School of Medicine, Cardiff University, Cardiff, UK
Gynaecological Oncology, University Hospital of Wales, Cardiff, UK.
Int J Gynecol Cancer. 2020 Aug;30(8):1113-1117. doi: 10.1136/ijgc-2019-001014. Epub 2020 May 4.
Inguino-femoral lymph node dissection plays a crucial role in the management of vulvar cancer. The procedure is associated with high complication rates, including infection, lymphocysts/lymphoedema and wound dehiscence. Several skin incision techniques exist and practice among gynecology oncologists is variable. Little evidence exists to guide surgeons regarding the optimal surgical approach. This study aimed to determine the difference in 30-day complication rates, number of lymph nodes and length of stay between patients undergoing the modified oblique and classical 'lazy S' skin incision.
A retrospective review between January 2014 and September 2018 was performed in the University Hospital of Wales, Cardiff. All cases of inguino-femoral lymph node dissection performed for vulvar cancer were included in the study without exclusion. Data collected included age, body mass index (BMI), incision type, suture material, length of hospital stay, complication rates, cancer stage, lymph node count, lymph node positivity rate and recurrence rates. Data were analyzed using SPSS software and clinical significance was set as p<0.05.
Thirty-five cases of classical 'lazy S' and 14 cases of modified oblique were included in the analysis. The mean patient age was 65 years (range 41-86) in the classical 'lazy S' group and 58 years (range 19-81) in the modified oblique group. The mean BMI was 28 kg/m (range 18-45) in the classical 'lazy S' group and 29 kg/m (range 20-36) in the modified oblique group. In the classical 'lazy S' group, the stage classification was as follows: stage IB (18), II (2), IIIA (3), IIIB (4), IIIC (8). In the modified oblique group, the stage classification was: stage IB (8), II (4), IIIA (2). Grade 3-4 complications were statistically significantly more common after the classical 'lazy S' versus the modified oblique operation (20/35, 57.1% vs 2/14, 14.3%, p<0.02). Mean number of nodes harvested was statistically significantly higher in the classical 'lazy S' group compared with the modified oblique group (11.1 nodes, range 6-17 vs 7 nodes, range 4-11, p<0.001). Node positivity rate was higher in the classical 'lazy S' group compared with the modified oblique group (28.6% vs 10%, p=0.08). Mean hospital stay was statistically significantly longer in patients undergoing classical 'lazy S' versus modified oblique (10.7 vs 4.5 days, p=0.02). One case of groin node recurrence occurred and this patient was in the classical 'lazy S' arm.
The rate of overall and serious complications was lower after modified oblique skin incision compared with classical 'lazy S'. However, the absolute lymph node count and lymph node positivity rate were higher in the 'lazy S' group.
腹股沟-股部淋巴结清扫术在外阴癌的治疗中起着至关重要的作用。该手术与高并发症发生率相关，包括感染、淋巴囊肿/淋巴水肿和伤口裂开。存在几种皮肤切口技术，妇科肿瘤医生的实践方式也各不相同。目前几乎没有证据可以指导外科医生选择最佳的手术方法。本研究旨在确定改良斜切口与经典“懒 S”皮切口在 30 天并发症发生率、淋巴结数量和住院时间方面的差异。
对 2014 年 1 月至 2018 年 9 月期间在威尔士大学医院进行的所有外阴癌腹股沟-股部淋巴结清扫术病例进行回顾性分析。研究纳入了所有接受外阴癌腹股沟-股部淋巴结清扫术的患者，无排除标准。收集的数据包括年龄、体重指数（BMI）、切口类型、缝线材料、住院时间、并发症发生率、癌症分期、淋巴结数量、淋巴结阳性率和复发率。使用 SPSS 软件进行数据分析，以 p<0.05 为临床显著性差异标准。
分析纳入了 35 例经典“懒 S”和 14 例改良斜切口。经典“懒 S”组的平均患者年龄为 65 岁（范围 41-86），改良斜切口组为 58 岁（范围 19-81）。经典“懒 S”组的平均 BMI 为 28kg/m²（范围 18-45），改良斜切口组为 29kg/m²（范围 20-36）。经典“懒 S”组的分期分类如下：IB 期（18）、II 期（2）、IIIA 期（3）、IIIB 期（4）、IIIC 期（8）。改良斜切口组的分期分类为：IB 期（8）、II 期（4）、IIIA 期（2）。经典“懒 S”组术后 3-4 级并发症发生率明显高于改良斜切口组（20/35，57.1%比 2/14，14.3%，p<0.02）。经典“懒 S”组淋巴结采集数量明显高于改良斜切口组（11.1 个，范围 6-17 比 7 个，范围 4-11，p<0.001）。经典“懒 S”组淋巴结阳性率高于改良斜切口组（28.6%比 10%，p=0.08）。经典“懒 S”组的住院时间明显长于改良斜切口组（10.7 天比 4.5 天，p=0.02）。有 1 例腹股沟淋巴结复发，发生在经典“懒 S”组。
改良斜切口组的总体并发症和严重并发症发生率低于经典“懒 S”组。然而，“懒 S”组的绝对淋巴结数量和淋巴结阳性率更高。
