Definition and severity grading of postoperative lymphatic leakage following inguinal lymph node dissection
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ORIGINAL ARTICLE
Definition and severity grading of postoperative lymphatic leakage following inguinal lymph node dissection Andreas Lutz Heinrich Gerken 1 & Florian Herrle 1 & Jens Jakob 2 & Christel Weiß 3 & Nuh N. Rahbari 1 & Kai Nowak 1,4 & Constantin Karthein 5 & Peter Hohenberger 1 & Jürgen Weitz 5 & Christoph Reißfelder 1 & Jakob C. Dobroschke 5 Received: 11 December 2019 / Accepted: 2 July 2020 # The Author(s) 2020
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. Keywords ILND . Complications . Outcome . Lymphogenic morbidity . Lymphatic fistula . Melanoma
Introduction * Andreas Lutz Heinrich Gerken [email protected] 1
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
2
Department of General, Visceral and Pediatric Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
3
Department of Biometry and Statistics, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
4
Department of General Vascular and Thoracic Surgery, RoMed Hospital Rosenheim, Pettenkoferstraße 10, 83022 Rosenheim, Germany
5
Department of Visceral Surgery, University Hospital, Technical University Dresden, Fetscherstr. 74, 0
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