Complications of radical oncogynecological operations

Czech version

Authors: L. Minář ¹; V. Weinberger ¹; P. Kysela ²
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc. ¹; Chirurgická klinika LF MU a FN, Brno, přednosta prof. MUDr. Z. Kala, CSc. ²
Published in: Ceska Gynekol 2010; 75(4): 346-352

Overview

Objective:
Information sheet about the most frequently complications of radical oncogynecological operations.

Design:
Literature review with case reports.

Setting:
Department of Gynaecology and Obstetrics, Faculty of Medicine, Masaryk’s University and Faculty Hospital, Brno.

Methods:
Literature review about complications of radical oncogynecological operations with illustrative case reports.

Conclusions:
Radical oncogynecological operations, due to their size, associated with a higher morbidity compared with traditional gynecological surgery. The literature states morbidity parameters between 25‑45% depending on the center of erudition and range of out performance. Basic division of surgical complications is on perioperative complications and postoperative complications, which are further divided into early and late.

The most frequently intraoperative complication is large blood loss requiring the application of blood substitutes. Less common complications are injury to the urinary bladder, ureter, rarely bowel or neural structures, especially nerve obturatorius. Among early postoperative complications are dominated urological complications, particularly urinary bladder hypotonia, another important group are the vascular complications, ie trombembolia and bleeding. Between late postoperative complications is possible to define several basic groups, ie urology, intestinal, lymphovascular and complications associated with laparotomy wound suture.

Prevention of complications should be based on several basic assumptions. These include adequate erudition and composition of the operating team, perfect knowledge of anatomical conditions in the pelvic retroperitoneum, the paraaortic, the paracaval and inguinal area, implementation radicality adequate performance in relation to the extent of the disease and developing new surgical techniques (eg nerve sparing surgery). Absolute necessity is also the possibility of interdisciplinary cooperation with other surgical disciplines, which is important both in terms of preventing complications, and for their event. subsequent solutions.

Key words:
intraoperative and postoperative complications, blood loss, injury to the urinary bladder and ureter, urinary fistula, thromboembolic complications, lymphedema, lymphocyst, hemangioma.

Sources

1. Beesley, V., Janda, M., Eakin, E., et al. Lymphedema after gynecological cancer treatment. Cancer 2007, 109 (12), p. 2607-2614.

2. Benda, K. Lymfedém končetin v ordinaci praktického lékaře. Med pro praxi 2006, 6, s. 276-279.

3. Benedetti-Panici, P., Angioli, R. Gynecologic oncology specialty. Eur J Gynaecol Oncol 2004, 25 (1), p. 25-26.

4. Bishoff., JT., et al. Laparoscopy bowel injury: incidence and clinical presentation. J Urol 1999, 161(3), p. 887-890.

5. Bouda, J., Rokyta, Z., Mleziva, J. Onkogynekologický operatér - subspecializace. Čes Gynek 1999, 64(2 Suppl), s. 31-32.

6. Brandes, S., Coburn, M., Armenakas, N., et al. Diagnosis and management of ureteric injury: an evidence-based analysis. Brit J Urol Internat 2004, 94(3), p. 277-289.

7. Brouns, E., Donceel, P., Stas, M. Quality of life and disability after ilio-inguinal lymphadenectomy. Acta Chir. Belg 2008, 108(6), p. 685-690.

8. Cibula, D., Kesic, V. Surgical education and training in gynecologic oncology I: European perspective. Gynecol Oncol 2009, 114(2 Suppl), p.52-55.

9. Cibula, D., Petruželka, L., et al. Onkogynekologie. Praha: Grada 2009, s. 171-186.

10. Cornish, BH., Thomas, BJ., Ward, LC. Improved prediction of extracellular and total body water using impedance loci generated by multiple frequency bioelectrical impedance analysis. Phys Med Biol 1993, 38, p. 337-346.

11. Franchi, M., Ghezzi, F., Riva, C., et al. Postoperative complications after pelvic lymphadenectomy for the surgical staging of endometrial cancer. J Surg Oncol 2001, 78(4), p. 232-237.

12. Füller, J., Guderian, D., Köhler, C., et al. Lymphedema of the lower extremities after lymphadenectomy and radiotherapy for cervical cancer. Strahlenther Onkol 2008, 184 (4), p. 206‑211.

13. Goff, BA. Surgical education for gynecologic oncologists. Gynecol Oncol, 2009, 114(2 Suppl), p. 46.

14. Halaška, M.J., Komárek, V., Malá, I., et al. A method for the detection of post-operative lymphoedema after operation for breast cancer: multifrequency bioelectrical impedance analysis. J Appl Biomed 2006, 4, p. 179-185.

15. Hanuš, T., Jarolím, L., Petřík, R. et al. Iatrogenní léze močovodu u žen. Rozhl Chir 1997, 76(6), s. 302-305.

16. Hanuš, T., Jarolím, L., Petřík, R., et al. Vesikovaginální a uretrovaginální píštěle. Rozhl Chir 1997, 76(6), s. 306-309.

17. Hoffman, MS. Extent of radical hysterectomy: evolving emphasis. Gynec Oncol 2004, 94, p. 1.

18. Horning, KM., Guhde, J. Lymphedema: an under-treated problem. Medsurg Nurs 2007, 16 (4), p. 221-227.

19. Ju, XZ., Li, ZT., Yang, HJ., et al. Nerve-sparing radical hysterectomy and radical hysterectomy: a retrospective study. Zhonghua Fu Chan Ke Za Zhi 2009, 44(8), p. 605-609.

20. Kim, JH., Kim, HJ., Hong, S., et al. Post-hysterectomy radiotherapy in FIGO stage IB-IIB uterine cervical carcinoma. Gynecol Oncol 2005, 96, p. 407-414.

21. Kim, SJ., Park, YD. Effects of complex decongestive physiotherapy on the oedema and the quality of live of lower unilateral lymphoedema following treatment for gynaecological cancer. Eur J Cancer Care 2008, 17(5), p. 463‑468.

22. Mehra, G., Weekes, A., Vantrappen, P., et al. Laparoscopic assisted radical vaginal hysterectomy for cervical carcinoma: Morbidity and long-term follow-up. Eur J Surg Oncol 2010, 36(3), p. 304-308.

23. Moore, RG., Robison, K., Brown, AK., et al. Isolated sentinel node dissection with conservative management in patients with squamous cell carcinoma of the vulva: A prospective trial. Gynecol Oncol 2008, 109 (1), p. 65-70.

24. Nováčková, M., Halaška, M., Chmel, R., et al. Lymfedémy dolních končetin po chirurgické léčbě gynekologických nádorů. Gynekolog 2009, 18(6), s. 208-211.

25. Ogawa, D., Shikata, K., Matsuda, M., et al. Pelvic lymphocyst infection associated with maternally inherited diabetes mellitus. Diabetes Res Clin Pract 2003, 61(2), p. 137‑141.

26. Piver, MS., et al. Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynec 1974, 44, p. 265.

27. Recio, F., Ghamande, S., Hempling, R., et al. Effective management of pelvic lymphocysts by laparoscopic marsupialization. JSLS 1999, 3(2), p. 97-102.

28. Ryan, M., Stainton, MC., Slaytor, EK., et al. Aetiology and prevalence of lower limb lymphoedema following treatment for gynaecological cancer. Aust N Z J Obstet Gynaecol 2003, 43, p. 148-151.

29. Sadmani, S., Lachmann, E., Nagler, W. Unilateral extremity swelling in female patients with cancer. J Womens Health Gend Based Med 2001, 10 (4), p. 319-326.

30. Tada, H., Teramukai, S., Fukushima, M., Sasaki, H. Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma. BMC Cancer 2009, 9, p. 47.

31. Yan, X., Li, G., Slang, H., et al. Complications of laparoscopic radical hysterectomy and pelvic lymphadenectomy-experience of 117 patients. Int J Gynecol Cancer 2009, 19(5), p. 963-967.