Complications of Lymph Node Dissection

Even in the most experienced hands lymphadenectomy is not without complications. This accounts for the reluctance in offering lymphadenectomy to every patient presenting with penile cancer. The reported complication rate varies from 35% to 88%, and appears to be lower when inguinal lymphadenectomy is performed in a prophylactic or therapeutic setting compared with a palliative dissec-tion.14 Furthermore, pelvic node dissection and radiotherapy have shown to increase the complication rates.412 The most commonly cited complications are wound infection (15 ± 10%), skin necrosis (Fig. 9.13a) with or without wound

Fig. 9.13 (a) Skin necrosis. (b) Wound infection and dehiscence

Fig. 9.14 (a) Lymphocele. (b) Lymphedema. (c) Serous lymphedema of the right leg

dehiscence (Fig. 9.13b) (14 ± 50%), lymphocele/seroma (10 ± 10%) (Fig. 9.14a) lymphedema (Fig. 9.14b) (27 ± 30%), and other complications including hemorrhage, thrombosis, and even death. A summary of the most frequent complications is listed in Table 9.2 . Techniques in order to prevent complications have already been mentioned but will again be reviewed. Understanding the course of the vasculature of the inguinal skin is important in planning the incision. In a series from Brazil, three types of incision were compared, i.e. a large bi-iliac incision, a transverse S-shaped incision, and a skin-bridge technique with two separate incisions. The latter had the lowest incidence of skin necrosis and lymphedema.13 Utmost care must be taken when handling the skin in order to preserve its viability. Antibiotic prophylaxis and preventing venous thrombosis with low molecular weight heparin is strongly recommended.66 Individually fitted

Table 9.2 Complications of lymphadenectomy (%)

Number of

Wound

Skin edge

Seroma

Lymph

dissections

infection

necrosis

formation

edema

Death

10111

14

50

16

50

0

40512

17

62

7

27

1

20013

15

45

10

23

-

10614

10

8

10

23

2

102a4

22

8

18

56

0

aPer-patient

stockings should be available immediately after surgery. Extensive experience in nodal dissection is an important factor in the optimal removal of all lymphatic tissue and preventing complications13; this is also shown in results from the authors' institute. Thus it is reasonable to centralize this type of surgery and to refer patients to institutes with a large experience. Although a recent series has shown that the complication rate of lymphadenectomy has decreased, the incidence and magnitude of complications appears to remain significant with a complication-rate of 58% per-patient.14

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