Lymphocele prevention after pelvic laparoscopic lymphadenectomy by a collagen patch coated with human coagulation factors: A matched case-control study

Andrea Tinelli, Ospan A. Mynbaev, Daniel Alberto Tsin, Giorgio Giorda, Antonio Malvasi, Marcello Guido, Farr R. Nezhat

Research output: Contribution to journalArticle

Abstract

Objective: Lymphoceles are among the most common postoperative complications of pelvic lymphadenectomy (PL), with a reported incidence of 1% to 50%. Symptoms are pelvic pain, leg edema, gastrointestinal obstruction, obstructive uropathy, and deep vein thrombosis, and severe complications such as sepsis and lymphatic fistula formation. After laparoscopic PL, we tested the prevention of lymphoceles using collagen patch coated with the human coagulation factors (TachoSil, Nycomed International Management GmbH, Zurich, Switzerland) on 55 patients with endometrial cancer stages IB to II who had undergone laparoscopy. Materials and Methods: The authors divided the patients into 2 laparoscopy groups: PL plus TachoSil (group 1: 26 patients) and PL without TachoSil in a control group (group 2: 29 patients), as historical cohort of patients who underwent PL between 2010 and 2012. We collected surgical parameters, and the patients underwent ultrasound examination on postoperative days 7, 14, and 28. The main outcome measures were the development of symptomatic or asymptomatic lymphoceles, the need for further surgical intervention, as adverse effect of surgery, and the drainage volume and duration. Results: The same number of lymph nodes in both groups was removed; group 1 showed a lower drainage volume. Lymphoceles developed in 5 patients in group 1 and in 15 patients in group 2; of these, only 2 patients were symptomatic in group 1 and 5 patients were symptomatic in group 2, without statistical difference and no percutaneous drainage request. Conclusions: In this preliminary investigation, the intraoperative laparoscopy application of TachoSil seems to reduce the rate of postoperative lymphoceles after PL, providing a useful additional treatment option for reducing drainage volume and preventing lymphocele development after PL.

Original languageEnglish
Pages (from-to)956-963
Number of pages8
JournalInternational Journal of Gynecological Cancer
Volume23
Issue number5
DOIs
Publication statusPublished - Jun 2013

Fingerprint

Lymphocele
Blood Coagulation Factors
Lymph Node Excision
Case-Control Studies
Collagen
Drainage
Laparoscopy
Pelvic Pain
Endometrial Neoplasms
Switzerland
Venous Thrombosis
Fistula
Edema
Leg
Sepsis
Lymph Nodes
Outcome Assessment (Health Care)

Keywords

  • Complications
  • Drainage
  • Endometrial cancer
  • Lymph nodes
  • Lymphocele
  • Lymphocysts
  • Pelvic lymphadenectomy
  • Radical hysterectomy
  • TachoSil

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology

Cite this

Lymphocele prevention after pelvic laparoscopic lymphadenectomy by a collagen patch coated with human coagulation factors : A matched case-control study. / Tinelli, Andrea; Mynbaev, Ospan A.; Tsin, Daniel Alberto; Giorda, Giorgio; Malvasi, Antonio; Guido, Marcello; Nezhat, Farr R.

In: International Journal of Gynecological Cancer, Vol. 23, No. 5, 06.2013, p. 956-963.

Research output: Contribution to journalArticle

Tinelli, Andrea ; Mynbaev, Ospan A. ; Tsin, Daniel Alberto ; Giorda, Giorgio ; Malvasi, Antonio ; Guido, Marcello ; Nezhat, Farr R. / Lymphocele prevention after pelvic laparoscopic lymphadenectomy by a collagen patch coated with human coagulation factors : A matched case-control study. In: International Journal of Gynecological Cancer. 2013 ; Vol. 23, No. 5. pp. 956-963.
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T1 - Lymphocele prevention after pelvic laparoscopic lymphadenectomy by a collagen patch coated with human coagulation factors

T2 - A matched case-control study

AU - Tinelli, Andrea

AU - Mynbaev, Ospan A.

AU - Tsin, Daniel Alberto

AU - Giorda, Giorgio

AU - Malvasi, Antonio

AU - Guido, Marcello

AU - Nezhat, Farr R.

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N2 - Objective: Lymphoceles are among the most common postoperative complications of pelvic lymphadenectomy (PL), with a reported incidence of 1% to 50%. Symptoms are pelvic pain, leg edema, gastrointestinal obstruction, obstructive uropathy, and deep vein thrombosis, and severe complications such as sepsis and lymphatic fistula formation. After laparoscopic PL, we tested the prevention of lymphoceles using collagen patch coated with the human coagulation factors (TachoSil, Nycomed International Management GmbH, Zurich, Switzerland) on 55 patients with endometrial cancer stages IB to II who had undergone laparoscopy. Materials and Methods: The authors divided the patients into 2 laparoscopy groups: PL plus TachoSil (group 1: 26 patients) and PL without TachoSil in a control group (group 2: 29 patients), as historical cohort of patients who underwent PL between 2010 and 2012. We collected surgical parameters, and the patients underwent ultrasound examination on postoperative days 7, 14, and 28. The main outcome measures were the development of symptomatic or asymptomatic lymphoceles, the need for further surgical intervention, as adverse effect of surgery, and the drainage volume and duration. Results: The same number of lymph nodes in both groups was removed; group 1 showed a lower drainage volume. Lymphoceles developed in 5 patients in group 1 and in 15 patients in group 2; of these, only 2 patients were symptomatic in group 1 and 5 patients were symptomatic in group 2, without statistical difference and no percutaneous drainage request. Conclusions: In this preliminary investigation, the intraoperative laparoscopy application of TachoSil seems to reduce the rate of postoperative lymphoceles after PL, providing a useful additional treatment option for reducing drainage volume and preventing lymphocele development after PL.

AB - Objective: Lymphoceles are among the most common postoperative complications of pelvic lymphadenectomy (PL), with a reported incidence of 1% to 50%. Symptoms are pelvic pain, leg edema, gastrointestinal obstruction, obstructive uropathy, and deep vein thrombosis, and severe complications such as sepsis and lymphatic fistula formation. After laparoscopic PL, we tested the prevention of lymphoceles using collagen patch coated with the human coagulation factors (TachoSil, Nycomed International Management GmbH, Zurich, Switzerland) on 55 patients with endometrial cancer stages IB to II who had undergone laparoscopy. Materials and Methods: The authors divided the patients into 2 laparoscopy groups: PL plus TachoSil (group 1: 26 patients) and PL without TachoSil in a control group (group 2: 29 patients), as historical cohort of patients who underwent PL between 2010 and 2012. We collected surgical parameters, and the patients underwent ultrasound examination on postoperative days 7, 14, and 28. The main outcome measures were the development of symptomatic or asymptomatic lymphoceles, the need for further surgical intervention, as adverse effect of surgery, and the drainage volume and duration. Results: The same number of lymph nodes in both groups was removed; group 1 showed a lower drainage volume. Lymphoceles developed in 5 patients in group 1 and in 15 patients in group 2; of these, only 2 patients were symptomatic in group 1 and 5 patients were symptomatic in group 2, without statistical difference and no percutaneous drainage request. Conclusions: In this preliminary investigation, the intraoperative laparoscopy application of TachoSil seems to reduce the rate of postoperative lymphoceles after PL, providing a useful additional treatment option for reducing drainage volume and preventing lymphocele development after PL.

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KW - Lymph nodes

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KW - Pelvic lymphadenectomy

KW - Radical hysterectomy

KW - TachoSil

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