ABSTRACT
OBJECTIVE: The aim of this study was to investigate the clinical effects of sartorius tendon transposition versus sartorius transposition during bilateral inguinal lymphadenectomy of radical vulvectomy. METHODS: A total of 58 vulvar cancer patients who had surgery from May 2007 to October 2013, in which 30 patients received sartorius transposition and 28 patients received sartorius tendon transposition. All patients were matched by age, body mass index, stage, histology, and grade. Intraoperative variables and postoperative complications, recurrence, progression-free survival (PFS), and overall survival (OS) and postoperative life quality were compared and analyzed. RESULTS: No significant differences were found at median surgical times and amounts of bleeding (p=0.316 and p=0.249, respectively), neither at the incidences of groin cellulitis and lymphocele (p=0.673 and p=0.473, respectively), but the recovery times of the inguinal wounds were shorter (p=0.026) and the incidences of wound break and chronic lymphedema were significantly decreased in the tendon transposition group (p=0.012 and p=0.022, respectively). Postoperative quality of life in tendon transposition group was significantly improved as indicated by the EORTC QLQ-C30 questionnaire. Recurrences were similar (p=0.346) and no significant differences were found at PFS and OS (p=0.990 and p=0.683, respectively). CONCLUSION: Compared to sartorius transposition, sartorius tendon transposition during inguinal lymphadenectomy led to improved patient recovery, reduced postoperative complications, and improved life quality without compromising the outcomes.
Subject(s)
Lymph Node Excision/methods , Tendons/transplantation , Vulva/surgery , Vulvar Neoplasms/surgery , Case-Control Studies , Female , Follow-Up Studies , Humans , Lymphatic Metastasis , Organ Sparing Treatments/methods , Surgical Flaps , Surgical Wound Infection/etiologyABSTRACT
OBJECTIVE: The aim of this study was to investigate the clinical effects of sartorius tendon transposition versus sartorius transposition during bilateral inguinal lymphadenectomy of radical vulvectomy. METHODS: A total of 58 vulvar cancer patients who had surgery from May 2007 to October 2013, in which 30 patients received sartorius transposition and 28 patients received sartorius tendon transposition. All patients were matched by age, body mass index, stage, histology, and grade. Intraoperative variables and postoperative complications, recurrence, progression-free survival (PFS), and overall survival (OS) and postoperative life quality were compared and analyzed. RESULTS: No significant differences were found at median surgical times and amounts of bleeding (p=0.316 and p=0.249, respectively), neither at the incidences of groin cellulitis and lymphocele (p=0.673 and p=0.473, respectively), but the recovery times of the inguinal wounds were shorter (p=0.026) and the incidences of wound break and chronic lymphedema were significantly decreased in the tendon transposition group (p=0.012 and p=0.022, respectively). Postoperative quality of life in tendon transposition group was significantly improved as indicated by the EORTC QLQ-C30 questionnaire. Recurrences were similar (p=0.346) and no significant differences were found at PFS and OS (p=0.990 and p=0.683, respectively). CONCLUSION: Compared to sartorius transposition, sartorius tendon transposition during inguinal lymphadenectomy led to improved patient recovery, reduced postoperative complications, and improved life quality without compromising the outcomes.
Subject(s)
Female , Humans , Case-Control Studies , Follow-Up Studies , Lymph Node Excision/methods , Lymphatic Metastasis , Organ Sparing Treatments/methods , Surgical Flaps , Surgical Wound Infection/etiology , Tendons/transplantation , Vulva/surgery , Vulvar Neoplasms/surgeryABSTRACT
BACKGROUND: Inguinal lymph node dissection (ILND) for melanoma has been associated with high rates of wound complication (WC). Sartorius transposition (ST) is a technique that has been proposed to minimize morbidity. We report the frequency of utilization of ST and associated clinical outcomes in a national sample. MATERIALS AND METHODS: Patients undergoing ILND for melanoma were identified in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (2005-2011). ST status was determined. Univariate logistic regression analyses were performed. Propensity score matching was used to control for operative time. Conditional logistic regression was used to determine the likelihood of a WC following ST in the matched cohort. RESULTS: Of the 381 patients identified, 13% had a WC. By univariate analysis, increasing body mass index (P = 0.006), diabetes (P = 0.02), and longer operative time (P = 0.005) were associated with WC. Sixty-three patients received a prophylactic ST (16.5%). ST use was significantly associated with deep nodal dissection (P = 0.03) and increased operative time (P < 0.0001) but not with any preoperative risk factors. WC rates were similar between ST and non-ST patients (10% versus 14%, P = 0.39). In the multivariate analysis of patients matched for operative time, ST was the only factor significantly associated with lower WC rate. The WC rate was 23% in non-ST compared with 8% in ST patients (P = 0.05). CONCLUSIONS: Nationally, ST is used infrequently at the time of ILND. Moreover, patients undergoing ST do not appear to be selected based on the patient factors associated with increased risk of WC. Risk factors for wound complication should be considered in the selective use of ST.
