Skip to main content
SpringerLink
Log in

Komplikationen und deren Management nach axillärer, inguinaler und iliakaler Lymphknotendissektion

Complications and their management following axillary, inguinal and iliac lymph node dissection

  • Leitthema
  • Published:
Die Chirurgie Aims and scope Submit manuscript

Zusammenfassung

Ungeachtet zahlreicher technischer Entwicklungen stellen Lymphadenektomien einen notwendigen Bestandteil der chirurgischen Tumortherapie dar. Abhängig von der Ausdehnung und anatomischen Lokalisation können trotz sorgfältiger Präparationstechnik lymphgefäßassoziierte Komplikationen wie Lymphozelen oder Lymphfisteln oder ein sekundäres Lymphödem in unterschiedlicher Häufigkeit auftreten. Bei chronischen Lymphfisteln oder Lymphozelen sind oftmals interventionelle oder chirurgische Verfahren erforderlich. Bei gleichzeitig bestehenden Wundheilungsstörungen oder Hautweichteildefekten, insbesondere in einem bestrahlten Areal, sind häufig gestielte oder freie mikrochirurgische Lappenplastiken erforderlich. Für das sekundäre Lymphödem sind konservative und operative Therapiemethoden etabliert. Eine adäquate leitliniengerechte konservative Therapie ist die Methode der 1. Wahl. Wenn diese nicht zum gewünschten Ergebnis führt, stehen mikrochirurgisch-rekonstruktive, deviierende oder resezierende Verfahren zur Verfügung.

Abstract

Irrespective of numerous technical developments, lymphadenectomy remains a necessary component of surgical tumor therapy. Depending on the extent and anatomical localization, complications associated with the lymph vessels such as lymphoceles, lymphatic fistulas or secondary lymphedema can occur with varying frequency, despite a meticulous dissection technique. Chronic lymph fistulas or lymphoceles often require interventional or surgical procedures. Pedicled or free microsurgical flaps are often required in the case of coexisting wound healing disorders or skin soft tissue defects, especially in an irradiated area. For secondary lymphedema a number of conservative and surgical treatment methods have been established. Adequate guideline-based conservative treatment is the method of first choice. If this does not lead to the desired result, microsurgical reconstructive, deviating or resecting procedures are available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Agrawal J, Mehta S, Goel A et al (2018) Lymphatic microsurgical preventing healing approach (LYMPHA) for prevention of breast cancer-related lymphedema‑a preliminary report. Indian J Surg Oncol 9:369–373

    Article  Google Scholar 

  2. Ahmadzadeh N, Robering JW, Kengelbach-Weigand A et al (2020) Human adipose-derived stem cells support lymphangiogenesis in vitro by secretion of lymphangiogenic factors. Exp Cell Res 388:111816

    Article  CAS  Google Scholar 

  3. Arbeitsgemeinschaft Der Wissenschaftlichen Medizinischen Fachgesellschaften (Awmf) GDLEVG, Deutsche Gesellschaft Für Lymphologie (Dgl) (Mai 2017) S2k Leitlinie Diagnostik und Therapie der Lymphödeme Langfassung (Internet).

  4. Arbeitsgemeinschaft Der Wissenschaftlichen Medizinischen Fachgesellschaften E. V. (Awmf) DGFGUGD, Deutsche Krebsgesellschaft (Dkg) Interdisziplinäre S3-Leitlinie für die Früherkennung, Diagnostik, Therapie und Nachsorge des Mammakarzinoms – Langversion 4.4 – Juni 2021.

  5. Baumeister Rg FA (2003) Die mikrochirurgische Lymphgefäßtransplantation. HaMiPla 35:202–209

    Google Scholar 

  6. Borchers H, Jakse G (2005) Lymphadenectomy for penile cancer. Diagnostic and prognostic significance as well as therapeutic benefit. Urologe A 44:657–661

    Article  CAS  Google Scholar 

  7. Burnier P, Niddam J, Bosc R et al (2017) Indocyanine green applications in plastic surgery: a review of the literature. J Plast Reconstr Aesthet Surg 70:814–827

    Article  Google Scholar 

  8. Cai A, Zheng ZM, Himmler M et al (2022) Schwann cells promote myogenic differentiation of myoblasts and adipogenic mesenchymal stromal cells on poly-ɛ-caprolactone-collagen I‑nanofibers. Cells. https://doi.org/10.3390/cells11091436

    Article  Google Scholar 

  9. Catalona WJ (1988) Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol 140:306–310

    Article  CAS  Google Scholar 

  10. Eidtmann H (1999) Kontroversen der axillären Lymphonodektomie. Onkologie 22(suppl 2):18–21

    Google Scholar 

  11. Geierlehner A, Horch RE, Ludolph I et al (2022) Intraoperative blood flow analysis of DIEP vs. ms-TRAM flap breast reconstruction combining transit-time flowmetry and microvascular Indocyanine green Angiography. J Pers Med. https://doi.org/10.3390/jpm12030482

    Article  Google Scholar 

  12. Halsted CP, Benson JR, Jatoi I (2014) A historical account of breast cancer surgery: beware of local recurrence but be not radical. Future Oncol 10:1649–1657

    Article  CAS  Google Scholar 

  13. He Z, Zhou Y, Wang F et al (2019) Clinical value of postoperative sentinel lymph node biopsy. Ann Transl Med 7:683

    Article  Google Scholar 

  14. Hirche C, Engel H, Seidenstuecker K et al (2019) Lympho-reconstructive microsurgery for secondary lymphedema: Consensus of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels (DAM) on indication, diagnostic and therapy by lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT). Handchir Mikrochir Plast Chir 51:424–433

    Google Scholar 

  15. Horch RE, Ludolph I, Arkudas A (2021) Reconstruction of oncological defects of the perianal region. Chirurg 92:1159–1170

    Article  Google Scholar 

  16. Horch RE, Ludolph I, Arkudas A et al (2021) Personalized reconstruction of genital defects in complicated wounds with vertical rectus abdominis myocutaneous flaps including urethral neo-orifice. J Pers Med. https://doi.org/10.3390/jpm11111076

    Article  Google Scholar 

  17. Kim Y, Jeon GS, Choi SY et al (2017) Evaluation of sclerotherapy for the treatment of infected postoperative lymphocele. Taiwan J Obstet Gynecol 56:477–481

    Article  Google Scholar 

  18. Lambertz R, Chang DH, Hickethier T et al (2019) Ultrasound-guided lymphangiography and interventional embolization of chylous leaks following esophagectomy. Innov Surg Sci 4:85–90

    Google Scholar 

  19. Liu D, Liu B, Xia W et al (2018) Unilateral pedal lymphangiography plus computed tomography angiography for location of persistent idiopathic chyle leakage not detectable by ordinary contrast computed tomography. BMC Urol 18:9

    Article  Google Scholar 

  20. Lohrmann C, Foeldi E, Langer M (2011) Lymphocutaneous fistulas: pre-therapeutic evaluation by magnetic resonance lymphangiography. Br J Radiol 84:714–718

    Article  CAS  Google Scholar 

  21. Mahrer A, Ramchandani P, Trerotola SO et al (2010) Sclerotherapy in the management of postoperative lymphocele. J Vasc Interv Radiol 21:1050–1053

    Article  Google Scholar 

  22. Mall JW, Reetz C, Koplin G et al (2009) Surgical technique and postoperative morbidity following radical inguinal/iliacal lymph node dissection—a prospective study in 67 patients with malignant melanoma metastatic to the groin. Zentralbl Chir 134:437–442

    Article  CAS  Google Scholar 

  23. Mattig H, Stubert B, Schmerler R (1997) Changes in radical surgery of breast carcinoma in the last 20 years. Zentralbl Chir 122:92–96

    CAS  Google Scholar 

  24. Moseley AL, Carati CJ, Piller NB (2007) A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Ann Oncol 18:639–646

    Article  CAS  Google Scholar 

  25. Muller-Seubert W, Ostermaier P, Horch RE et al (2022) Intra- and early postoperative evaluation of malperfused areas in an irradiated random pattern skin flap model using Indocyanine green angiography and near-infrared reflectance-based imaging and infrared thermography. J Pers Med. https://doi.org/10.3390/jpm12020237

    Article  Google Scholar 

  26. Pan F, Loos M, Do TD et al (2020) Percutaneous afferent lymphatic vessel sclerotherapy for postoperative lymphatic leakage after previous ineffective therapeutic transpedal lymphangiography. Eur Radiol Exp 4:60

    Article  CAS  Google Scholar 

  27. Polykandriotis E, Daenicke J, Bolat A et al (2022) Individualized wound closure-mechanical properties of suture materials. J Pers Med. https://doi.org/10.3390/jpm12071041

    Article  Google Scholar 

  28. Robering JW, Al-Abboodi M, Titzmann A et al (2021) Tissue engineering of lymphatic vasculature in the arteriovenous loop model of the rat. Tissue Eng Part A 27:129–141

    Article  CAS  Google Scholar 

  29. Seki Y, Kajikawa A, Yamamoto T et al (2019) Real-time Indocyanine green videolymphography navigation for lymphaticovenular anastomosis. Plast Reconstr Surg Glob Open 7:e2253

    Article  Google Scholar 

  30. Steiner D, Winkler S, Heltmann-Meyer S et al (2021) Enhanced vascularization andde novotissue formation in hydrogels made of engineered RGD-tagged spider silk proteins in the arteriovenous loop model. Biofabrication. https://doi.org/10.1088/1758-5090/ac0d9b

    Article  Google Scholar 

  31. Unno N, Nishiyama M, Suzuki M et al (2008) Quantitative lymph imaging for assessment of lymph function using indocyanine green fluorescence lymphography. Eur J Vasc Endovasc Surg 36:230–236

    Article  CAS  Google Scholar 

  32. Wagenpfeil J, Attenberger U, Pieper CC (2021) Unusual left periclavicular cutaneous lymphatic fistula after port explantation without lymph vessel injury: imaging and interventional treatment. Cardiovasc Intervent Radiol 44:1279–1281

    Article  Google Scholar 

  33. Wigbers FM, Woitalla-Bruning J, Bruning G (2021) Open revision in combination with a 2-layer dressing for therapy of postoperative seroma after inguinal crossectomy. J Dtsch Dermatol Ges 19:1367–1369

    Google Scholar 

  34. Zetzmann K, Ludolph I, Horch RE et al (2018) Imaging for treatment planning in lipo-and lymphedema. Handchir Mikrochir Plast Chir 50:386–392

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Plastisch- und Handchirurgische Klinik und Labor für Tissue Engineering und Regenerative Medizin, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Krankenhausstraße 12, 91054, Erlangen, Deutschland

    Ingo Ludolph, Andreas Arkudas, Wibke Müller-Seubert, Aijia Cai &  Raymund E. Horch

Authors
  1. Ingo Ludolph
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andreas Arkudas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wibke Müller-Seubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aijia Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raymund E. Horch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raymund E. Horch.

Ethics declarations

Interessenkonflikt

I. Ludolph, A. Arkudas, W. Müller-Seubert, A. Cai und R. E. Horch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Zur besseren Lesbarkeit (und Vereinfachung des Sprachduktus) wird hier nur eine Form der Geschlechter verwendet, nämlich die männliche. Dabei sind stets alle geschlechtlichen Identitäten mitgemeint.

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ludolph, I., Arkudas, A., Müller-Seubert, W. et al. Komplikationen und deren Management nach axillärer, inguinaler und iliakaler Lymphknotendissektion. Chirurgie 94, 130–137 (2023). https://doi.org/10.1007/s00104-022-01736-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-022-01736-2

Schlüsselwörter

Keywords

Search

Navigation