자궁경부암 환자에서 근치적 자궁절제술 및 골반림프절절제술 시행 후 발생하는 림프낭종의 위험인자
Risk factors of lymphocele after RAH with pelvic lymph node dissection for women with cervical cancer
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적자궁경부암 환자에서 근치적 자궁절제술 및 골반림프절절제술 시행 후 발생하는 림프낭종의 위험인자에 대해 분석해 보았다. 연구방법2005년 4월부터 2010년 6월까지 단일기관에서 자궁경부암으로 진단받고 근치적 자궁절제술 및 골반림프절절제술을 시행받은 병력이있는 62명의 환자의 의무기록을 후향적으로 분석하였다. 림프낭종의 발생 여부는 초음파 혹은 골반 및 복부 전산화단층촬영을 통하여 확인하였다. 환자군의 나이, 체질량지수, 수술한 의사, 과거 수술력, 병기, 종양의 조직형, 획득한 림프절의 개수, 방사선치료 여부 등에 대하여 조사하였다. 이변량 분석 및 다변량 분석을 통하여 림프낭종에 대한 위험인자를 평가하였다. 결과평균 추적관찰 기간 34.5개월(범위, 12-69개월) 동안 62명의 환자 중 20명(32%)에서 림프낭종이 있었고, 그 중 증상이 있는 경우가 8명이었다. 단변량 분석 결과 방사선치료 병력과 획득한 림프절의 개수가 많을수록 림프낭종의 발생률이 유의하게 높았다. 로지스틱 회귀 분석을 통해 방사선치료 병력과 획득한 림프절의 개수가 림프낭종에 대한 독립적인 위험인자임을 보였다. 결론방사선치료 병력과 획득한 림프절의 개수는 근치적 자궁절제술 및 골반림프절절제술을 시행받은 자궁경부암 환자에서의 림프낭종의 발생과 유의한 연관성을 보였다.
Abstract
Objective To identify the risk factors of lymphocele formation in patients with cervical cancer who underwent radical abdominal hysterectomy and pelvic lymph node dissection. Methods We conducted a retrospective study of 62 patients diagnosed with cervical cancer who underwent radical abdominal hysterectomy, including pelvic lymph node dissection between April 2005 and June 2010. Lymphocele was confirmed by imaging studies such as computed tomography or ultrasonography. Included risk factors were patient’s age, body mass index, surgeon’s experience, tumor histology, stage of cancer, previous surgery, number of retrieved lymph nodes, and radiation therapy. Multiple logistic regression analysis was performed to evaluate the risk factors of lymphocele formation. Results During median follow-up of 34.5 months (range, 12−69 months), 20 patients (32%) out of 62 had developed lymphocele. Eight patients developed symptomatic lymphocle. Univariate analysis showed the radiation therapy, and the number of retrieved lymph nodes as significant risk factors of lymphocele formation. When applying mutivariate analysis using logistic regression, radiation therapy (odds ratio=5.19, P=0.010) and the number of retrieved lymph node (odds ratio=4.80, P=0.021) were independent risk factors of lymphocele formation. Conclusion Radiation therapy and the number of retrieved lymph node were significant risk factors of lymphocele formation in patients with cervical cancer who underwent radical abdominal hysterectomy and pelvic lymph node dissection.
참고문헌 (31)
- Ohba Y, "Risk factors for lower-limb lymphedema after surgery for cervical cancer", Int J Clin Oncol, 16, pp.238~243 (2011)
- Matsuda T, "Cancer incidence and incidence rates in Japan in 2003: based on data from 13 population-based cancer registries in the Monitoring of Cancer Incidence in Japan (MCIJ) Project", Jpn J Clin Oncol, 39, pp.850~858 (2009)
- Musch M, "Complications of pelvic lymphadenectomy in 1,380 patients undergoing radical retropubic prostatectomy between 1993 and 2006", J Urol, 179, pp.923~928 (2008)
- Briganti A, "Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer", Eur Urol, 50, pp.1006~1013 (2006)
- Naselli A, "Predictors of symptomatic lymphocele after lymph node excision and radical prostatectomy", Urology, 75, pp.630~635 (2010)
- Augustin H, "Intraoperative and perioperative morbidity of contemporary radical retropubic prostatectomy in a consecutive series of 1243 patients: results of a single center between 1999 and 2002", Eur Urol, 43, pp.113~118 (2003)
- Suzuki M, "Pelvic lymphocysts following retroperitoneal lymphadenectomy: retroperitoneal partial “noclosure” for ovarian and endometrial cancers", J Surg Oncol, 68, pp.149~152 (1998)
- Hakenberg OW, "The incidence and treatment of lymphoceles after radical retropubic prostatectomy", BJU Int, 96, pp.1422~ (2005)
- Kim JK, "Postoperative pelvic lymphocele: treatment with simple percutaneous catheter drainage", Radiology, 212, pp.390~394 (1999)
- Fallick ML, "Laparoscopic marsupialization of lymphocele after laparoscopic lymph node dissection", J Endourol, 10, pp.533~534 (1996)
- Gilliland JD, "Lymphoceles: percutaneous treatment with povidone-iodine sclerosis", Radiology, 171, pp.227~229 (1989)
- Sawhney R, "Treatment of postoperative lymphoceles with percutaneous drainage and alcohol sclerotherapy", J Vasc Interv Radiol, 7, pp.241~245 (1996)
- Zanetta G, "Early and short-term complications after US-guided puncture of gynecologic lesions: evaluation after 1,000 consecutive cases", Radiology, 189, pp.161~164 (1993)
- Yamamoto R, "Prevention of lymphocyst formation following systematic lymphadenectomy", Jpn J Clin Oncol, 30, pp.397~400 (2000)
- 강승훈, "부인암 관련 하지 림프부종의 유병률 및 위험인자", Obstetrics & Gynecology Science, 52(08), pp.815~820 (2009), 대한산부인과학회
- Heidenreich A, "Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis", J Urol, 167, pp.1681~1686 (2002)
- Clark T, "Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer", J Urol, 169, pp.145~147 (2003)
- Khoder WY, "Risk factors for pelvic lymphoceles post-radical prostatectomy", Int J Urol, 18, pp.638~643 (2011)
- Ryan M, "The experience of lower limb lymphedema for women after treatment for gynecologic cancer", Oncol Nurs Forum, 30, pp.417~423 (2003)
- Abu-Rustum NR, "The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center", Gynecol Oncol, 103, pp.714~718 (2006)
- Werngren-Elgström M, "Lymphoedema of the lower extremities after surgery and radiotherapy for cancer of the cervix", Scand J Plast Reconstr Surg Hand Surg, 28, pp.289~293 (1994)
- Füller J, "Lymph edema of the lower extremities after lymphadenectomy and radiotherapy for cervical cancer", Strahlenther Onkol, 184, pp.206~211 (2008)
- 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~ (2010)
- 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
- Franchi M, "Randomised trial of drains versus no drains following radical hysterectomy and pelvic lymph node dissection: a European Organisation for Research and Treatment of Cancer- Gynaecological Cancer Group (EORTC-GCG) study in 234 patients", Eur J Cancer, 43, pp.1265~1268 (2007)
- Benedetti-Panici P, "A randomized study comparing retroperitoneal drainage with no drainage after lymphadenectomy in gynecologic malignancies", Gynecol Oncol, 65, pp.478~482 (1997)
- Srisomboon J, "A prospective randomized study comparing retroperitoneal drainage with no drainage and no peritonization following radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer", J Obstet Gynaecol Res, 28, pp.149~153 (2002)
- Morice P, "Retroperitoneal drainage after complete Paraaortic lymphadenectomy for gynecologic cancer: a randomized trial", Obstet Gynecol, 97, pp.243~247 (2001)
- Abu-Rustum NR, "Observations on the role of circumflex iliac node resection and the etiology of lower extremity lymphedema following pelvic lymphadenectomy for gynecologic malignancy", Gynecol Oncol, 106, pp.4~5 (2007)
- 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)
- Tinelli A, "Prevention of lymphocele in female pelvic lymphadenectomy by a collagen patch coated with the human coagulation factors: a pilot study", J Surg Oncol, 105, pp.835~840 (2012)