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Assessment and Reporting of Perioperative Adverse Events and Complications in Patients Undergoing Inguinal Lymphadenectomy for Melanoma, Vulvar Cancer, and Penile Cancer: A Systematic Review and Meta-analysis

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Abstract

Background

Inguinal lymph node dissection (ILND) plays a crucial role in the oncological management of patients with melanoma, penile, and vulvar cancer. This study aims to systematically evaluate perioperative adverse events (AEs) in patients undergoing ILND and its reporting.

Methods

A systematic review was conducted according to PRISMA. PubMed, MEDLINE, Scopus, and Embase were queried to identify studies discussing perioperative AEs in patients with melanoma, penile, and vulvar cancer following ILND.

Results

Our search generated 3.469 publications, with 296 studies meeting the inclusion criteria. Details of 14.421 patients were analyzed. Of these studies, 58 (19.5%) described intraoperative AEs (iAEs) as an outcome of interest. Overall, 68 (2.9%) patients reported at least one iAE. Postoperative AEs were reported in 278 studies, combining data on 10.898 patients. Overall, 5.748 (52.7%) patients documented ≥1 postoperative AEs. The most reported ILND-related AEs were lymphatic AEs, with a total of 4.055 (38.8%) events. The pooled meta-analysis confirmed that high BMI (RR 1.09; p = 0.006), ≥1 comorbidities (RR 1.79; p = 0.01), and diabetes (RR 1.81; p =  < 0.00001) are independent predictors for any AEs after ILND. When assessing the quality of the AEs reporting, we found 25% of studies reported at least 50% of the required criteria.

Conclusion

ILND performed in melanoma, penile, and vulvar cancer patients is a morbid procedure. The quality of the AEs reporting is suboptimal. A more standardized AEs reporting system is needed to produce comparable data across studies for furthering the development of strategies to decrease AEs.

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References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A (2022) Cancer statistics, 2022. CA Cancer J Clin 72(1):7–33

    Article  PubMed  Google Scholar 

  2. Clark PE, Spiess PE, Agarwal N, Biagioli MC, Eisenberger MA, Greenberg RE et al (2013) Clinical practice guidelines in oncology. J Natl Compr Canc Netw 11(5):22

    Google Scholar 

  3. Greer BE, Koh WJ (2016) New NCCN Guidelines for Vulvar Cancer. J Natl Compr Canc Netw 14(5S):656–658

    Article  PubMed  Google Scholar 

  4. Swetter SM, Thompson JA, Albertini MR, Barker CA, Baumgartner J, Boland G et al (2021) NCCN Guidelines® insights: melanoma: cutaneous, Version 2.2021: featured updates to the NCCN guidelines. J Natl Compr Canc Netw 19(4):364–376

    Article  PubMed  Google Scholar 

  5. Matin SF, Cormier JN, Ward JF, Pisters LL, Wood CG, Dinney CPN et al (2013) Phase 1 prospective evaluation of the oncological adequacy of robotic assisted video-endoscopic inguinal lymphadenectomy in patients with penile carcinoma: robotic assisted video-endoscopic inguinal lymphadenectomy. BJU Int 111(7):1068–1074

    Article  PubMed  PubMed Central  Google Scholar 

  6. Catalona WJ (1988) Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol 140(2):306–310

    Article  CAS  PubMed  Google Scholar 

  7. Bishoff JT, Du K (2018) Endoscopic subcutaneous modified inguinal lymph node dissection for squamous cell carcinoma of the penis. In: Smith AD, Preminger GM, Kavoussi LR, Badlani GH, Rastinehad AR (eds) Smith’s textbook of endourology [Internet]. Chichester, UK: Wiley [cited 2022 Jul 11]. 1060–1065. https://doi.org/10.1002/9781119245193.ch90

  8. Sotelo R, Sánchez-Salas R, Carmona O, Garcia A, Mariano M, Neiva G et al (2007) Endoscopic lymphadenectomy for penile carcinoma. J Endourol 21(4):364–367

    Article  PubMed  Google Scholar 

  9. Gopman JM, Djajadiningrat RS, Baumgarten AS, Espiritu PN, Horenblas S, Zhu Y et al (2015) Predicting postoperative complications of inguinal lymph node dissection for penile cancer in an international multicentre cohort. BJU Int 116(2):196–201

    Article  PubMed  Google Scholar 

  10. Martin RCG, Brennan MF, Jaques DP (2002) Quality of complication reporting in the surgical literature. Ann Surg 235(6):803–813

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mitropoulos D, Artibani W, Graefen M, Remzi M, Rouprêt M, Truss M (2012) Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol 61(2):341–349

    Article  PubMed  Google Scholar 

  12. Zorzela L, Loke YK, Ioannidis JP, Golder S, Santaguida P, Altman DG et al (2016) PRISMA harms checklist: improving harms reporting in systematic reviews. BMJ 1:i157

    Article  Google Scholar 

  13. Cacciamani GE, Maas M, Nassiri N, Ortega D, Gill K, Dell’Oglio P et al (2021) Impact of pelvic lymph node dissection and its extent on perioperative morbidity in patients undergoing radical prostatectomy for prostate cancer: a comprehensive systematic review and meta-analysis. Eur Urol Oncol 4(2):134–149

    Article  PubMed  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Review 8:336–341

    Google Scholar 

  15. Dell’Oglio P, Andras I, Ortega D, Galfano A, Artibani W, Autorino R et al (2021) Impact of the implementation of the EAU guidelines recommendation on reporting and grading of complications in patients undergoing robot-assisted radical cystectomy: a systematic review. Eur Urol 80(2):129–133

    Article  PubMed  Google Scholar 

  16. Tellini R, Mari A, Muto G, Cacciamani GE, Ferro M, Stangl-Kremser J et al (2021) Impact of smoking habit on perioperative morbidity in patients treated with radical cystectomy for urothelial bladder cancer: a systematic review and meta-analysis. Eur Urol Oncol 4(4):580–593

    Article  PubMed  Google Scholar 

  17. Nassiri N, Maas M, Basin M, Cacciamani GE, Doumanian LR (2021) Urethral complications after gender reassignment surgery: a systematic review. Int J Impot Res 33(8):793–800

    Article  Google Scholar 

  18. Cacciamani GE, Tafuri A, Iwata A, Iwata T, Medina L, Gill K et al (2020) Quality assessment of intraoperative adverse event reporting during 29 227 robotic partial nephrectomies: a systematic review and cumulative analysis. Eur Urol Oncol 3(6):780–783

    Article  PubMed  Google Scholar 

  19. Cacciamani GE, Medina LG, Tafuri A, Gill T, Baccaglini W, Blasic V et al (2020) Impact of implementation of standardized criteria in the assessment of complication reporting after robotic partial nephrectomy: a systematic review. Eur Urol Focus 6(3):513–517

    Article  PubMed  Google Scholar 

  20. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP et al (2019) Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Editorial Unit, editor. Cochrane Database Syst Rev [Internet]. 2019 Oct 3 [cited 2022 Jul 11]; https://doi.org/10.1002/14651858.ED000142

  21. Cacciamani GE, Sholklapper T, Dell’Oglio P, Rocco B, Annino F, Antonelli A et al (2022) The intraoperative complications assessment and reporting with universal standards (ICARUS) global surgical collaboration project: development of criteria for reporting adverse events during surgical procedures and evaluating their impact on the postoperative course. Eur Urol Focus 8:1847–1858

    Article  PubMed  Google Scholar 

  22. Cacciamani G, Sholklapper T, Sotelo R, Desai M, Gill I (2021) A protocol for the development of the intraoperative complications assessment and reporting with universal standards criteria: the ICARUS project. Int J Surg Protoc 25(1):160–164

    Article  PubMed  PubMed Central  Google Scholar 

  23. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  24. Kaafarani HMA, Mavros MN, Hwabejire J, Fagenholz P, Yeh DD, Demoya M et al (2014) Derivation and validation of a novel severity classification for intraoperative adverse events. J Am Coll Surg 218(6):1120–1128

    Article  PubMed  Google Scholar 

  25. Biyani CS, Pecanka J, Rouprêt M, Jensen JB, Mitropoulos D (2020) Intraoperative Adverse Incident Classification (EAUiaiC) by the European association of urology ad hoc complications guidelines panel. Eur Urol 77(5):601–610

    Article  PubMed  Google Scholar 

  26. Dell-Kuster S, Gomes NV, Gawria L, Aghlmandi S, Aduse-Poku M, Bissett I et al (2020) Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study. BMJ 25:m2917

    Article  Google Scholar 

  27. On behalf of the EAES committees, Francis NK, Curtis NJ, Conti JA, Foster JD, Bonjer HJ et al (2018) EAES classification of intraoperative adverse events in laparoscopic surgery. Surg Endosc 32(9):3822–3829

    Article  Google Scholar 

  28. Cacciamani GE (2022) Intraoperative adverse events grading tools and their role in honest and accurate reporting of surgical outcomes. Surgery. https://doi.org/10.1016/j.surg.2022.04.029

    Article  PubMed  Google Scholar 

  29. Soliman C, Mulholland CJ, Santaguida P, Sathianathen NJ, Lawrentschuk N, Giannarini G et al (2022) Protocol for CAMUS Delphi study: a consensus on comprehensive reporting and grading of complications after urological surgery. Eur Urol Focus. https://doi.org/10.1016/j.euf.2022.01.016

    Article  PubMed  Google Scholar 

  30. ICARUS Classification System Working Group, Cacciamani GE, Sholklapper TN, Dell-Kuster S, Biyani CS, Francis N et al (2022) Assessing, grading, and reporting intraoperative adverse events during and after surgery. Br J Surg 109(4):301–302

    Article  Google Scholar 

  31. Enrico Cacciamani G, Sholklapper T, Dell-Kuster S, Biyani SC, Francis N, Kaafarani HM et al (2022) Standardizing the intraoperative adverse events assessment to create a positive culture of reporting errors in surgery and anesthesiology. Ann Surg 276(2):e75–e76

    PubMed  Google Scholar 

  32. Artibani W (2018) what you measure depends on the tool you use: a short step from incorrect measurements to fake data. Eur Urol 74(1):8–9

    Article  PubMed  Google Scholar 

  33. Document C. The diagnosis and treatment of peripheral lymphedema: 2020 consensus document of the international society of lymphology. Lymphology [Internet]. 2020 Jun 2 [cited 2022 Apr 6];53(1). Available from: https://journals.librarypublishing.arizona.edu/lymph/article/id/4649/

  34. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM (2010) Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer 116(22):5138–5149

    Article  PubMed  Google Scholar 

  35. Yamamoto T, Yamamoto N, Doi K, Oshima A, Yoshimatsu H, Todokoro T et al (2011) Indocyanine green-enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow patterns. Plast Reconstr Surg 128(4):941–947

    Article  CAS  PubMed  Google Scholar 

  36. Yamamoto T, Matsuda N, Doi K, Oshima A, Yoshimatsu H, Todokoro T et al (2011) The earliest finding of indocyanine green lymphography in asymptomatic limbs of lower extremity lymphedema patients secondary to cancer treatment: the modified dermal backflow stage and concept of subclinical lymphedema. Plast Reconstr Surg 128(4):314e-e321

    Article  CAS  PubMed  Google Scholar 

  37. Leone A, Diorio GJ, Pettaway C, Master V, Spiess PE (2017) Contemporary management of patients with penile cancer and lymph node metastasis. Nat Rev Urol 14(6):335–347

    Article  PubMed  Google Scholar 

  38. Rabe E, Partsch H, Hafner J, Lattimer C, Mosti G, Neumann M et al (2018) Indications for medical compression stockings in venous and lymphatic disorders: an evidence-based consensus statement. Phlebol J Venous Dis 33(3):163–184

    Article  Google Scholar 

  39. US Department of Health and Human Services (2017) Common terminology criteria for adverse events. Version 5.0

  40. Tobias-Machado M, Tavares A, Molina WR Jr, Forseto PH Jr, Juliano RV, Wroclawski ER (2006) Video endoscopic inguinal lymphadenectomy (VEIL): minimally invasive resection of inguinal lymph nodes. Int Braz J Urol 32(3):316–321

    Article  CAS  PubMed  Google Scholar 

  41. Loughlin KR (2006) Surgical atlas surgical management of penile carcinoma: the inguinal nodes. BJU Int 97(5):1125–1134

    Article  PubMed  Google Scholar 

  42. Koifman L, Hampl D, Koifman N, Vides AJ, Ornellas AA (2013) Radical open inguinal lymphadenectomy for penile carcinoma: surgical technique, early complications and late outcomes. J Urol 190(6):2086–2092

    Article  PubMed  Google Scholar 

  43. Bevan-Thomas R, Slaton JW, Pettaway CA (2002) COntemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson cancer center experience. Comparative study 167(4):1638–42

    Google Scholar 

  44. Spiess PE, Hernandez MS, Pettaway CA (2009) Contemporary inguinal lymph node dissection: minimizing complications. World J Urol 27(2):205–212

    Article  PubMed  Google Scholar 

  45. Sood A, Rudzinski JK, Spiess PE, Pettaway CA (2022) The acute complications after surgery for penile carcinoma and strategies for their management: a systematic review of the literature. Semin Oncol Nurs 38(3):151285

    Article  PubMed  Google Scholar 

  46. Solar IN, Gipponi MA, Franco DSCRI, Rè FE, Sonia O, Bertog Lio S et al (2016) Videoscopic Inguinal-iliac-obturator lymph-node dissection: new videoscopic technique for regional lymphadenectomy in patients with Melanom. Anticancer Res 36(12):6579–84

    Google Scholar 

  47. Tobias-Machado M, Tavares A, Silva MNR, Molina WR Jr, Forseto PH, Juliano RV et al (2008) Can Video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol 22(8):1687–1692

    Article  PubMed  Google Scholar 

  48. Kumar V, Sethia KK (2017) Prospective study comparing video-endoscopic radical inguinal lymph node dissection (VEILND) with open radical ILND (OILND) for penile cancer over an 8-year period. BJU Int 119(4):530–534

    Article  PubMed  Google Scholar 

  49. Nabavizadeh R, Petrinec B, Necchi A, Tsaur I, Albersen M, Master V (2020) Utility of minimally invasive technology for inguinal lymph node dissection in penile cancer. J Clin Med 9(8):2501

    Article  PubMed  PubMed Central  Google Scholar 

  50. Renner P, Torzewski M, Zeman F, Babilas P, Kroemer A, Schlitt HJ et al (2017) Increasing morbidity with extent of lymphadenectomy for primary malignant melanoma. Lymphat Res Biol 15(2):146–152

    Article  PubMed  Google Scholar 

  51. Faut M, Heidema RM, Hoekstra HJ, van Ginkel RJ, Been SLB, Kruijff S et al (2017) Morbidity after inguinal lymph node dissections: it is time for a change. Ann Surg Oncol 24(2):330–339

    Article  PubMed  Google Scholar 

  52. Stuiver MM, Djajadiningrat RS, Graafland NM, Vincent AD, Lucas C, Horenblas S (2013) Early wound complications after inguinal lymphadenectomy in penile cancer: a historical cohort study and risk-factor analysis. Eur Urol 64(3):486–492

    Article  PubMed  Google Scholar 

  53. Sars C, Gillgren P, Schultz I, Lindqvist EK (2020) Risk factors for complications and long-term outcomes following completion lymph node dissection for cutaneous melanoma: a retrospective cohort study. J Plast Reconstr Aesthet Surg 73(8):1540–1546

    Article  PubMed  Google Scholar 

  54. Wevers KP, Poos HPAM, van Ginkel RJ, van Etten B, Hoekstra HJ (2013) Early mobilization after ilio-inguinal lymph node dissection for melanoma does not increase the wound complication rate. Eur J Surg Oncol EJSO 39(2):185–190

    Article  CAS  PubMed  Google Scholar 

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Funding

Giovanni E. Cacciamani and Luis G. Medina certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: none.

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Author notes

  1. Giovanni E. Cacciamani and Luis G. Medina have contributed equally to the paper.

Authors and Affiliations

  1. Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine,, University of Southern California, Los Angeles, CA, USA

    Giovanni E. Cacciamani, Luis G. Medina, Aref S. Sayegh, Anibal La Riva, Laura C. Perez, Michael B. Eppler, Inderbir Gill & Rene Sotelo

  2. Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Anibal La Riva

  3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Laura C. Perez

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  1. Giovanni E. Cacciamani
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Consortia

the Complications and Adverse Events in Lymphadenectomy of the Inguinal Area (CALI) project, the International Consensus Panel on Complications in Urology (ICPCU), and the Intraoperative Complications assessment and reporting with Universal Standards (ICARUS) Global Surgical Collaboration

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Correspondence to Giovanni E. Cacciamani or Rene Sotelo.

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Cacciamani, G.E., Medina, L.G., Sayegh, A.S. et al. Assessment and Reporting of Perioperative Adverse Events and Complications in Patients Undergoing Inguinal Lymphadenectomy for Melanoma, Vulvar Cancer, and Penile Cancer: A Systematic Review and Meta-analysis. World J Surg 47, 962–974 (2023). https://doi.org/10.1007/s00268-022-06882-6

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