Prospective Assessment of Postoperative Complications and Associated Costs Following Inguinal Lymph Node Dissection (ILND) in Melanoma Patients
Identifieur interne : 005678 ( Main/Exploration ); précédent : 005677; suivant : 005679Prospective Assessment of Postoperative Complications and Associated Costs Following Inguinal Lymph Node Dissection (ILND) in Melanoma Patients
Auteurs : Sharon B. Chang ; Robert L. Askew ; Yan Xing ; Storm Weaver ; Jeffrey E. Gershenwald ; Jeffrey E. Lee ; Richard Royal ; Anthony Lucci ; Merrick I. Ross ; Janice N. CormierSource :
- Annals of surgical oncology [ 1068-9265 ] ; 2010.
Descripteurs français
- KwdFr :
- Adolescent, Adulte, Adulte d'âge moyen, Biopsie de noeud lymphatique sentinelle, Canal inguinal (), Canal inguinal (anatomopathologie), Complications postopératoires, Femelle, Humains, Infection de plaie opératoire (), Infection de plaie opératoire (économie), Infection de plaie opératoire (étiologie), Jeune adulte, Lymphadénectomie (économie), Lymphoedème (), Lymphoedème (économie), Lymphoedème (étiologie), Lâchage de suture (), Lâchage de suture (économie), Lâchage de suture (étiologie), Mâle, Mélanome (), Mélanome (économie), Métastase lymphatique, Résultat thérapeutique, Sujet âgé, Sujet âgé de 80 ans ou plus, Taux de survie, Études de suivi, Études prospectives.
- MESH :
- anatomopathologie : Canal inguinal.
- économie : Infection de plaie opératoire, Lymphadénectomie, Lymphoedème, Lâchage de suture, Mélanome.
- étiologie : Infection de plaie opératoire, Lymphoedème, Lâchage de suture.
- Adolescent, Adulte, Adulte d'âge moyen, Biopsie de noeud lymphatique sentinelle, Canal inguinal, Complications postopératoires, Femelle, Humains, Infection de plaie opératoire, Jeune adulte, Lymphoedème, Lâchage de suture, Mâle, Mélanome, Métastase lymphatique, Résultat thérapeutique, Sujet âgé, Sujet âgé de 80 ans ou plus, Taux de survie, Études de suivi, Études prospectives.
English descriptors
- KwdEn :
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Inguinal Canal (pathology), Inguinal Canal (surgery), Lymph Node Excision (economics), Lymphatic Metastasis, Lymphedema (economics), Lymphedema (etiology), Lymphedema (surgery), Male, Melanoma (complications), Melanoma (economics), Melanoma (surgery), Middle Aged, Postoperative Complications, Prospective Studies, Sentinel Lymph Node Biopsy, Surgical Wound Dehiscence (economics), Surgical Wound Dehiscence (etiology), Surgical Wound Dehiscence (surgery), Surgical Wound Infection (economics), Surgical Wound Infection (etiology), Surgical Wound Infection (surgery), Survival Rate, Treatment Outcome, Young Adult.
- MESH :
- complications : Melanoma.
- economics : Lymph Node Excision, Lymphedema, Melanoma, Surgical Wound Dehiscence, Surgical Wound Infection.
- etiology : Lymphedema, Surgical Wound Dehiscence, Surgical Wound Infection.
- pathology : Inguinal Canal.
- surgery : Inguinal Canal, Lymphedema, Melanoma, Surgical Wound Dehiscence, Surgical Wound Infection.
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Lymphatic Metastasis, Male, Middle Aged, Postoperative Complications, Prospective Studies, Sentinel Lymph Node Biopsy, Survival Rate, Treatment Outcome, Young Adult.
Abstract
We prospectively assessed the incidence, risk factors, and costs associated with wound complications and lymphedema in melanoma patients undergoing inguinal lymph node dissection (ILND).
A total of 53 melanoma patients were accrued to 2 trials (June 2005 to July 2008) that included prospective evaluations of postoperative complications; 30-day wound complications included infection, seroma, and/or dehiscence. There were 20 patients who underwent limb volume measurement and completed a 19-item lymphedema symptom assessment questionnaire preoperatively and 3 months postoperatively. A multivariate analysis was performed to evaluate potential risk factors for complications. A microcosting analysis was also performed to evaluate the direct costs associated with wound complications.
The 30-day wound complications were noted in 77.4% of patients. A BMI ≥ 30 (
Postoperative wound complications and early onset lymphedema occur frequently following ILND for melanoma. Obesity is an adverse risk factor for 30-day wound complications that can significantly increase postoperative costs, as is likely the case for advanced disease. Risk reduction practices and novel treatment approaches are needed to reduce postoperative morbidity.
Url:
DOI: 10.1245/s10434-010-1026-z
PubMed: 20336388
PubMed Central: 2943041
Affiliations:
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Le document en format XML
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Gershenwald</name></author><author><name sortKey="Lee, Jeffrey E" sort="Lee, Jeffrey E" uniqKey="Lee J" first="Jeffrey E." last="Lee">Jeffrey E. Lee</name></author><author><name sortKey="Royal, Richard" sort="Royal, Richard" uniqKey="Royal R" first="Richard" last="Royal">Richard Royal</name></author><author><name sortKey="Lucci, Anthony" sort="Lucci, Anthony" uniqKey="Lucci A" first="Anthony" last="Lucci">Anthony Lucci</name></author><author><name sortKey="Ross, Merrick I" sort="Ross, Merrick I" uniqKey="Ross M" first="Merrick I." last="Ross">Merrick I. Ross</name></author><author><name sortKey="Cormier, Janice N" sort="Cormier, Janice N" uniqKey="Cormier J" first="Janice N." last="Cormier">Janice N. 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Chang</name></author><author><name sortKey="Askew, Robert L" sort="Askew, Robert L" uniqKey="Askew R" first="Robert L." last="Askew">Robert L. Askew</name></author><author><name sortKey="Xing, Yan" sort="Xing, Yan" uniqKey="Xing Y" first="Yan" last="Xing">Yan Xing</name></author><author><name sortKey="Weaver, Storm" sort="Weaver, Storm" uniqKey="Weaver S" first="Storm" last="Weaver">Storm Weaver</name></author><author><name sortKey="Gershenwald, Jeffrey E" sort="Gershenwald, Jeffrey E" uniqKey="Gershenwald J" first="Jeffrey E." last="Gershenwald">Jeffrey E. Gershenwald</name></author><author><name sortKey="Lee, Jeffrey E" sort="Lee, Jeffrey E" uniqKey="Lee J" first="Jeffrey E." last="Lee">Jeffrey E. Lee</name></author><author><name sortKey="Royal, Richard" sort="Royal, Richard" uniqKey="Royal R" first="Richard" last="Royal">Richard Royal</name></author><author><name sortKey="Lucci, Anthony" sort="Lucci, Anthony" uniqKey="Lucci A" first="Anthony" last="Lucci">Anthony Lucci</name></author><author><name sortKey="Ross, Merrick I" sort="Ross, Merrick I" uniqKey="Ross M" first="Merrick I." last="Ross">Merrick I. Ross</name></author><author><name sortKey="Cormier, Janice N" sort="Cormier, Janice N" uniqKey="Cormier J" first="Janice N." last="Cormier">Janice N. Cormier</name></author></analytic><series><title level="j">Annals of surgical oncology</title><idno type="ISSN">1068-9265</idno><idno type="eISSN">1534-4681</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Inguinal Canal (pathology)</term><term>Inguinal Canal (surgery)</term><term>Lymph Node Excision (economics)</term><term>Lymphatic Metastasis</term><term>Lymphedema (economics)</term><term>Lymphedema (etiology)</term><term>Lymphedema (surgery)</term><term>Male</term><term>Melanoma (complications)</term><term>Melanoma (economics)</term><term>Melanoma (surgery)</term><term>Middle Aged</term><term>Postoperative Complications</term><term>Prospective Studies</term><term>Sentinel Lymph Node Biopsy</term><term>Surgical Wound Dehiscence (economics)</term><term>Surgical Wound Dehiscence (etiology)</term><term>Surgical Wound Dehiscence (surgery)</term><term>Surgical Wound Infection (economics)</term><term>Surgical Wound Infection (etiology)</term><term>Surgical Wound Infection (surgery)</term><term>Survival Rate</term><term>Treatment Outcome</term><term>Young Adult</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Canal inguinal ()</term><term>Canal inguinal (anatomopathologie)</term><term>Complications postopératoires</term><term>Femelle</term><term>Humains</term><term>Infection de plaie opératoire ()</term><term>Infection de plaie opératoire (économie)</term><term>Infection de plaie opératoire (étiologie)</term><term>Jeune adulte</term><term>Lymphadénectomie (économie)</term><term>Lymphoedème ()</term><term>Lymphoedème (économie)</term><term>Lymphoedème (étiologie)</term><term>Lâchage de suture ()</term><term>Lâchage de suture (économie)</term><term>Lâchage de suture (étiologie)</term><term>Mâle</term><term>Mélanome ()</term><term>Mélanome (économie)</term><term>Métastase lymphatique</term><term>Résultat thérapeutique</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Taux de survie</term><term>Études de suivi</term><term>Études prospectives</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Canal inguinal</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Melanoma</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Lymph Node Excision</term><term>Lymphedema</term><term>Melanoma</term><term>Surgical Wound Dehiscence</term><term>Surgical Wound Infection</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lymphedema</term><term>Surgical Wound Dehiscence</term><term>Surgical Wound Infection</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Inguinal Canal</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Inguinal Canal</term><term>Lymphedema</term><term>Melanoma</term><term>Surgical Wound Dehiscence</term><term>Surgical Wound Infection</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Infection de plaie opératoire</term><term>Lymphadénectomie</term><term>Lymphoedème</term><term>Lâchage de suture</term><term>Mélanome</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Infection de plaie opératoire</term><term>Lymphoedème</term><term>Lâchage de suture</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Lymphatic Metastasis</term><term>Male</term><term>Middle Aged</term><term>Postoperative Complications</term><term>Prospective Studies</term><term>Sentinel Lymph Node Biopsy</term><term>Survival Rate</term><term>Treatment Outcome</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Canal inguinal</term><term>Complications postopératoires</term><term>Femelle</term><term>Humains</term><term>Infection de plaie opératoire</term><term>Jeune adulte</term><term>Lymphoedème</term><term>Lâchage de suture</term><term>Mâle</term><term>Mélanome</term><term>Métastase lymphatique</term><term>Résultat thérapeutique</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Taux de survie</term><term>Études de suivi</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">We prospectively assessed the incidence, risk factors, and costs associated with wound complications and lymphedema in melanoma patients undergoing inguinal lymph node dissection (ILND).</p></sec><sec sec-type="materials|methods" id="S2"><title>Materials and Methods</title><p id="P2">A total of 53 melanoma patients were accrued to 2 trials (June 2005 to July 2008) that included prospective evaluations of postoperative complications; 30-day wound complications included infection, seroma, and/or dehiscence. There were 20 patients who underwent limb volume measurement and completed a 19-item lymphedema symptom assessment questionnaire preoperatively and 3 months postoperatively. A multivariate analysis was performed to evaluate potential risk factors for complications. A microcosting analysis was also performed to evaluate the direct costs associated with wound complications.</p></sec><sec id="S3"><title>Results</title><p id="P3">The 30-day wound complications were noted in 77.4% of patients. A BMI ≥ 30 (<italic>n</italic> = 28) increased the risk for wound complications (odds ratio [OR] = 11.4, 95% confidence interval [95%CI] 1.6–78.5, <italic>P</italic> = .01), while advanced nodal disease approached significance (OR = 9.0, 95%CI: 0.79–103.1, <italic>P</italic> = .08). Other risk factors, including diabetes, smoking, and the addition of a deep pelvic (iliac/obturator) dissection to ILND, were not significant. Of 20 patients, 9 (45%) developed limb volume change (LVC) ≥5% at 3 months, with associated mean symptom scores of 6.1 versus 4.6 for those without LVC. Costs for patients with wound complications were significantly higher than for those without wound complications.</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">Postoperative wound complications and early onset lymphedema occur frequently following ILND for melanoma. Obesity is an adverse risk factor for 30-day wound complications that can significantly increase postoperative costs, as is likely the case for advanced disease. Risk reduction practices and novel treatment approaches are needed to reduce postoperative morbidity.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Askew, Robert L" sort="Askew, Robert L" uniqKey="Askew R" first="Robert L." last="Askew">Robert L. Askew</name><name sortKey="Chang, Sharon B" sort="Chang, Sharon B" uniqKey="Chang S" first="Sharon B." last="Chang">Sharon B. Chang</name><name sortKey="Cormier, Janice N" sort="Cormier, Janice N" uniqKey="Cormier J" first="Janice N." last="Cormier">Janice N. Cormier</name><name sortKey="Gershenwald, Jeffrey E" sort="Gershenwald, Jeffrey E" uniqKey="Gershenwald J" first="Jeffrey E." last="Gershenwald">Jeffrey E. Gershenwald</name><name sortKey="Lee, Jeffrey E" sort="Lee, Jeffrey E" uniqKey="Lee J" first="Jeffrey E." last="Lee">Jeffrey E. Lee</name><name sortKey="Lucci, Anthony" sort="Lucci, Anthony" uniqKey="Lucci A" first="Anthony" last="Lucci">Anthony Lucci</name><name sortKey="Ross, Merrick I" sort="Ross, Merrick I" uniqKey="Ross M" first="Merrick I." last="Ross">Merrick I. Ross</name><name sortKey="Royal, Richard" sort="Royal, Richard" uniqKey="Royal R" first="Richard" last="Royal">Richard Royal</name><name sortKey="Weaver, Storm" sort="Weaver, Storm" uniqKey="Weaver S" first="Storm" last="Weaver">Storm Weaver</name><name sortKey="Xing, Yan" sort="Xing, Yan" uniqKey="Xing Y" first="Yan" last="Xing">Yan Xing</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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