Department of Urology, Emory University, Atlanta, Georgia, USA.
J Urol. 2012 Oct;188(4):1176-80. doi: 10.1016/j.juro.2012.06.038. Epub 2012 Aug 15.
Open inguinal lymphadenectomy has been associated with significant postoperative morbidity. Recently, small series have demonstrated the feasibility and efficacy of endoscopic groin lymphadenectomy as an alternative to open surgery. Previously we reported the favorable results of our initial experience. Few reports of novel surgical methods include long-term complications. In this report we present a detailed analysis of immediate and long-term complications associated with the procedure using standardized complications reporting methodology including the Clavien classification.
From September 2008 to December 2009, 29 patients underwent endoscopic groin dissection for inguinal lymphadenectomy. The indications for dissection were cutaneous malignancies of the genitourinary area and lower extremities. Endoscopic dissection was performed as previously published. Data were prospectively collected regarding patient demographics and minor/major complications during the perioperative period as well as long-term complications during 1 year. Complications were described using the Clavien classification as well as other complication profiles for open inguinal lymphadenectomy. Minor complications were defined as mild to moderate leg edema, seroma formation not requiring aspiration, minimal skin edge necrosis requiring no therapy and cellulitis managed with antibiotics. Major complications included death, sepsis, venous thromboembolism, re-exploration or other invasive procedures, severe leg edema interfering with ambulation, skin flap necrosis and rehospitalization.
A total of 41 endoscopic groin dissections (12 single session bilateral) were performed in 29 patients. Patient characteristics were median body mass index 30 kg/m(2) (range 19 to 53, mean 31.1), median age 61 years (range 16 to 86), median Charlson comorbidity score 4 (range 1 to 11) and median length of stay 1 day (range 1 to 14). Median followup was 604 days (range 177 to 1,172, mean 634). There were no perioperative mortalities. A total of 11 (27%) minor and 6 (14.6%) major complications occurred.
Complications from endoscopic minimally invasive lymphadenectomy have low clinical morbidity. Analysis of the immediate and long-term complication profile using standardized Clavien complications reporting reveals that this procedure is safe, even in patients with a high Charlson comorbidity score and body mass index. Major complications were most often infection requiring intravenous antibiotics.
开放性腹股沟淋巴结清扫术与显著的术后发病率有关。最近，小系列研究表明，内镜腹股沟淋巴结切除术作为开放手术的替代方法具有可行性和疗效。此前，我们报告了我们最初经验的良好结果。很少有关于新手术方法的报告包括长期并发症。在本报告中，我们使用标准化并发症报告方法，包括 Clavien 分类，对该手术相关的即时和长期并发症进行了详细分析。
2008 年 9 月至 2009 年 12 月，29 例患者因会阴部和下肢皮肤恶性肿瘤行内镜腹股沟淋巴结清扫术。行淋巴结清扫术的指征为泌尿生殖区和下肢的皮肤恶性肿瘤。内镜解剖如前所述进行。前瞻性收集患者人口统计学资料和围手术期的轻微/主要并发症，以及 1 年内的长期并发症。并发症采用 Clavien 分类和其他开放式腹股沟淋巴结清扫术的并发症特征进行描述。轻微并发症定义为轻度至中度腿部水肿、无需抽吸的血清肿形成、无需治疗的轻微边缘皮肤坏死和抗生素治疗的蜂窝织炎。主要并发症包括死亡、脓毒症、静脉血栓栓塞、再次探查或其他侵入性手术、严重腿部水肿妨碍行走、皮瓣坏死和再次住院。
29 例患者共行 41 次内镜腹股沟淋巴结清扫术（12 次为单次双侧）。患者特征为：平均体重指数 30kg/m2（范围 19-53，平均 31.1）、平均年龄 61 岁（范围 16-86）、平均 Charlson 合并症评分 4 分（范围 1-11）和平均住院时间 1 天（范围 1-14）。中位随访时间为 604 天（范围 177-1172 天，平均 634 天）。围手术期无死亡。轻微并发症 11 例（27%），严重并发症 6 例（14.6%）。
内镜微创淋巴结清扫术的并发症具有较低的临床发病率。使用标准化 Clavien 并发症报告对即时和长期并发症情况进行分析，表明该手术是安全的，即使在 Charlson 合并症评分和体重指数较高的患者中也是如此。主要并发症多为需要静脉使用抗生素的感染。
