Minimally Invasive Inguinal Lymphadenectomy via Endoscopic Groin Dissection: Comprehensive Assessment of Immediate and Long-Term Complications

Abstract

Open inguinal lymphadenectomy has been associated with significant postoperative morbidity. Recently, small series have demonstrated the feasibility and efficacy of endoscopic groin lymphadenectomy as an alternative to open surgery. Previously we reported the favorable results of our initial experience. Few reports of novel surgical methods include long-term complications. In this report we present a detailed analysis of immediate and long-term complications associated with the procedure using standardized complications reporting methodology including the Clavien classification. From September 2008 to December 2009, 29 patients underwent endoscopic groin dissection for inguinal lymphadenectomy. The indications for dissection were cutaneous malignancies of the genitourinary area and lower extremities. Endoscopic dissection was performed as previously published. Data were prospectively collected regarding patient demographics and minor/major complications during the perioperative period as well as long-term complications during 1 year. Complications were described using the Clavien classification as well as other complication profiles for open inguinal lymphadenectomy. Minor complications were defined as mild to moderate leg edema, seroma formation not requiring aspiration, minimal skin edge necrosis requiring no therapy and cellulitis managed with antibiotics. Major complications included death, sepsis, venous thromboembolism, re-exploration or other invasive procedures, severe leg edema interfering with ambulation, skin flap necrosis and rehospitalization. A total of 41 endoscopic groin dissections (12 single session bilateral) were performed in 29 patients. Patient characteristics were median body mass index 30 kg/m² (range 19 to 53, mean 31.1), median age 61 years (range 16 to 86), median Charlson comorbidity score 4 (range 1 to 11) and median length of stay 1 day (range 1 to 14). Median followup was 604 days (range 177 to 1,172, mean 634). There were no perioperative mortalities. A total of 11 (27%) minor and 6 (14.6%) major complications occurred. Complications from endoscopic minimally invasive lymphadenectomy have low clinical morbidity. Analysis of the immediate and long-term complication profile using standardized Clavien complications reporting reveals that this procedure is safe, even in patients with a high Charlson comorbidity score and body mass index. Major complications were most often infection requiring intravenous antibiotics.