ABSTRACT
BACKGROUND AND OBJECTIVES: Wound complications occur frequently after inguinal lymph node dissection (ILND) in melanoma patients. Evidence on risk factors for complications is scarce and inconsistent. This study assessed wound complication rates after ILND and investigated associated risk factors, in the melanoma unit of a specialised cancer hospital. METHODS: A chart review was conducted of all patients on whom inguinal lymph node dissection had been performed between 2003 and 2013. Wound infections, seroma formation and skin flap problems were assessed according to explicit definitions and graded through the modified Clavien system. Univariable and multivariable penalized logistic regression was used to identify risk factors. The primary factors of interest were body mass index, age, smoking, diabetes, cardiovascular and/or pulmonal comorbidity, palpable disease and postoperative bedrest. Additionally, the influence of incision-type, sartorius transposition, saphenous vein sparing and skin removal was examined. RESULTS: A total of 145 procedures was examined. One or more complications occurred in 104 (72%) of the procedures; wound infection in 45%, seroma formation in 37% and skin flap problems in 26%. The only statistically significant risk factor was age (odds ratio for one standard deviation increase: 1.46, 95%CI 1.01-2.14, p = 0.05). CONCLUSIONS: Wound complication rates after ILND in melanoma patients are high. Age was the only predictor of complications in this cohort, other previously identified risk factors could not be confirmed.
Subject(s)
Inguinal Canal/surgery , Lymph Node Excision/methods , Lymph Nodes/pathology , Melanoma/surgery , Postoperative Complications/epidemiology , Seroma/epidemiology , Skin Neoplasms/surgery , Surgical Wound Infection/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Body Mass Index , Cardiovascular Diseases/epidemiology , Cohort Studies , Diabetes Mellitus/epidemiology , Female , Humans , Logistic Models , Lymph Nodes/surgery , Male , Middle Aged , Multivariate Analysis , Obesity/epidemiology , Pelvis , Retrospective Studies , Risk Factors , Smoking/epidemiology , Surgical Flaps , Young AdultABSTRACT
BACKGROUND: Delayed graft function (DGF) has a negative effect on the results of living-donor kidney transplantation. OBJECTIVE: To investigate potential risk factors for DGF. METHODS: This prospective study included 200 consecutive living donors and their recipients between January 2002 and July 2007. Delayed graft function was defined as need for dialysis within the first postoperative week. RESULTS: Delayed graft function was diagnosed in 12 patients (6%). Intraoperative complications occurred in 10 donors (5%), and postoperative complications in 24 donors (13.5%). One-year kidney graft survival with vs without DGF was 52% and 98%, respectively (P < .002). In donors, 2 univariate risk factors for DGF identified were lower counts per second at peak activity during scintigraphy, and multiple renal veins. In recipients, only 2 or more kidney transplantations and occurrence of an acute rejection episode were important factors. At multivariate analysis, increased risk of DGF was associated with the presence of multiple renal veins (odds ratio, 151.57; 95% confidence interval, 2.53-9093.86) and an acute rejection episode (odds ratio, 78.87; 95% confidence interval, 3.17-1959.62). CONCLUSION: Hand-assisted laparoscopic donor nephrectomy is a safe procedure. The presence of multiple renal veins and occurrence of an acute rejection episode are independent risk factors for DGF.
Subject(s)
Kidney Transplantation/methods , Kidney/diagnostic imaging , Laparoscopy/methods , Living Donors , Nephrectomy/methods , Adult , Delayed Graft Function/epidemiology , Family , Female , Functional Laterality , Humans , Male , Middle Aged , Nephrectomy/adverse effects , Patient Selection , Postoperative Complications/classification , Postoperative Complications/epidemiology , Prospective Studies , Radionuclide Imaging , Risk FactorsABSTRACT
OBJECTIVE: To evaluate the results of the first 100 hand-assisted donor nephrectomies in our hospital. DESIGN: Prospective, descriptive. METHOD: In the period January 2000-July 2004, 100 consecutive donors underwent laparoscopic nephrectomy as part of a living-related kidney transplantation at the Academic Medical Center in Amsterdam, the Netherlands. The operation was performed laparoscopically using a hand port (hand-assisted nephrectomy). The incision made for the hand port was also used for the removal of the kidney. RESULTS: Mean operating time was 168 min (range: 88-285). Median warm ischaemia time was 3 min (1.0-4.5) and median blood loss was 50 ml (20-1500). None of the operations required conversion to an open procedure and there were no deaths among donors or recipients. Postoperatively, 12 complications occurred in 10 donors. Median hospital stay for the donors was 5 days. In 3 recipients, the transplanted kidney had to be removed within 14 days. 1n 3 other recipients, surgical re-intervention was necessary due to urological complications. One-year graft survival was 94%. CONCLUSION: Hand-assisted laparoscopic donor nephrectomy was a safe and minimally invasive procedure for renal transplantation in this patient series.
