Lymphatic leakage after pelvic lymphadenectomy for cervical cancer: a retrospective case-control study

Li Chen,Haixin He,Zuolian Xie,Cuibo Lin,Liang Lin,Ling Li,An Lin,Jian Chen

doi:10.1186/s12885-021-08984-1

Abstract

BackgroundThe study aims to evaluate the clinical features and management of postoperative lymphatic leakage (PLL) in patients with cervical cancer who received pelvic lymphadenectomy.MethodsThis retrospective study screened consecutive patients with cervical cancer (stage Ia2-IIb).ResultsAmong 3427 cases screened, 63 patients (1.8%) were diagnosed with PLL, which manifested as persistent abdominal drainage (42/63, 66.7%), chylous ascites (12/63, 19.0%) or vaginal drainage (9/63, 14.3%). Median time from surgery to onset of PLL was 6 days (range, 4–21 days). All cases resolved in a median 10 days (range, 3–56 days) after conservative treatment; although one case experienced recurrence of vaginal drainage after 26 days, this also resolved after conservative therapy. Multivariate analysis showed that two cycles of neoadjuvant chemotherapy (odds ratio [OR], 3.283; 95% confidence interval [95%CI], 1.289–8.360; P = 0.013), a decrease in hemoglobin level of ≥20 and < 30 g/L (OR, 6.175; 95%CI, 1.033–10.919; P = 0.046) or ≥ 30 g/L (OR, 8.467; 95%CI, 1.248–17.426; P = 0.029), and postoperative albumin level ≥ 30 and < 35 g/L (OR, 2.552; 95%CI, 1.112–5.857; P = 0.027) or < 30 g/L (OR, 5.517; 95%CI, 2.047–18.148; P = 0.012) were associated with PLL.ConclusionNeoadjuvant chemotherapy, postoperative anemia and postoperative hypoproteinemia are risk factors for PLL.

Highlights

The study aims to evaluate the clinical features and management of postoperative lymphatic leakage (PLL) in patients with cervical cancer who received pelvic lymphadenectomy
Among 3427 cases screened, 63 patients (1.8%) were diagnosed with PLL, which manifested as persistent abdominal drainage (42/63, 66.7%), chylous ascites (12/63, 19.0%) or vaginal drainage (9/63, 14.3%)
Multivariate analysis showed that two cycles of neoadjuvant chemotherapy, a decrease in hemoglobin level of ≥20 and < 30 g/L (OR, 6.175; 95% confidence intervals (95%CIs), 1.033–10.919; P = 0.046) or ≥ 30 g/L (OR, 8.467; 95%CI, 1.248–17.426; P = 0.029), and postoperative albumin level ≥ 30 and < 35 g/L (OR, 2.552; 95%CI, 1.112–5.857; P = 0.027) or < 30 g/L (OR, 5.517; 95%CI, 2.047–18.148; P = 0.012) were associated with PLL

Summary

Introduction

The study aims to evaluate the clinical features and management of postoperative lymphatic leakage (PLL) in patients with cervical cancer who received pelvic lymphadenectomy. An important cause of postoperative lymphatic leakage in patients with gynecological malignancies is pelvic and paraaortic lymphadenectomy [10]. The reported incidences of postoperative lymphatic ascites and chylous ascites in patients undergoing lymph node dissection for gynecological malignancies are 2.7– 4.0% [10, 11] and 0.17–2.0% [12,13,14], respectively. In the aspect of abdominal surgery, a number of studies believe that the number of lymph node resection is closely related to the occurrence of chylous leakage [15, 16]. The extent of abdominal surgery, tumor grade, number of positive lymph nodes, number

Methods

Results

Conclusion