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Lymphatic Function of the Lower Limb after Groin Dissection for Vulvar Cancer and Reconstruction with Lymphatic SCIP Flap. Cancers (Basel) 2022; 14:cancers14041076. [PMID: 35205824 PMCID: PMC8870617 DOI: 10.3390/cancers14041076] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/27/2023] Open
Abstract
Inguinofemoral lymphadenectomy, frequently performed for vulvar cancer, is burdened with substantial immediate and long-term morbidity. One of the most disabling treatment-related sequelae is lower limb lymphedema (LLL). The present study aims to describe the wound complications and the severity of LLL in patients who have undergone groin dissection for vulvar cancer and immediate inguinal reconstruction with the Lymphatic Superficial Circumflex Iliac Perforator flap (L-SCIP). We retrospectively reviewed the data of patients who underwent bilateral groin dissection and unilateral inguinal reconstruction with the L-SCIP. The presence and severity of postoperative LLL during the follow-up period were assessed by lymphoscintigraphy and limbs' volume measurement. In addition, immediate complications at the level of the inguinal area were registered. The changes between preoperative and postoperative limb volumes were analyzed by Student's t test. p values < 0.05 were considered significant. Thirty-one patients were included. The mean variation of volume was 479 ± 330 cc3 in the side where groin reconstruction had been performed, and 683 ± 425 cc3 in the contralateral side, showing smaller variation in the treated side (p = 0.022). Lymphoscintigraphy confirmed the clinical findings. Based on our results, inguinal reconstruction with L-SCIP performed at the same time of groin dissection in patients treated for vulvar cancer can provide a significant protective effect on LLL.
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Gu HF, Liu GC, Chen JP, Li JY, Zhang XK, Liu ZM, Tu H. Proposal for modified inguinofemoral lymphadenectomy derived from investigation of anatomic distribution of sentinel and metastatic nodes in vulvar cancer. J Surg Oncol 2020; 123:660-666. [PMID: 33155291 DOI: 10.1002/jso.26290] [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: 07/31/2020] [Revised: 10/09/2020] [Accepted: 10/23/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We aimed to develop a less invasive inguinofemoral lymphadenectomy (IFL) approach for vulvar cancer based on the investigation of the anatomic distribution of sentinel and metastatic nodes. METHODS Patients with vulvar cancer treated by surgery between 1995 and 2019 were retrospectively reviewed. A seven-field method was adopted to assign the anatomic locations for lymph nodes removed via IFL or sentinel node biopsy. Only patients with nodal metastasis or sentinel nodes were included. RESULTS A total of 102 patients with eligible data were analyzed. Nodal metastasis was confirmed in 118 groins undergoing IFL; sentinel node detection succeeded in 46 groins. The medial-inguinal field had the highest rate of nodal metastasis involvement (59.3%, 70/118) and sentinel nodes present (73.9%, 34/46). The inferior-femoral field was involved only in one groin with quadruple-field metastases. The lateral-inguinal field was not involved in any groin. Neither the lateral-inguinal nor the inferior-femoral field presented sentinel nodes. CONCLUSION The lateral-inguinal and inferior-femoral fields of the groins have a low risk of developing nodal metastasis. Therefore, a modified IFL preserving these fields can be established to reduce surgical morbidity without sacrificing its therapeutic effect.
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Affiliation(s)
- Hai-Feng Gu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guo-Chen Liu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jie-Ping Chen
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jun-Yun Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xin-Ke Zhang
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhi-Min Liu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hua Tu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Scaglioni MF, Meroni M, Fritsche E, Fuchs B. Combined pedicled superficial circumflex iliac artery perforator (SCIP) flap with lymphatic tissue preservation and lymphovenous anastomosis (LVA) for defect reconstruction and lymphedema-lymphocele prevention in thigh sarcoma surgery: Preliminary results. J Surg Oncol 2020; 123:96-103. [PMID: 32964444 DOI: 10.1002/jso.26228] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/16/2020] [Accepted: 09/08/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Sarcoma surgery often requires large tissue resection to be treated safely. When the tumor is localized in the groin and/or medial thigh, lymphocele and lymphedema are common complications because of the rich lymphatic network present there. The aim of this study is to share the outcome of seven patients who received defect reconstruction in this area with combined pedicled superficial circumflex artery perforator (SCIP) flap with lymphatic tissue preservation and lymphovenous anastomosis (LVA) for prevention of lymphatic complications. PATIENTS AND METHODS Seven patients who underwent surgical resection of sarcoma in the groin and/or adductors compartment received defect reconstruction with pedicled SCIP flap combined with LVA. For a better dead space obliteration, four of them also received an additional tissue flap: two pedicled deep inferior epigastric perforator flaps and two free anterolateral thigh flaps. Indocyanine green lymphography was performed in all cases to identify the lymphatic pathway, make the preoperative marking and check the patency of the anastomoses. RESULTS All seven patients were successfully treated reaching a good aesthetic result and a full range of motion. No immediate nor delayed complications such as lymphocele or lymphorrhea and early extremity lymphedema were observed during the follow up (range: 6-9 months; mean: 7.3) and no secondary procedures were required. CONCLUSIONS The combination of the pedicle SCIP lymphatic tissue transfer with LVA seems to be effective in preventing the development of lymphatic sequelae after large resections in the medial thigh.
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Affiliation(s)
- Mario F Scaglioni
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matteo Meroni
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Elmar Fritsche
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bruno Fuchs
- Department of Orthopedic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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Elevation of Thin Pudendal Artery Flap Using Fat Thickness Data in Vulvovaginal Reconstruction. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01913-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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5
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Scaglioni MF, Meroni M, Franchi A, Fritsche E. Combined lymphovenous anastomosis and deep inferior epigastric perforator flap with lymphatic tissue preservation for defect reconstruction and lymphedema‐lymphocele prevention after medial thigh sarcoma resection: A case report. Microsurgery 2020; 40:598-603. [DOI: 10.1002/micr.30558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/04/2019] [Accepted: 01/03/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Mario F. Scaglioni
- Depatment of Hand‐ and Plastic SurgeryLuzerner Kantonsspital Lucerne Switzerland
| | - Matteo Meroni
- Depatment of Hand‐ and Plastic SurgeryLuzerner Kantonsspital Lucerne Switzerland
| | - Alberto Franchi
- Depatment of Hand‐ and Plastic SurgeryLuzerner Kantonsspital Lucerne Switzerland
| | - Elmar Fritsche
- Depatment of Hand‐ and Plastic SurgeryLuzerner Kantonsspital Lucerne Switzerland
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Giacalone G, Yamamoto T, Hayashi A, Belva F, Gysen M, Hayashi N, Yamamoto N, Koshima I. Lymphatic supermicrosurgery for the treatment of recurrent lymphocele and severe lymphorrhea. Microsurgery 2019; 39:326-331. [DOI: 10.1002/micr.30435] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Guido Giacalone
- Department of Lymphatic SurgeryAZ Sint‐Maarten Hospital Mechelen Belgium
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive SurgeryNational Center for Global Health and Medicine (NCGM) Tokyo Japan
| | | | - Florence Belva
- Department of Lymphatic SurgeryAZ Sint‐Maarten Hospital Mechelen Belgium
| | - Mieke Gysen
- Department of Nuclear MedicineH. Hartziekenhuis Mol Belgium
| | - Nobuko Hayashi
- Department of Plastic SurgeryTaiyo‐kai Social Welfare Awachiiki Iryo Center Chiba Japan
| | - Nana Yamamoto
- Department of Plastic and Reconstructive SurgeryNational Center for Global Health and Medicine (NCGM) Tokyo Japan
| | - Isao Koshima
- International Lymphedema CenterHiroshima University Hospital Hiroshima Japan
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Lymphocele Following Liposuction in the Thigh. Aesthetic Plast Surg 2017; 41:1408-1412. [PMID: 28664307 DOI: 10.1007/s00266-017-0930-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
Lymphocele has not been reported as a complication after liposuction. In this study, we present the case of a patient who developed a cystic lesion after liposuction in her right thigh. The cyst could contract and evolve. The diagnosis of pseudobursa seroma (late seroma) was first considered. However, lymphoscintigraphy showed that lymphatic fluid accumulated in the cyst, and lymphatic vessel connected with it. The final diagnose was a lymphocele. After interventional therapy and conservative treatment failed, the lymphocele was resected. The subcutaneous soft tissue around the cyst was divided into bundles and then ligated with the purpose of blocking lymph leakage from the lymphatic duct. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Bizzarri N, Vellone VG, Parodi L, Calanni Fraccono L, Ghirardi V, Costantini S, Menada MV, Sala P. Cutaneous metastasis from vulvar squamous cell carcinoma: a rare occurrence that should not be forgotten. J OBSTET GYNAECOL 2017; 37:975-981. [PMID: 28657384 DOI: 10.1080/01443615.2017.1318269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vulvar cancer accounts for 5% of the female genital tract cancers. Cutaneous metastases from vulvar cancer are extremely rare and for this reason, it can be difficult to reach a diagnosis with a consequent delay in the treatment. A systematic literature review of articles on this subject was conducted through a MEDLINE-based search for articles published in English or French. To date, 16 cases (including ours unpublished) of cutaneous metastasis from vulvar cancer have been reported. Cutaneous metastasis can occur from any stage of vulvar cancer, even after a short period. Different treatments have been described but none of them seems to be more effective. In all reported cases the prognosis was very poor. Every time a vulvar cancer survivor shows a suspicious cutaneous lesion, this should be biopsied to exclude skin relapse. Impact statement Cutaneous metastases from vulvar cancer are extremely rare and due to its rarity, a standard treatment has not been established yet. Cutaneous metastasis can occur from any stage of vulvar cancer, even after a short period. In all the reported cases, the prognosis was very poor. Every time a vulvar cancer survivor shows a suspect cutaneous lesion, this should be biopsied to exclude skin relapse.
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Affiliation(s)
- Nicolò Bizzarri
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy.,b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - Valerio Gaetano Vellone
- c Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC) , University of Genoa , Genoa , Italy
| | - Luca Parodi
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy.,b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - Luana Calanni Fraccono
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy.,b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - Valentina Ghirardi
- d Northern Gynaecological Oncology Centre (NGOC) , Queen Elizabeth Hospital , Gateshead , UK
| | - Sergio Costantini
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy.,b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - Mario Valenzano Menada
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy.,b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - Paolo Sala
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy
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Pouwer AFW, Arts HJ, van der Velden J, de Hullu JA. Limiting the morbidity of inguinofemoral lymphadenectomy in vulvar cancer patients; a review. Expert Rev Anticancer Ther 2017; 17:615-624. [PMID: 28608762 DOI: 10.1080/14737140.2017.1337513] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inguinofemoral lymphadenectomy (IFL) is performed in the treatment for vulvar cancer. One or more complications after IFL is reported in up to 85% of the patients. This review presents an overview of surgical techniques and peri- and post-operative care that has been studied in order to reduce the morbidity associated with IFL in vulvar cancer patients. Areas covered: Current knowledge on post-operative complications after different surgical techniques and peri- and post-operative protocols were discussed. A systematic literature review was conducted using MEDLINE, EMBASE and the Cochrane library on 20 February 2017. In order to be eligible for inclusion, studies must report the associated post-operative morbidity per surgical technique, or peri- or post-operative care given after IFL in vulvar cancer patients. Expert commentary: After the implementation of several new surgical techniques, the morbidity after IFL decreased but remains high and clinically meaningful. More research is needed on surgical techniques and peri-or post-operative care to further reduce the complication rates after IFL in vulvar cancer patients.
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Affiliation(s)
- Anne-Floor W Pouwer
- a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands
| | - Henriette J Arts
- b Department of Obstetrics and Gynaecology , University Medical Center Groningen , Groningen , The Netherlands
| | - Jacobus van der Velden
- c Department of Obstetrics and Gynaecology , Center for Gynaecologic Oncology Amsterdam (location: Academic Medical Center) , Amsterdam , The Netherlands
| | - Joanne A de Hullu
- a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands
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Raphaelis S, Mayer H, Ott S, Mueller MD, Steiner E, Joura E, Senn B. The impact of written information and counseling (WOMAN-PRO II Program) on symptom outcomes in women with vulvar neoplasia: A multicenter randomized controlled phase II study. Gynecol Oncol 2017; 146:114-122. [PMID: 28483270 DOI: 10.1016/j.ygyno.2017.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether written information and/or counseling based on the WOMAN-PRO II Program decreases symptom prevalence in women with vulvar neoplasia by a clinically relevant degree, and to explore the differences between the 2 interventions in symptom prevalence, symptom distress prevalence, and symptom experience. METHODS A multicenter randomized controlled parallel-group phase II trial with 2 interventions provided to patients after the initial diagnosis was performed in Austria and Switzerland. Women randomized to written information received a predefined set of leaflets concerning wound care and available healthcare services. Women allocated to counseling were additionally provided with 5 consultations by an Advanced Practice Nurse (APN) between the initial diagnosis and 6months post-surgery that focused on symptom management, utilization of healthcare services, and health-related decision-making. Symptom outcomes were simultaneously measured 5 times to the counseling time points. RESULTS A total of 49 women with vulvar neoplasia participated in the study. Symptom prevalence decreased in women with counseling by a clinically relevant degree, but not in women with written information. Sporadically, significant differences between the 2 interventions could be observed in individual items, but not in the total scales or subscales of the symptom outcomes. CONCLUSIONS The results indicate that counseling may reduce symptom prevalence in women with vulvar neoplasia by a clinically relevant extent. The observed group differences between the 2 interventions slightly favor counseling over written information. The results justify testing the benefit of counseling thoroughly in a comparative phase III trial.
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Affiliation(s)
- Silvia Raphaelis
- Department of Nursing Science, University of Vienna, Alser Strasse 23, 1080 Vienna, Austria.
| | - Hanna Mayer
- Department of Nursing Science, University of Vienna, Alser Strasse 23, 1080 Vienna, Austria
| | - Stefan Ott
- Lecturer for Business Mathematics and Statistics, University of Applied Sciences FHS St. Gallen, Rosenbergstrasse 59, 9001 St. Gallen, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Inselspital, University Hospital Bern, Effingerstrasse 102, 3010 Berne, Switzerland
| | - Enikö Steiner
- Department of Obstetrics and Gynecology, Vienna General University Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Elmar Joura
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Beate Senn
- Institute for Applied Nursing Sciences IPW-FHS, University of Applied Sciences FHS St. Gallen, Rosenbergstrasse 59, 9001 St. Gallen, Switzerland; Sydney Nursing School, The University of Sydney, Mallett Street 88, 2050 Camperdown, NSW, Australia
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Li L, Kou X, Feng X, Liu F, Chao H, Wang L. Clinical application of sartorius tendon transposition during radical vulvectomy: a case control study of 58 cases at a single institution. J Gynecol Oncol 2015; 26:320-6. [PMID: 26404124 PMCID: PMC4620369 DOI: 10.3802/jgo.2015.26.4.320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/09/2015] [Accepted: 06/28/2015] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to investigate the clinical effects of sartorius tendon transposition versus sartorius transposition during bilateral inguinal lymphadenectomy of radical vulvectomy. Methods A total of 58 vulvar cancer patients who had surgery from May 2007 to October 2013, in which 30 patients received sartorius transposition and 28 patients received sartorius tendon transposition. All patients were matched by age, body mass index, stage, histology, and grade. Intraoperative variables and postoperative complications, recurrence, progression-free survival (PFS), and overall survival (OS) and postoperative life quality were compared and analyzed. Results No significant differences were found at median surgical times and amounts of bleeding (p=0.316 and p=0.249, respectively), neither at the incidences of groin cellulitis and lymphocele (p=0.673 and p=0.473, respectively), but the recovery times of the inguinal wounds were shorter (p=0.026) and the incidences of wound break and chronic lymphedema were significantly decreased in the tendon transposition group (p=0.012 and p=0.022, respectively). Postoperative quality of life in tendon transposition group was significantly improved as indicated by the EORTC QLQ-C30 questionnaire. Recurrences were similar (p=0.346) and no significant differences were found at PFS and OS (p=0.990 and p=0.683, respectively). Conclusion Compared to sartorius transposition, sartorius tendon transposition during inguinal lymphadenectomy led to improved patient recovery, reduced postoperative complications, and improved life quality without compromising the outcomes.
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Affiliation(s)
- Lei Li
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China.
| | - Xinxin Kou
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojie Feng
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Fenghua Liu
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongtu Chao
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Liying Wang
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
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Gentileschi S, Servillo M, Salgarello M. Supramicrosurgical lymphatic-venous anastomosis for postsurgical subcutaneous lymphocele treatment. Microsurgery 2015; 35:565-8. [DOI: 10.1002/micr.22478] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 07/26/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Stefano Gentileschi
- Department of Plastic and Reconstructive Surgery; Catholic University Sacred Heart, Policlinico Agostino Gemelli; Rome Italy
| | - Maria Servillo
- Department of Plastic and Reconstructive Surgery; Catholic University Sacred Heart, Policlinico Agostino Gemelli; Rome Italy
| | - Marzia Salgarello
- Department of Plastic and Reconstructive Surgery; Catholic University Sacred Heart, Policlinico Agostino Gemelli; Rome Italy
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Panici PB, Tomao F, Domenici L, Giannini A, Giannarelli D, Palaia I, Di Donato V, Musella A, Angioli R, Muzii L. Prognostic role of inguinal lymphadenectomy in vulvar squamous carcinoma: younger and older patients should be equally treated. A prospective study and literature review. Gynecol Oncol 2015; 137:373-9. [DOI: 10.1016/j.ygyno.2015.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/09/2015] [Indexed: 11/25/2022]
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Bertheuil N, Sulpice L, Levi Sandri G, Lavoué V, Watier E, Meunier B. Inguinal lymphadenectomy for stage III melanoma: A comparative study of two surgical approaches at the onset of lymphoedema. Eur J Surg Oncol 2015; 41:215-9. [DOI: 10.1016/j.ejso.2014.10.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/26/2014] [Accepted: 10/24/2014] [Indexed: 11/28/2022] Open
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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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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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Boccardo F, Dessalvi S, Campisi C, Molinari L, Spinaci S, Talamo G, Campisi C. Microsurgery for groin lymphocele and lymphedema after oncologic surgery. Microsurgery 2013; 34:10-3. [DOI: 10.1002/micr.22129] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 03/22/2013] [Accepted: 03/29/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Francesco Boccardo
- Department of Surgery-Unit of Lymphatic Surgery; IRCCS S.Martino University Hospital-IST; Genoa Italy
| | - Sara Dessalvi
- Department of Surgery-Unit of Lymphatic Surgery; IRCCS S.Martino University Hospital-IST; Genoa Italy
| | - Corrado Campisi
- Department of Surgery-Unit of Plastic and Reconstructive Surgery; IRCCS S.Martino University Hospital-IST; Genoa Italy
| | - Lidia Molinari
- Department of Surgery-Unit of Lymphatic Surgery; IRCCS S.Martino University Hospital-IST; Genoa Italy
| | - Stefano Spinaci
- Department of Surgery-Unit of Lymphatic Surgery; IRCCS S.Martino University Hospital-IST; Genoa Italy
| | - Giuseppina Talamo
- Department of Surgery-Unit of Lymphatic Surgery; IRCCS S.Martino University Hospital-IST; Genoa Italy
| | - Corradino Campisi
- Department of Surgery-Unit of Lymphatic Surgery; IRCCS S.Martino University Hospital-IST; Genoa Italy
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Baiocchi G, Silva Cestari F, Rocha R, Faloppa C, Kumagai L, Fukazawa E, Badiglian-Filho L, Cestari L, Sant’Ana Rodrigues I, Lavorato-Rocha A, Maia B, Soares F. Does the count after inguinofemoral lymphadenectomy in vulvar cancer correlate with outcome? Eur J Surg Oncol 2013; 39:339-43. [DOI: 10.1016/j.ejso.2013.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 01/09/2013] [Accepted: 02/01/2013] [Indexed: 11/28/2022] Open
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Sentinel Lymph Node Biopsy in Vulvar Cancer: A Health Technology Assessment for the Canadian Health Care Context. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:1053-1065. [DOI: 10.1016/s1701-2163(16)35435-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gertych W, Mathevet P. Technique du curage ganglionnaire inguinal dans les cancers vulvaires. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1624-5857(12)40993-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Palaia I, Giorgini M, Graziano M, Di Donato V, Marchetti C, Musella A, Benedetti Panici P. Isolated contralateral groin relapse in vulvar cancer. Arch Gynecol Obstet 2012; 286:793-4. [PMID: 22427010 DOI: 10.1007/s00404-012-2295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
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Endoscopic inguinal lymphadenectomy with a novel abdominal approach to vulvar cancer: description of technique and surgical outcome. J Minim Invasive Gynecol 2011; 18:644-50. [PMID: 21872170 DOI: 10.1016/j.jmig.2011.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/28/2011] [Accepted: 06/16/2011] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To evaluate the feasibility and surgical outcome of a novel technique of endoscopic inguinal lymphadenectomy to treat vulvar cancer. DESIGN Retrospective analysis performed by a single center over 2 years (Canadian Task Force classification II-2). SETTING Major university teaching hospital. PATIENTS The medical records for 17 consecutive patients who underwent endoscopic inguinal lymphadenectomy because of invasive vulvar cancer were retrospectively reviewed. INTERVENTION Endoscopic inguinal lymphadenectomy was performed using a novel abdominal approach. MEASUREMENTS AND MAIN RESULTS All patients underwent abdominal endoscopic inguinal lymphadenectomy without intraoperative complications. Median (range) operative time for the endoscopic procedure was 94 minutes, with estimated blood loss of approximately 137 mL (80-170 mL). A mean (range) of 16 (11-23) nodes were retrieved. In an additional 5 patients, pelvic node dissection was performed, with retrieval of 6 (3-11) nodes. Of the 17 patients, 2 demonstrated vulvar wound necrosis, and 1 exhibited lymphorrhea through the drain orifice. No other inguinal wound-related complications were observed. Mean postoperative hospital stay was 11 (8-19) days. All patients were followed up for more than 13 months, with no recurrence of cancer. CONCLUSIONS Endoscopic inguinal lymph node dissection using this novel abdominal approach in patients with vulvar cancer is a safe and feasible technique that may diminish the wound-related complications associated with the standard open approach.
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Nakamura Y, Fujisawa Y, Maruyama H, Furuta J, Kawachi Y, Otsuka F. Intraoperative mapping with isosulfan blue of lymphatic leakage during inguinal lymph node dissection (ILND) for skin cancer for the prevention of postoperative lymphocele. J Surg Oncol 2011; 104:657-60. [DOI: 10.1002/jso.21989] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 05/12/2011] [Indexed: 11/10/2022]
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