Minimizing Post-operative Complications of Groin Dissection Using Modified Skin Bridge Technique: A Single-Centre Descriptive Study Showing Post-operative and Early Oncological Outcomes

  • Mukur Dipi Ray
  • Ashish Jakhetiya
  • Sunil Kumar
  • Ashutosh Mishra
  • Seema Singh
  • Nootan Kumar Shukla
Original Scientific Report
First Online:

Abstract

Introduction

Historically, groin dissections are associated with high morbidity. Various modifications have been described in the literature with inconsistent outcomes. The aim of this paper is to highlight modified skin bridge technique to minimize all post-operative complications of groin dissection without compromising early oncological outcomes.

Methods

A retrospective descriptive study of the computerized cancer database was performed to retrieve details of all the cancer patients who had undergone groin dissections during January 2012 to September 2016. Data pertaining to clinical profile including demographics, clinical and histopathological details, treatment profile, procedure-related morbidity and relapse patterns were extracted and analysed.

Results

A total of 75 patients underwent 105 groin dissections during this period. Out of 105 groin dissections, 43 were inguinal lymph node dissection (ILND) and 62 were combined ilio-inguinal lymph node dissection (IILND). The most common diagnosis was carcinoma penis (25%) followed by malignant melanoma (14.6%) and squamous cell carcinoma (13.33%) of lower extremities. Overall, the most common complications were seroma (14.28%) and skin edge necrosis (7.61%) followed by surgical site infection (4.76%). After a median follow-up of 17.64 months (IQR 5–61.53), a total of 18 patients (24%) developed recurrence.

Conclusion

Groin dissection still remains an important diagnostic as well as therapeutic procedure justifying its potential of morbidity. Modified skin bridge technique is a very effective method to minimize all post-operative complications with optimal early oncological outcomes.

This is a preview of subscription content, log in to check access

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

References

  1. 1.
    Tonouchi H, Ohmori Y, Kobayashi M et al (2004) Operative morbidity associated with groin dissections. Surg Today 34(5):413–418CrossRefPubMedGoogle Scholar
  2. 2.
    Ray MD, Garg PK, Jakhetiya A et al (2016) Modified skin bridge technique for ilio-inguinal lymph node dissection: a forgotten technique revisited. World J Methodol 6(3):187–189CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Spratt J (2000) Groin dissection. J Surg Oncol 73(4):243–262CrossRefPubMedGoogle Scholar
  4. 4.
    Bevan-Thomas R, Slaton JW, Pettaway CA (2002) Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol 167(4):1638–1642CrossRefPubMedGoogle Scholar
  5. 5.
    Fraley EE, Hutchens HC (1972) Radical ilio-inguinal node dissection: the skin bridge technique. A new procedure. J Urol 108(2):279–281CrossRefPubMedGoogle Scholar
  6. 6.
    Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical skin site infections, 1992; A modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608CrossRefPubMedGoogle Scholar
  7. 7.
    Hegarty PK, Dinney CP, Pettaway CA (2010) Controversies in ilioinguinal lymphadenectomy. Urol Clin North Am 37(3):421–434CrossRefPubMedGoogle Scholar
  8. 8.
    Pandey D, Mahajan V, Kannan RR (2006) Prognostic factors in node-positive carcinoma of the penis. J Surg Oncol 93(2):133–138CrossRefPubMedGoogle Scholar
  9. 9.
    White RR, Stanley WE, Johnson JL et al (2002) Long-term survival in 2,505 patients with melanoma with regional lymph node metastasis. Ann Surg 235(6):879–887CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ornellas AA, Seixas AL, de Moraes JR (1991) Analyses of 200 lymphadenectomies in patients with penile carcinoma. J Urol 146(2):330–332CrossRefPubMedGoogle Scholar
  11. 11.
    Ravi R (1993) Morbidity following groin dissection for penile carcinoma. Br J Urol 72(6):941–945CrossRefPubMedGoogle Scholar
  12. 12.
    Johnson DE, Lo RK (1984) Complications of groin dissection in penile cancer. Experience with 101 lymphadenectomies. Urology 24(4):312–314CrossRefPubMedGoogle Scholar
  13. 13.
    Arbeit JM, Lowry SF, Line BR et al (1981) Deep venous thromboembolism in patients undergoing inguinal lymph node dissection for melanoma. Ann Surg 194(5):648–655CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Jakhetiya A, Shukla NK, Deo SVS (2016) Deep vein thrombosis in Indian cancer patients undergoing major thoracic and abdominopelvic surgery. Indian J Surg Oncol 7(4):425–429CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Shukla PJ, Siddachari R, Ahire S (2008) Postoperative deep vein thrombosis in patients with colorectal cancer. Indian J Gastroenterol 27:71–73PubMedGoogle Scholar
  16. 16.
    Svatek RS, Munsell M, Kincaid JM et al (2009) Association between lymph node density and disease specific survival in patients with penile cancer. J Urol 182(6):2721–2727CrossRefPubMedGoogle Scholar
  17. 17.
    Sotelo R, Sanchez-Salas R, Clavijo R (2009) Endoscopic inguinal lymph node dissection for penile carcinoma: the developing of a novel technique. World J Urol 27(2):213–219CrossRefPubMedGoogle Scholar
  18. 18.
    Tobias-Machado M, Tavares A, Ornellas AA et al (2007) Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol 177(3):953–958CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  1. 1.Department of Surgical OncologyDr BRA-IRCH, All India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of Cancer SurgeryVardhman Mahavir Medical college (VMMC) and Safdarjung HospitalNew DelhiIndia

Personalised recommendations