Morel-Journel N, Murez T, Ferretti L, Camparo P, Rocher L, Sèbe P, Méjean A. Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : tumeurs du pénis. Prog Urol 2018; 28 Suppl 1:R133-R148. [DOI: 10.1016/j.purol.2019.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 10/26/2022]
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Savoie PH, Fléchon A, Morel-Journel N, Murez T, Ferretti L, Camparo P, Rocher L, Sèbe P, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020: tumeurs du pénis French ccAFU guidelines — Update 2018—2020: Penile cancer. Prog Urol 2018; 28:S131-S146. [PMID: 30361138 DOI: 10.1016/j.purol.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 01/04/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.008.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the doi:10.1016/j.purol.2019.01.008.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France.
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier Lyon Sud (Pierre Bénite), HCL groupement hospitalier du Sud, 69495 Pierre Bénite cedex, France
| | - T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHRU de Montpellier, 371, Avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, MSP de Bordeaux-Bagatelle, 203, route de Toulouse, BP 50048, 33401 Talence cedex, France
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre de pathologie, 51, rue de Jeanne-D'Arc, 80000 Amiens, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, HU Paris Sud, site Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - P Sèbe
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, groupe hospitalier Diaconesses Croix Saint Simon, 125, rue d'Avron, 75020 Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
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Jørgensen MG, Toyserkani NM, Thomsen JB, Sørensen JA. Surgical-site infection following lymph node excision indicates susceptibility for lymphedema: A retrospective cohort study of malignant melanoma patients. J Plast Reconstr Aesthet Surg 2018; 71:590-596. [PMID: 29246739 DOI: 10.1016/j.bjps.2017.11.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/25/2017] [Accepted: 11/12/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Cancer-related lymphedema is a common complication following lymph node excision. Prevention of lymphedema is essential, as treatment options are limited. Known risk factors are firmly anchored to the cancer treatment itself; however potentially preventable factors such as seroma and surgical-site infection (SSI) have yet to be asserted. METHODS All malignant melanoma patients treated with sentinel lymph node biopsy (SNB) and/or complete lymph node dissection (CLND) in the axilla or groin between January 2008 and December 2014 were retrospectively identified. Identified patients were followed until March 2017 for the incidence of lymphedema. RESULTS We identified 70 cases of extremity lymphedema following 640 SNB/CLND. SSI was an independent risk factor for developing lymphedema (HR 8.46, 95%CI 4.37-16.36, p < 0.001), whilst seroma was an independent risk factor for developing SSI (OR 6.92, 95%CI 4.11-12.54, p < 0.001). In addition, the risk of lymphedema was significantly larger following inguinal incisions compared to axillary incisions (HR 2.49, 95%CI 1.36-4.55, p < 0.05). CONCLUSION SSI was the greatest independent risk factor for developing lymphedema. Additionally, patients' that developed postoperative seroma were at an increased risk of also developing SSI. Future studies should examine if lymphedema can be prevented, by reducing seroma and SSI.
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Affiliation(s)
| | | | - Jørn Bo Thomsen
- Department of Plastic Surgery, Odense University Hospital, Odense C, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense C, Denmark.
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Wawroschek F, Winter A. [Lymph node management of cN0 penile cancer]. Urologe A 2018; 57:435-439. [PMID: 29470655 DOI: 10.1007/s00120-018-0598-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In penile cancer, lymph node metastasis is the main known prognostic factor affecting patients' survival. Early inguinal lymph node dissection or the resection of clinically occult lymph node metastases improves survival compared with removal when the metastases become clinically apparent. Micrometastatic lymph node involvement is undetectable by current imaging modalities. Nomograms based on clinical and histopathological tumor characteristics are unreliable in predicting lymph node involvement. Consequently, in penile cancer patients with clinically normal inguinal lymph nodes (cN0) and a tumor stage ≥pT1, G2 surgical lymph node exploration is recommended. Radical inguinal lymphadenectomy is no longer recommended because of its invasiveness and high complication rate. Modified lymphadenectomy and dynamic sentinel lymph node surgery allow the detection of lymph node-positive patients with sufficient certainty. Thereby, the sentinel lymph node approach offers the least invasiveness and high sensitivity. Extended inguinal lymphadenectomy is still recommended in the case of positive nodes.
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Affiliation(s)
- F Wawroschek
- Universitätsklinik für Urologie, Klinikum Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Deutschland.
| | - A Winter
- Universitätsklinik für Urologie, Klinikum Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Deutschland
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Vulvar postoperative care, gestalt or evidence based medicine? A comprehensive systematic review. Gynecol Oncol 2017; 145:386-392. [DOI: 10.1016/j.ygyno.2017.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 11/18/2022]
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Jørgensen MG, Toyserkani NM, Sørensen JA. The effect of prophylactic lymphovenous anastomosis and shunts for preventing cancer-related lymphedema: a systematic review and meta-analysis. Microsurgery 2017; 38:576-585. [PMID: 28370317 DOI: 10.1002/micr.30180] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/27/2017] [Accepted: 03/17/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lymphedema is one of the most dreaded side effects to any cancer treatment involving lymphadenectomy. Progressed lymphedema is adversely complex and currently there is no widely acknowledged curative treatment. Therefore recent focus has shifted to risk reduction and prevention. It has been hypothesized that bypassing lymphatic vessels to veins prophylactically, could minimize the lymphatic dysfunction seen following lymphadenectomy. METHODS To investigate this possible future treatment modality, we performed a systematic meta-analysis of studies treating patients with prophylactic lymphovenous analysisstomosis (LVA) for the prevention of secondary lymphedema following lymphadenectomy. A systematic search yielded 12 articles included in the qualitative analysis and four of these were further eligible to be included in the quantitative analysis. RESULTS We found that patients treated with prophylactic LVA had a significant reduction in lymphedema incidence (Relative risk: 0.33, 95%CI: 0.19 to 0.56) when compared to patients receiving no prophylactic treatment (P < 0.0001). CONCLUSION Prophylactic LVA in relation to lymphadenectomy shows promising results, however because of the low number of eligible studies and method heterogeneity between studies, there is an urgent need for uniformly high quality studies, before the treatment can be concluded effective.
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Affiliation(s)
- Mads G Jørgensen
- Department of Plastic Surgery, Odense University Hospital, Denmark
| | | | - Jens A Sørensen
- Department of Plastic Surgery, Odense University Hospital, Denmark
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Scalise A, Calamita R, Tartaglione C, Pierangeli M, Bolletta E, Gioacchini M, Gesuita R, Di Benedetto G. 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 2016; 13:1260-1281. [PMID: 26424609 PMCID: PMC7950088 DOI: 10.1111/iwj.12492] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/20/2015] [Accepted: 08/07/2015] [Indexed: 01/01/2023] Open
Abstract
Advances in preoperative care, surgical techniques and technologies have enabled surgeons to achieve primary closure in a high percentage of surgical procedures. However, often, underlying patient comorbidities in addition to surgical-related factors make the management of surgical wounds primary closure challenging because of the higher risk of developing complications. To date, extensive evidence exists, which demonstrate the benefits of negative pressure dressing in the treatment of open wounds; recently, Incisional Negative Pressure Wound Therapy (INPWT) technology as delivered by Prevena™ (KCI USA, Inc., San Antonio, TX) and Pico (Smith & Nephew Inc, Andover, MA) systems has been the focus of a new investigation on possible prophylactic measures to prevent complications via application immediately after surgery in high-risk, clean, closed surgical incisions. A systematic review was performed to evaluate INPWT's effect on surgical sites healing by primary intention. The primary outcomes of interest are an understanding of INPWT functioning and mechanisms of action, extrapolated from animal and biomedical engineering studies and incidence of complications (infection, dehiscence, seroma, hematoma, skin and fat necrosis, skin and fascial dehiscence or blistering) and other variables influenced by applying INPWT (re-operation and re-hospitalization rates, time to dry wound, cost saving) extrapolated from human studies. A search was conducted for published articles in various databases including PubMed, Google Scholar and Scopus Database from 2006 to March 2014. Supplemental searches were performed using reference lists and conference proceedings. Studies selection was based on predetermined inclusion and exclusion criteria and data extraction regarding study quality, model investigated, epidemiological and clinical characteristics and type of surgery, and the outcomes were applied to all the articles included. 1 biomedical engineering study, 2 animal studies, 15 human studies for a total of 6 randomized controlled trials, 5 prospective cohort studies, 7 retrospective analyses, were included. Human studies investigated the outcomes of 1042 incisions on 1003 patients. The literature shows a decrease in the incidence of infection, sero-haematoma formation and on the re-operation rates when using INPWT. Lower level of evidence was found on dehiscence, decreased in some studies, and was inconsistent to make a conclusion. Because of limited studies, it is difficult to make any assertions on the other variables, suggesting a requirement for further studies for proper recommendations on INPWT.
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Affiliation(s)
- Alessandro Scalise
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Roberto Calamita
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Caterina Tartaglione
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Marina Pierangeli
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Elisa Bolletta
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Matteo Gioacchini
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Rosaria Gesuita
- Interdepartmental Centre of EpidemiologyBiostatistics and Medical Informatics (EBI Centre), Università Politecnica delle MarcheAnconaItaly
| | - Giovanni Di Benedetto
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
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Sèbe P, Ferretti L, Savoie PH, Morel-Journel N, Fléchon A, Murez T, Rocher L, Camparo P, Méjean A, Durand X. [CCAFU french national guidelines 2016-2018 on penile cancer]. Prog Urol 2016; 27 Suppl 1:S167-S179. [PMID: 27846930 DOI: 10.1016/s1166-7087(16)30707-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of this work is to establish guidelines proposed by the external genital organ group of the CCAFU for the diagnosis, treatment and follow-up of penile cancer. MATERIAL AND METHODS The multidisciplinary working party studied 2013 guidelines exhaustively reviewed the literature, and evaluated references and their level of proof in order to attribute grades of recommandation. RESULTS The most common histological type is squamous cell carcinoma. Clinical examination of the penis is usually sufficient to access local extension. It can be completed by MRI to assess deeper extension. Physical examination of both groins must evaluate inguinal regional lymph nodes involvement. In the presence of palpable lymph nodes, abdomen and pelvis computed tomography and 18F-FDG PET-CT are recommended. Sentinel lymph node biopsy is recommended in the case of penile cancer with high risk of lymph node extension with no palpable lymph nodes. Treatment of the primary tumour is usually surgical. It must be as conservative as possible while ensuring negative surgical margins. Brachytherapy or local treatment can be proposed in some cases. Bilateral inguinal lymph node areas must be systematically treated. Inguinal lymphadenectomy alone has a curative role in patients with metastatic invasion of a single node (stage pN1). In the case of more extensive lymph node involvement, multimodal management combining chemotherapy, surgery, and possibly radiotherapy has to be considered. CONCLUSIONS The treatment of penile cancer is usually surgical possibly in combination with chemotherapy in the presence of lymph node extension. The main prognostic factor is lymph node involvement, requiring appropriate management at the time of diagnosis.x © 2016 Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - X Durand
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France
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Vacuum-assisted closure in the treatment of seroma after axillary lymph node dissection. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-015-1153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Willy C, Agarwal A, Andersen CA, Santis GD, Gabriel A, Grauhan O, Guerra OM, Lipsky BA, Malas MB, Mathiesen LL, Singh DP, Reddy VS. Closed incision negative pressure therapy: international multidisciplinary consensus recommendations. Int Wound J 2016; 14:385-398. [PMID: 27170231 PMCID: PMC7949983 DOI: 10.1111/iwj.12612] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/05/2016] [Indexed: 12/13/2022] Open
Abstract
Surgical site occurrences (SSOs) affect up to or over 25% of patients undergoing operative procedures, with the subset of surgical site infections (SSIs) being the most common. Commercially available closed incision negative pressure therapy (ciNPT) may offer surgeons an additional option to manage clean, closed surgical incisions. We conducted an extensive literature search for studies describing ciNPT use and assembled a diverse panel of experts to create consensus recommendations for when using ciNPT may be appropriate. A literature search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials using key words ‘prevention’, ‘negative pressure wound therapy (NPWT)’, ‘active incisional management’, ‘incisional vacuum therapy’, ‘incisional NPWT’, ‘incisional wound VAC’, ‘closed incisional NPWT’, ‘wound infection’, and ‘SSIs’ identified peer‐reviewed studies published from 2000 to 2015. During a multidisciplinary consensus meeting, the 12 experts reviewed the literature, presented their own ciNPT experiences, identified risk factors for SSOs and developed comprehensive consensus recommendations. A total of 100 publications satisfied the search requirements for ciNPT use. A majority presented data supporting ciNPT use. Numerous publications reported SSI risk factors, with the most common including obesity (body mass index ≥30 kg/m2); diabetes mellitus; tobacco use; or prolonged surgical time. We recommend that the surgeon assess the individual patient's risk factors and surgical risks. Surgeons should consider using ciNPT for patients at high risk for developing SSOs or who are undergoing a high‐risk procedure or a procedure that would have highly morbid consequences if an SSI occurred.
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Affiliation(s)
- Christian Willy
- Department of Traumatology and Orthopaedic, Septic and Reconstructive Surgery, Research and Treatment Center for Complex Combat Injuries, Wound Centre Berlin, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Animesh Agarwal
- Division of Orthopaedic Traumatology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Charles A Andersen
- Vascular/Endovascular/Limb Preservation Surgery Service, Madigan Army Medical Center, Tacoma, WA, USA
| | - Giorgio De Santis
- Plastic, Reconstructive, Microvascular and Aesthetic Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Allen Gabriel
- Plastic Surgery, PeaceHealth Medical Group, Vancouver, WA, USA
| | - Onnen Grauhan
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Omar M Guerra
- Surgery, Suburban Surgical Associates, St. Louis, MO, USA
| | | | - Mahmoud B Malas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lars L Mathiesen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Devinder P Singh
- Division of Plastic Surgery, Anne Arundel Medical Center, Annapolis, MD, USA
| | - V Sreenath Reddy
- TriStar CV Surgery, Centennial Heart and Vascular Center, Nashville, TN, USA
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Stollwerck PL, Schlarb D, Münstermann N, Stenske S, Kruess C, Brodner G, Krapohl BD, Krause-Bergmann AF. Reducing morbidity with surgical adhesives following inguinal lymph node dissections for the treatment of malignant skin tumors. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2016; 5:Doc05. [PMID: 26816671 PMCID: PMC4724756 DOI: 10.3205/iprs000084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Inguinal lymph node dissection (ILND) is associated with a high rate of morbidity. To evaluate the clinical benefit of surgical adhesives to reduce complications in patients undergoing ILND, we compared the use of TissuGlu® Surgical Adhesive and ARTISS® fibrin sealant with a control population. Material and methods: We conducted a retrospective analysis of patients undergoing ILND for metastatic malignant skin tumors at one hospital, Fachklinik Hornheide (Münster, Germany), from January 2011 through September 2013, assessing 137 patients with a total of 142 procedures. Results: Complications occurred in 22/60 procedures in the TissuGlu group (TG), in 8/17 in the ARTISS group (AG), and in 29/65 in the control group (CG). Prolonged drainage and seroma were recorded in 16 (26.7%), four (23.5%), and 26 (40%) respectively (non-significant). TG showed less extended drainage vs. CG (p=0.082). Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). With regard to wound infection, there was a 15% reduction in TG and 74% increase in AG group. Revision surgery was reduced by 36% in TG and increased by 54% in AG. Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). Mean total post-operative drain volume was lower in TG and AG vs. CG (p<0.001 among groups, CG vs. TG p<0.001, CG vs. AG p<0.001). The mean body mass index (BMI) was significantly higher in patients with complications, 29.4±5.8 vs. 25.3±4.1 (p=0.000). Conclusion: The use of TissuGlu in our ILND patients was associated with a reduction in post-operative wound related complications and the need for revision surgeries compared to the control group. Daily drainage was significantly lower within the first 7 post-operative days with the use of ARTISS, but the benefit was lost due to the higher occurrence of wound infection and revision surgery. BMI above 29 is a risk factor for complications following ILND. (Level of evidence: level IV, retrospective case study)
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Affiliation(s)
- Peter L Stollwerck
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Dominik Schlarb
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Nicole Münstermann
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Sebastian Stenske
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Christoph Kruess
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Gerhard Brodner
- Department of Anesthesiology, Intensive Care and Pain Medicine, Fachklinik Hornheide, Münster, Germany
| | - Björn Dirk Krapohl
- Department for Plastic Surgery and Hand Surgery, St. Marien Hospital, Berlin, Germany; Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Germany
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Leiboff AR. Vertically drained closed incision NPWT. A novel method for managing surgical incisions: a case series. J Wound Care 2015; 23:623-9. [PMID: 25492278 DOI: 10.12968/jowc.2014.23.12.623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Topical negative pressure wound therapy (NPWT) is being used with increasing frequency to treat closed surgical incisions that are at high risk for wound complications. Known benefits of topical NPWT include improved perfusion, physical wound support and isolation. This case series report of four colon operations introduces a method to manage closed surgical incisions that is designed to potentiate the effects of topical NPWT. Channel drains are placed vertically through a closed incision and in contact with the foam sponge of a NPWT dressing. The drains transmit negative pressure into the wound in order to enhance fluid removal, reduce dead space and improve tissue apposition for primary healing. DECLARATION OF INTEREST Dr Leiboff received no funding for this study. Dr Leiboff is President of Tools for Surgery, L.L.C.
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Affiliation(s)
- A R Leiboff
- Assistant Professor of Surgery; Division of Colon and Rectal Surgery, Department of Surgery, Health Sciences Center, T18-046B, Stony Brook Medicine, Stony Brook, NY 11794-8191
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EAU Guidelines on Penile Cancer: 2014 Update. Eur Urol 2015; 67:142-150. [DOI: 10.1016/j.eururo.2014.10.017] [Citation(s) in RCA: 378] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/08/2014] [Indexed: 11/20/2022]
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Bi H, Fang S, Jiang D, Xing X, Zhu J, Wang X, Dai H, Zhong X, Li J. Ultrasound-guided scraping of fibrous capsule plus bilayered negative pressure wound therapy for treatment of refractory postmastectomy seroma. J Plast Reconstr Aesthet Surg 2014; 68:403-9. [PMID: 25547936 DOI: 10.1016/j.bjps.2014.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/29/2014] [Accepted: 11/09/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Seroma is a frequent complication of breast cancer surgery. Treatment of prolonged or refractory seroma remains a clinical challenge. This study aimed to evaluate the efficacy of a novel approach for refractory seroma treatment; the method combines minimally invasive scraping for fibrous capsule removal and self-designed bilayered negative pressure wound therapy (b-NPWT) to achieve favorable wound healing. METHODS Twenty-four patients with refractory seroma received ultrasound-guided scraping of fibrous capsule around the refractory seroma, and then a bilayered NPWT system simultaneously allowing for fluid drainage and dynamic topical pressure was manually implemented immediately. The time of NPWT application and wound healing was recorded, and pathological examination was conducted for the removed fibrous tissues. RESULTS Removal of the fibrous capsule was securely achieved by minimally invasive scraping through a 1.5-cm incision guided with ultrasound scanning. All refractory seromas in the 24 patients healed uneventfully after an average application of NPWT for 7.2±3.3 days without recurrence during the 3-12 months of follow-up. Biopsy of the removed fibrous tissue demonstrated that single-layered endothelial cells stained with CD31, D2-40, and Ki-67 existed both on the surface of and inside the fibrous tissue. CONCLUSIONS The combination of fibrous capsule removal by ultrasound-guided scraping with successive bilayered NPWT therapy is effective and minimally invasive for promoting wound healing of refractory postmastectomy seroma.
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Affiliation(s)
- Hongda Bi
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Shuo Fang
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Dong Jiang
- Department of Ultrasound, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xin Xing
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
| | - Ji Zhu
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xiaoyun Wang
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Haiying Dai
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xueying Zhong
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Junhui Li
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
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Thomson DR, Sadideen H, Furniss D. Wound drainage following groin dissection for malignant disease in adults. Cochrane Database Syst Rev 2014:CD010933. [PMID: 25387103 DOI: 10.1002/14651858.cd010933.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Groin dissection is commonly performed for the treatment of a variety of cancers, including melanoma, and squamous cell carcinoma of the skin, penis or vulva. It is uncertain whether insertion of a drain reduces complication rates, and, if used, the optimum time for drain removal after surgery is also unknown. OBJECTIVES To assess the current level of evidence to determine whether placement of a drain is beneficial after groin dissection in terms of reducing seroma, haematoma, wound dehiscence and wound infection rates, and to determine the optimal type and duration of drainage following groin dissection if it is shown to be beneficial. SEARCH METHODS In September 2014 we searched the following electronic databases using a pre-designed search strategy: the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library). In November 2013 we searched Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We did not restrict the search and study selection with respect to language, date of publication or study setting. SELECTION CRITERIA We considered all randomised controlled trials (RCTs) comparing wound drainage with no wound drainage in individuals undergoing groin dissection, where the most superior node excised was Cloquet's node (the most superior inguinal lymph node). No limits were applied to language of publication or trial location. Two review authors independently determined the eligibility of each trial. DATA COLLECTION AND ANALYSIS Two review authors, working independently, screened studies identified from the search; there were no disagreements. MAIN RESULTS We did not identify any RCTs that met the inclusion criteria for the review. AUTHORS' CONCLUSIONS There is a need for high quality RCTs to guide clinical practice in this under-researched area.
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Affiliation(s)
- David R Thomson
- Oxford University Clinical Academic Graduate School, University of Oxford, John Radcliffe Hospital, Medical Sciences Division, Level 3, John Radcliffe Hospital., Oxford, Oxfordshire, UK, OX3 9DU
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Han JG, Pang GY, Wang ZJ, Zhao Q, Ma SZ. The combined application of human acellular dermal matrix and vacuum wound drainage on incarcerated abdominal wall hernias. Int J Surg 2014; 12:452-6. [DOI: 10.1016/j.ijsu.2014.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/24/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
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Dohmen PM, Misfeld M, Borger MA, Mohr FW. Closed incision management with negative pressure wound therapy. Expert Rev Med Devices 2014; 11:395-402. [PMID: 24754343 DOI: 10.1586/17434440.2014.911081] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Post-sternotomy mediastinitis is the most severe surgical site infection after sternotomy with an incidence between 1-4% related to the patient co-morbidity. This complication will increase morbidity and mortality and may also have an economic impact. There are guidelines to prevent surgical site infections; however, age and co-morbidities increase and therefore it is important to develop new tools to improve wound healing. This manuscript will give an overview of a new concept using negative pressure wound therapy over a closed incision (so-called, closed incision management) after surgery and will include the principles of negative pressure wound therapy and the positively applied mechanical forces as a permutation of Wolff's law. The use and indication of this therapy is supported by experimental studies divided into physiological and biomechanical property studies. Finally, an overview of clinical studies is given based on the evidence rating scale for therapeutic studies.
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Affiliation(s)
- Pascal M Dohmen
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
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Deppe G, Mert I, Winer IS. Management of squamous cell vulvar cancer: A review. J Obstet Gynaecol Res 2014; 40:1217-25. [DOI: 10.1111/jog.12352] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Gunter Deppe
- Department of Obstetrics and Gynecology; Wayne State University; Detroit Michigan USA
- Division of Gynecologic Oncology; Wayne State University; Detroit Michigan USA
| | - Ismail Mert
- Department of Obstetrics and Gynecology; Wayne State University; Detroit Michigan USA
| | - Ira S. Winer
- Department of Obstetrics and Gynecology; Wayne State University; Detroit Michigan USA
- Division of Gynecologic Oncology; Wayne State University; Detroit Michigan USA
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[Inguinal lymphadenectomy for penile cancer: study on the prevention of wound healing complications]. Urologe A 2014; 53:561-2. [PMID: 24700190 DOI: 10.1007/s00120-014-3432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Basés Valenzuela C, Bruna Esteban M, Puche Pla J. Terapia con presión negativa para el tratamiento de fístula linfática inguinal. Cir Esp 2014; 92:133-5. [DOI: 10.1016/j.ciresp.2013.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 07/12/2013] [Accepted: 07/21/2013] [Indexed: 11/30/2022]
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Thomson DR, Sadideen H, Furniss D. Wound drainage following groin dissection for malignant disease in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd010933] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Karlakki S, Brem M, Giannini S, Khanduja V, Stannard J, Martin R. Negative pressure wound therapy for managementof the surgical incision in orthopaedic surgery: A review of evidence and mechanisms for an emerging indication. Bone Joint Res 2013; 2:276-84. [PMID: 24352756 PMCID: PMC3884878 DOI: 10.1302/2046-3758.212.2000190] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives The period of post-operative treatment before surgical wounds
are completely closed remains a key window, during which one can
apply new technologies that can minimise complications. One such
technology is the use of negative pressure wound therapy to manage
and accelerate healing of the closed incisional wound (incisional
NPWT). Methods We undertook a literature review of this emerging indication
to identify evidence within orthopaedic surgery and other surgical
disciplines. Literature that supports our current understanding
of the mechanisms of action was also reviewed in detail. Results A total of 33 publications were identified, including nine clinical
study reports from orthopaedic surgery; four from cardiothoracic
surgery and 12 from studies in abdominal, plastic and vascular disciplines.
Most papers (26 of 33) had been published within the past three
years. Thus far two randomised controlled trials – one in orthopaedic
and one in cardiothoracic surgery – show evidence of reduced incidence
of wound healing complications after between three and five days
of post-operative NPWT of two- and four-fold, respectively. Investigations
show that reduction in haematoma and seroma, accelerated wound healing
and increased clearance of oedema are significant mechanisms of
action. Conclusions There is a rapidly emerging literature on the effect of NPWT
on the closed incision. Initiated and confirmed first with a randomised
controlled trial in orthopaedic trauma surgery, studies in abdominal,
plastic and vascular surgery with high rates of complications have
been reported recently. The evidence from single-use NPWT devices
is accumulating. There are no large randomised studies yet in reconstructive
joint replacement. Cite this article: Bone Joint Res 2013;2:276–84.
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Affiliation(s)
- S Karlakki
- Robert Jones Agnes Hunt Orthopaedic Hospital, ArthroplastyDepartment, Oswestry SY10 7AG, UK
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A review of complications associated with the surgical treatment of vulvar cancer. Gynecol Oncol 2013; 131:467-79. [PMID: 23863358 DOI: 10.1016/j.ygyno.2013.07.082] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/26/2013] [Accepted: 07/05/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The mainstay of treatment for most vulvar malignancies is surgery to the vulva with lymphadenectomy to the inguino-femoral areas, plus radiotherapy or/and chemotherapy for locally advanced, or recurrent disease. Treatment is associated with significant physical, sexual, and psychological morbidity. The high morbidity rate has resulted in a continuing shift in treatment paradigms that focus on treatments that reduce morbidity without compromising cure rates. This paper reviews the complications associated with contemporary surgical treatment for vulva cancer and discusses preventative strategies. METHODS A review of the English literature was undertaken for articles published between 1965 and August 31, 2012 to identify articles that assessed complications resulting from surgery to the vulva or groins in patients with vulva cancer. Two independent researchers selected and qualitatively analyzed the articles using a predetermined protocol. RESULTS The heterogeneity of articles and differences in definitions and outcomes made this unsuitable for meta-analysis. Most studies advocated for change in surgical technique to reduce complications associated with inguino-femoral lymphadenectomy and surgery to the vulva, with varying success. The most effective means of preventing complications is by omitting systematic lymph node dissection. This can be achieved safely through sentinel lymph node biopsy. Saphenous vein sparing, VTE prophylaxis, the use of flaps and grafts, and preoperative counseling are additional ways to decrease morbidity. CONCLUSION Despite technical advances, complications following surgical treatment for vulva cancer remain high. More research, particularly multi centered randomized controlled trials to improve the quality of evidence and studies that focus on complications as an outcome measure and analyze individual surgeon complication rates, are needed. Measures also need to be standardized throughout the gynecologic oncology community to allow for better comparison between studies.
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[Cervical, inguinal and abdominal lymphnode dissection]. Chirurg 2013; 84:551-8. [PMID: 23719728 DOI: 10.1007/s00104-012-2412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Diagnostic lymph node dissections can be defined as a form of oncological service surgery. These procedures aim at clarification of differential diagnoses of local or systemic lymph node pathologies or contribute to tumor staging. Procedure implementation can either involve incisional biopsy, selective lymph node extirpation or regional systematic lymph node dissection. Sentinel lymph node lymphadenectomy is a focused form of selective lymphadenectomy. Both surgeon and oncologist must have a preoperative consensus and mutual understanding about the detailed purpose of the procedure in the individual patient setting. Terminology conventions must be considered in communication. Potential reasons to extend surgery should be strategically reflected prior to surgery. Interventional techniques and minimally invasive forms of surgical lymph node dissection must be technically taken into account in order to reduce procedural morbidity. Clinically indicative scenarios, pathophysiological concepts and technical options of surgical lymph node dissection are described and discussed for various anatomical regions.
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