Postoperative administration of octreotide to reduce lymphorrhea, lymphocele, lymphedema and lymphatic ascites after lymphadenectomy in gynecological malignancies


Authors: V. Weinberger 1;  L. Minář 1;  M. Felsinger 1;  D. Seidlová 2;  P. Ovesná 3;  M. Bednaříková 4;  E. Jandáková 5;  I. Rovný 6
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA 1;  Anesteziologicko-resuscitační klinika LF MU a FN, Brno, přednosta prof. MUDr. R. Gál, Ph. D. 2;  Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty MU, Brno, přednosta doc. RNDr. L. Dušek, Ph. D. 3;  Interní hematologická a onkologická klinika LF MU a FN, Brno, přednosta prof. MUDr. J. Mayer, CSc. 4;  Ústav patologie LF MU a FN, Brno, přednosta doc. MUDr. L. Křen, Ph. D. 5;  Chirurgická klinika LF MU a FN, Brno, přednosta prof. MUDr. Z. Kala, CSc. 6
Published in: Čes. Gynek.2017, 82, č. 2 s. 92-99

Overview

Introduction:
Octreotide is a synthetic analogue of natural somatostatin. Octreotide effect on lymphorrhea reduction in gynecological malignancies has only been assessed in case studies.

Design:
Original work.

Setting:
Gynecologic Oncology Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno.

Methods:
In 2014 there was a prospective, randomized, one-institution study. Patients underwent surgery including pelvic or pelvic and paraaortic lymphadenectomy for cervical, uterine and ovarian cancer. The informed consent was signed. Octreotide was evaluated in relation to diagnosis, surgery (laparoscopy versus laparotomy), pelvic and/or paraaortic lymphadenectomy, number of removed lymph nodes and their positivity, neoadjuvant chemotherapy, adjuvant chemotherapy, adjuvant radiotherapy, albumin, BMI, number of days with drains postoperatively, number of days in hospital, blood loss during surgery, time of surgery, total number of drains placed into abdominal cavity. In follow up period, within 1 year after surgery, we searched for lymphocele, lymph­edema of lower extremities and lymphatic ascites in relation to lymphorrhea.

Results:
44 patients (9 cervical, 19 endometrial and 16 ovarian cancer) were enrolled in two statistically comparable randomized groups. „Octreotide group“, which paradoxically showed lymphorrhea of 4082 ml on average, (without 1992 ml, p = 0.001), needed drainage for more days (p = 0.001). The diagnosis had no influence on lymphorrhea in both groups (p = 0.966). The neoadjuvant chemotherapy was administered (p = 0.026), the more lymph nodes were removed (p = 0.018), the more days the drainage was in place (p < 0.001), the bigger the lymphorrhea; no relationship between lymphorrhea and age (p = 0.631), albumin level (p = 0.584), BMI ( p= 0.966) or number of positive nodes (p = 0.259), length of surgery (p = 0.206), blood loss (p = 0.494). Nor lymphedema (p = 0.404), nor lymphocele (p = 0.086), correlated with postoperative lymphorrhea. Lymphatic ascites was associated with lymphorrhea (p = 0.048).

Conclusion:
Octreotide did not reduce lymphorrhea and the incidence of lymphocele, lymphedema of lower extremities and lymphatic ascites within one year of follow-up period after surgery. According to our results, we do not recommend to administer the octreotide in oncogynecological patients after pelvic and/or paraaortic lymphadenectomy.

Keywords:
lymphadenectomy, lymphatic ascites, lymphedema, lymphocele, octreotide


Sources

1. Achouri, A., Huchon, C., Bats, AS., et al. Complications of lymphadenectomy for gynecological cancer. Eur J Surg Oncol, 2013, 39(1), p. 81–88.

2. Akita, S., Mitsukawa, N., Kuriyama, M., et al. Suitable therapy options for sub-clinical and early-stage lymphoedema patients. J Plast Reconstr Aesthet Surg, 2014, 67(4), p. 520–525.

3. Benedetti-Panici, P., Maneschi, F., Cutillo, G., et al. A randomized study comparing retroperitoneal drainage with no drainage after lymphadenectomy in gynecologic malignancies. Gynecol Oncol, 1997, 65(3), p. 478–482.

4. Benedetti-Panici, P., Maneschi, F., Cutillo, G. Pelvic and aortic lymphadenectomy. Surg Clin North Am, 2001, 81(4), p. 841–858.

5. Carcoforo, P., Soliani, G., Maestroni, U., et al. Octreotide in the treatment of lymphorrhea after axillary node dissection: a prospective randomized controlled trial. J Am Coll Surg, 2003, 196(3), p. 365–369.

6. Ferguson, JH., Maclure, JG. Lymphocele following lymphadenectomy. Am J Obstet Gynecol, 1961, 82, p. 783–792.

7. Franchi, M., Trimbos, JB., Zanaboni, F., et al. Randomised trial of drains versus no drains following radical hysterectomy and pelvic lymph node dissection. A European Organisation for Research and Treatment of Cancer Group (EORTCC– GCG) study in 234 patients. Eur J Cancer, 2007, 43(8), p. 1265–1268.

8. Ghezzi, F., Uccella, S., Cromi, A., Bogani, G., et al. Lymphoceles, lymphorrhoea, and lymphedema after laparoscopic and open endometrial cancer staging. Ann Surg Oncol, 2012, 19(1), p. 259–267.

9. Gray, MJ., Plentl, AA., Taylor, HC. The lymphocyst: a complication of pelvic lymph node dissections. Am J Obstet Gynecol, 1958, 75(5), p. 1059–1062.

10. Han, LP., Zhang, HM., Abha, HD., et al. Management and prevention of chylous leakage after laparoscopic lymphadenectomy. Eur Rev Med Pharmacol Sci, 2014, 18(17), p. 2518–2522.

11. Ilancheran, A., Monaghan, JM. Pelvic lymphocyst – a 10 year experience, Gynecol Oncol, 1988, (29), p. 333–336.

12. Kim, WT., Ham, WS., Koo, KC., Choi, YD. Efficacy of octreotide for management of lymphorrhea after pelvic lymph node dissection in radical prostatectomy. Urology, 2010, 76(2), p. 398–401.

13. Kong, TW., Chang, SJ., Kim, J., et al. Risk factor analysis for massive lymphatic ascites after laparoscopic retroperitonal lymphadenectomy in gynecologic cancers and treatment using intranodal lymphangiography with glue embolization. J Gynecol Oncol, 2016, 27(4), p 44.

14. Logmans, A., Kruyt, RH., De Bruin, HG., et al. Lymphedema and lymphocysts following lymphadenectomy may be prevented by omentoplasty: A pilot study. Gynecol Oncol, 1999, 75(3), p. 323–327.

15. Mahmoud, SA., Abdel-Elah, K., Eldesoky, AH., El-Awady, SI. Octreotide can control lymphorrhea after axillary node dissection in mastectomy operations. Breast J, 2007, 13(1), p. 108–109.

16. Mori, N. Clinical and experimental studies on the so-called lymphocyst which develops after radical hysterectomy in cancer of the uterine cervix. J Jpn Obstet Gynecol Soc, 1955, 2(2), p. 178–203.

17. Ryan, M., Stainton, MC., Jaconelli, C., et al. The experience of lower limb lymphedema for women after treatment for gynecologic cancer. Oncol Nurs Forum, 2003, 30(3), p. 417–423.

18. Thomé, Saint. PM., Brémond, A., Rochet, Y. Absence of peritonization after pelvic cancer surgery. Results in 157 cases. J Gynecol Obstet Biol Reprod (Paris), 1991, 20(7), p. 957–960.

19. Weinberger, V., Zikán, M., Cibula, D. Lymphocele: prevalence and management in gynecological malignancies: Expert Rev Anticancer Ther, 2014, 3, p. 307–317.

20. Zikan, M., Fischerova, D., Pinkavova, I., et al. A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer. Gynecol Oncol, 2015, 137(2), p. 291–298.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 2

2017 Issue 2

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account