A W Pouwer1, F Hinten2, J van der Velden3, R G V Smolders4, B F M Slangen5, H J M A A Zijlmans6, J IntHout7, A G J van der Zee8, D Boll9, K N Gaarenstroom10, H J Arts8, J A de Hullu2. 1. Department of Obstetrics and Gynaecology, Radboud university medical center, PO Box 9101, 6500 HB Nijmegen, the Netherlands. Electronic address: Anne-Floor.W.Pouwer@radboudumc.nl. 2. Department of Obstetrics and Gynaecology, Radboud university medical center, PO Box 9101, 6500 HB Nijmegen, the Netherlands. 3. Center for Gynaecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, the Netherlands. 4. Department of Obstetrics and Gynaecology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands. 5. Department of Obstetrics and Gynaecology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands. 6. Center for Gynaecologic Oncology Amsterdam, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, Amsterdam, the Netherlands. 7. Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, PO Box 9101, 6500 HB Nijmegen, the Netherlands. 8. Department of Obstetrics and Gynaecology, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands. 9. Department of Obstetrics and Gynaecology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, the Netherlands. 10. Department of Obstetrics and Gynaecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
Abstract
OBJECTIVE: Inguinofemoral lymphadenectomy for patients with vulvar squamous cell carcinoma is associated with a high incidence of postoperative wound complications, which may be influenced by inguinal drain management. The aim of this nationwide prospective study (MAMBO: Morbidity And Measurement of the BOdy) was to assess the feasibility and the incidence of complications after volume-controlled versus short drainage. METHODS: The MAMBO study consisted of two observational studies in all eight oncology centers in the Netherlands, conducted between 2012 and 2016. In the first study, the drain was removed when the production was <30ml/24h, except in the first 48h, and after a maximum of 28days (MAMBO-IA). In the second study, the drain was removed five days postoperatively regardless of production (MAMBO-IB). We assessed the complications within eight weeks after surgery using logistic regression to compare the incidence of one or more complications between the two drainage protocols, adjusting for possible confounders. RESULTS: We included 77 patients (139 groins) for volume-controlled drainage and 64 patients (112 groins) for short drainage. Volume-controlled drainage was associated with significant less lymphocele formation. Moreover, we found no difference in wound infection or primary wound breakdown. The estimated incidence of one or more complications was 46% per groin after volume-controlled drainage versus 75% after short drainage, (RD 29% (95% CI 8, 49) p=0.006). CONCLUSIONS: This prospective study shows that volume-controlled drainage is associated with significantly less complications compared to short drainage. We therefore recommend volume-controlled drainage after inguinofemoral lymphadenectomy in patients with vulvar squamous cell carcinoma.
OBJECTIVE: Inguinofemoral lymphadenectomy for patients with vulvar squamous cell carcinoma is associated with a high incidence of postoperative wound complications, which may be influenced by inguinal drain management. The aim of this nationwide prospective study (MAMBO: Morbidity And Measurement of the BOdy) was to assess the feasibility and the incidence of complications after volume-controlled versus short drainage. METHODS: The MAMBO study consisted of two observational studies in all eight oncology centers in the Netherlands, conducted between 2012 and 2016. In the first study, the drain was removed when the production was <30ml/24h, except in the first 48h, and after a maximum of 28days (MAMBO-IA). In the second study, the drain was removed five days postoperatively regardless of production (MAMBO-IB). We assessed the complications within eight weeks after surgery using logistic regression to compare the incidence of one or more complications between the two drainage protocols, adjusting for possible confounders. RESULTS: We included 77 patients (139 groins) for volume-controlled drainage and 64 patients (112 groins) for short drainage. Volume-controlled drainage was associated with significant less lymphocele formation. Moreover, we found no difference in wound infection or primary wound breakdown. The estimated incidence of one or more complications was 46% per groin after volume-controlled drainage versus 75% after short drainage, (RD 29% (95% CI 8, 49) p=0.006). CONCLUSIONS: This prospective study shows that volume-controlled drainage is associated with significantly less complications compared to short drainage. We therefore recommend volume-controlled drainage after inguinofemoral lymphadenectomy in patients with vulvar squamous cell carcinoma.
Authors: Maaike H M Oonk; Brian Slomovitz; Peter J W Baldwin; Helena C van Doorn; Jacobus van der Velden; Joanne A de Hullu; Katja N Gaarenstroom; Brigitte F M Slangen; Ignace Vergote; Mats Brännström; Eleonora B L van Dorst; Willemien J van Driel; Ralph H Hermans; David Nunns; Martin Widschwendter; David Nugent; Cathrine M Holland; Aarti Sharma; Paul A DiSilvestro; Robert Mannel; Dorry Boll; David Cibula; Al Covens; Diane Provencher; Ingo B Runnebaum; David Luesley; Patricia Ellis; Timothy J Duncan; Ming Y Tjiong; Derek J Cruickshank; Preben Kjølhede; Charles F Levenback; Jiri Bouda; Katharina E Kieser; Connie Palle; Nicola M Spirtos; David M O'Malley; Mario M Leitao; Melissa A Geller; Kalyan Dhar; Viren Asher; Karl Tamussino; Daniel H Tobias; Christer Borgfeldt; Jayanthi S Lea; Jo Bailey; Margareta Lood; Brynhildur Eyjolfsdottir; Stephen Attard-Montalto; Krishnansu S Tewari; Ranjit Manchanda; Pernille T Jensen; Par Persson; Linda Van Le; Hein Putter; Geertruida H de Bock; Bradley J Monk; Carien L Creutzberg; Ate G J van der Zee Journal: J Clin Oncol Date: 2021-08-25 Impact factor: 50.717
Authors: Anne-Floor W Pouwer; Peter Bult; Irene Otte; Michiel van der Brand; Judith van der Horst; Laurette J V Harterink; Koen K van de Vijver; Esther Guerra; Riena P Aliredjo; Steven L Bosch; Johanna M M Grefte; Saskia Zomer; Harry Hollema; Barry de Heus; Saphira Satumalaij; Patricia C Ewing-Graham; Joanna IntHout; Joanne A de Hullu; Johan Bulten Journal: Histopathology Date: 2019-07-26 Impact factor: 5.087
Authors: Peter Dall; Thomas Hildebrandt; Andreas du Bois; Eric Boetel; Janine Ahlfaenger; Matthias W Beckmann; Mareike Bommert Journal: Arch Gynecol Obstet Date: 2020-04-18 Impact factor: 2.344