Nomogram predicting risk of lymphocele in gynecologic cancer patients undergoing pelvic lymph node dissection
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Objective: The purpose of this study is to estimate the risk of postoperative lymphocele development after lymphadenectomy in gynecologic cancer patients through establishing a nomogram. Methods: We retrospectively reviewed 371 consecutive gynecologic cancer patients undergoing lymphadenectomy between 2009 and 2014. Association of the development of postoperative lymphocele with clinical characteristics was evaluated in univariate and multivariate regression analyses. Nomograms were built based on the data of multivariate analysis using R-software. Results: Mean age at the operation was 50.8±11.1 years. Postoperative lymphocele was found in 70 (18.9%) patients. Of them, 22 (31.4%) had complicated one. Multivariate analysis revealed that hypertension (hazard ratio [HR], 3.0; 95% confidence interval [CI], 1.5 to 6.0; P=0.003), open surgery (HR, 3.2; 95% CI, 1.4 to 7.1; P=0.004), retrieved lymph nodes (LNs) >21 (HR, 1.8; 95% CI, 1.0 to 3.3; P=0.042), and no use of intermittent pneumatic compression (HR, 2.7; 95% CI, 1.0 to 7.2; P=0.047) were independent risk factors for the development of postoperative lymphocele. The nomogram appeared to be accurate and predicted the lymphocele development better than chance (concordance index, 0.754). For complicated lymphoceles, most variables which have shown significant association with general lymphocele lost the statistical significance, except hypertension (P=0.011) and mean number of retrieved LNs (29.5 vs. 21.1; P=0.001). A nomogram for complicated lymphocele showed similar predictive accuracy (concordance index, 0.727). Conclusion: We developed a nomogram to predict the risk of lymphocele in gynecologic cancer patients on the basis of readily obtained clinical variables. External validation of this nomogram in different group of patients is needed.
Abstract
Objective: The purpose of this study is to estimate the risk of postoperative lymphocele development after lymphadenectomy in gynecologic cancer patients through establishing a nomogram. Methods: We retrospectively reviewed 371 consecutive gynecologic cancer patients undergoing lymphadenectomy between 2009 and 2014. Association of the development of postoperative lymphocele with clinical characteristics was evaluated in univariate and multivariate regression analyses. Nomograms were built based on the data of multivariate analysis using R-software. Results: Mean age at the operation was 50.8±11.1 years. Postoperative lymphocele was found in 70 (18.9%) patients. Of them, 22 (31.4%) had complicated one. Multivariate analysis revealed that hypertension (hazard ratio [HR], 3.0; 95% confidence interval [CI], 1.5 to 6.0; P=0.003), open surgery (HR, 3.2; 95% CI, 1.4 to 7.1; P=0.004), retrieved lymph nodes (LNs) >21 (HR, 1.8; 95% CI, 1.0 to 3.3; P=0.042), and no use of intermittent pneumatic compression (HR, 2.7; 95% CI, 1.0 to 7.2; P=0.047) were independent risk factors for the development of postoperative lymphocele. The nomogram appeared to be accurate and predicted the lymphocele development better than chance (concordance index, 0.754). For complicated lymphoceles, most variables which have shown significant association with general lymphocele lost the statistical significance, except hypertension (P=0.011) and mean number of retrieved LNs (29.5 vs. 21.1; P=0.001). A nomogram for complicated lymphocele showed similar predictive accuracy (concordance index, 0.727). Conclusion: We developed a nomogram to predict the risk of lymphocele in gynecologic cancer patients on the basis of readily obtained clinical variables. External validation of this nomogram in different group of patients is needed.
참고문헌 (13)
- Hiramatsu K, "Optimal timing for drainage of infected lymphocysts after lymphadenectomy for gynecologic cancer", Int J Gynecol Cancer, 25, pp.337~341 (2015)
- Gallotta V, "A randomized study comparing the use of the Ligaclip with bipolar energy to prevent lymphocele during laparoscopic pelvic lymphadenectomy for gynecologic cancer", Am J Obstet Gynecol, 203, pp.483.e1-6~ (2010)
- 김윤환, "Prevention of lymphocele by using gelatin-thrombin matrix as a tissue sealant after pelvic lymphadenectomy in patients with gynecologic cancers: a prospective randomized controlled study", Journal of Gynecologic Oncology, 28(3), pp.1~7 (2017), 대한부인종양학회[DOI]
- Hee Yeon Kim, "An Analysis of the Risk Factors and Management of Lymphocele after Pelvic Lymphadenectomy in Patients with Gynecologic Malignancies", Cancer Research and Treatment, 36(6), pp.377~383 (2004), 대한암학회
- Charoenkwan K, "Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphocyst formation in patients with gynaecological malignancies", Cochrane Database Syst Rev, 2014(6), pp.CD007387~ (2014)
- Mori N., "Clinical and experimental studies on the socalled lymphocyst which develops after radical hysterectomy in cancer of the uterine cervix", J Jpn Obstet Gynecol Soc, 2, pp.178~203 (1955)
- Metcalf KS, "Lymphocele", Ann R Coll Surg Engl, 75, pp.387~392 (1993)
- Suzuki M, "Pelvic lymphocysts following retroperitoneal lymphadenectomy: retroperitoneal partial “no-closure” for ovarian and endometrial cancers", J Surg Oncol, 68, pp.149~152 (1998)
- Kim JK, "Postoperative pelvic lymphocele: treatment with simple percutaneous catheter drainage", Radiology, 212, pp.390~394 (1999)
- Park NY, "The effect of nonperitonization and laparoscopic lymphadenectomy for minimizing the incidence of lymphocyst formation after radical hysterectomy for cervical cancer", Int J Gynecol Cancer, 20, pp.443~448 (2010)
- Achouri A, "Complications of lymphadenectomy for gynecologic cancer", Eur J Surg Oncol, 39, pp.81~86 (2013)
- Tam KF, "Natural history of pelvic lymphocysts as observed by ultrasonography after bilateral pelvic lymphadenectomy", Ultrasound Obstet Gynecol, 32, pp.87~90 (2008)
- Benedetti-Panici P, "A randomized study comparing retroperitoneal drainage with no drainage after lymphadenectomy in gynecologic malignancies", Gynecol Oncol, 65, pp.478~482 (1997)