Predictors of complications after inguinal lymphadenectomy.

OBJECTIVE The aim of this study was to identify predictors of complications in patients undergoing inguinal lymphadenectomy (LND) in the treatment of vulvar carcinoma. METHODS Clinical information was abstracted from records of patients with invasive vulvar cancer. All patients underwent LND. Closed suction drains were placed in groin incisions and removed when output was less than 30 ml/24 h. Associations between variables were studied by chi(2) and t tests. RESULTS Sixty-seven patients undergoing 112 LND were evaluated. Eighty-eight percent of patients underwent radical vulvar surgery and LND while 12% underwent LND alone. Patients were treated with either unilateral (22) or bilateral (45) LND. Seventy-three percent received extended postoperative prophylactic antibiotics. The median duration of suction drainage was 15 days for one drain and 14 days for two drains. Early postoperative cellulitis (<30 days after surgery) developed in 35.4%, early wound breakdown in 19.4%, early lymphedema in 4.8%, and early lymphocyst formation in 13.1%. Late cellulitis (>30 days after surgery) developed in 22.2%, late wound breakdown in 3.2%, late lymphedema in 29.5%, and late lymphocysts in 5%. Patients developing early cellulitis were more likely to have early wound breakdown (P = <0.001, RR 14.2) or early lymphocyst formation (P = 0.016, RR 7.6). Type of procedure, antibiotic use, need for adjuvant therapy, and duration of suction drainage did not influence early complications. Early complications and management strategies did not predict late complications. CONCLUSIONS Chronic lymphedema occurs in nearly 30% of patients after LND. Late complications after LND were not predicted by early complications. New strategies for prevention of chronic lymphedema are needed.