Long term outcomes from lymphatic venous anastomosis after total hysterectomy to prevent postoperative lymphedema in lower limb.

BACKGROUND: Lymphedema in lower limb is one of major postoperative complications followed by a total hysterectomy with lymph node dissection. The objective of this report is to examine a long-term result of lymphaticovenous anastomosis procedure as a preventive surgery. METHODS: Sixteen patients with endometrial cancer underwent an abdominal hysterectomy with a bilateral salpingo-oophorectomy. Just after pelvic lymph node dissection, either end-to-end or sleeve anastomosis utilizing venules and suprainguinal lymph vessels was performed. During the observation period from 4 to 13 years, the symptom of lymphedema in lower extremities has been assessed. RESULTS: Among 16 patients, 1 presented postoperative lymphedema grade 3 (CTCAE (Common Terminology Criteria for Adverse Events) Ver. 4.0, 10025233) in lower limb, and a second surgery at 7 years after the first one was required. Other 6 patients showed non-severe symptoms of lymphedema, diagnosed as grade 1. The rest 9 patients did not show any symptoms of postoperative lymphedema in a long term (up to 13 years). CONCLUSION: From the long term outcomes of our 16 cases, we propose that a direct lymphaticovenous microsurgery immediately after a hysterectomy with lymphadenectomy of external inguinal lymph node is one of the appropriate therapeutic choices to prevent severe lymphedema in lower limb.

Neoadjuvant Chemotherapy for Patients With Diaphragmatic Lesions: A Prognostic Postoperative Analysis.

BACKGROUND/AIM: We aimed to analyse the prognosis of patients who underwent primary debulking surgery (PDS) and those who underwent interval debulking surgery (IDS) following four courses of paclitaxel+ carboplatin as preoperative chemotherapy to examine the usefulness of preoperative chemotherapy. PATIENTS AND METHODS: We included 45 patients with epithelial ovarian and peritoneal cancers accompanied with diaphragmatic lesions who underwent standard surgery combined with diaphragmatic surgery at two related institutions in January 2010-December 2013. Using medical records, we surveyed the recurrence period, recurrence site, and date of last confirmed survival, and analysed prognosis. RESULTS: The PDS and IDS groups comprised 32 and 13 patients (overall survival, 61.2 and 43.2 months), respectively. Progression-free survival in the PDS and IDS groups was 31.2 and 16.8 months, respectively. CONCLUSION: NAC-IDS can be a standard treatment option for patients with a tumour in the triangular ligament, in whom complete surgery is difficult.