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Optimal Timing for Drainage of Infected Lymphocysts After Lymphadenectomy for Gynecologic Cancer
  1. Kosuke Hiramatsu, MD,
  2. Eiji Kobayashi, MD,
  3. Yutaka Ueda, MD, PhD,
  4. Tomomi Egawa-Takata, MD, PhD,
  5. Shinya Matsuzaki, MD, PhD,
  6. Toshihiro Kimura, MD, PhD,
  7. Kenjiro Sawada, MD, PhD,
  8. Kiyoshi Yoshino, MD, PhD,
  9. Masami Fujita, MD, PhD and
  10. Tadashi Kimura, MD, PhD
  1. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
  1. Address correspondence and reprint requests to Eiji Kobayashi, MD, Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, Japan, 565-0871. E-mail: ekobayashi{at}gyne.med.osaka-u.ac.jp.

Abstract

Background A lymphocyst (lymphocele) is a common complication of lymphadenectomy, which is a widely used surgical method for gynecologic cancers. In cases of infected lymphocysts, therapeutic strategies, including the timing and duration of antibiotics administration and cyst drainage, may vary depending on the physician. The aim of this study was to determine the optimal timing for drainage of lymphocysts infected with bacteria resistant to antibiotic treatment.

Materials and Methods Clinical data for 1175 patients who underwent a lymphadenectomy as part of surgery for a gynecologic malignancy between April 2000 and August 2012 at Osaka University Hospital, Osaka, Japan, were analyzed.

Results Of the 282 patients who developed a lymphocyst (24%), 35 with infected lymphocysts (12%) were analyzed. Lymphocyst infection was not associated with tumor origin, type of hysterectomy, or region of lymphadenectomy (P = 0.81, P = 0.59, and P = 0.86, respectively). The total treatment period of cases treated only with antibiotics tended to be shorter than that of cases treated with combined antibiotics and drainage, but the difference was not significant (P = 0.061). However, for severe cases which needed drainage, initiating the drainage by day 5 significantly shortened the total treatment period compared with cases started on or after day 6 (P = 0.042).

Conclusions The appropriate time point for initiating lymphocyst drainage has been difficult to determine. The present study implies that for severe lymphocyst infections, where drainage is required in addition to antibiotics, the earlier the drainage is performed, the shorter the treatment period is. Further studies may be required to decide other optimal treatment strategies for infected lymphocysts.

  • Lymphocyst
  • Lymphadenectomy
  • Drainage
  • Infection
  • Gynecologic cancer
  • Antibiotics

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Footnotes

  • The authors declare no conflicts of interest.

  • This study was approved by the institutional review board and the ethics committee of the Osaka University Hospital.

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