[Diagnosis and treatment of complications related with lymph-node dissection surgery: Lymphorrea, lymphocele and lymphedema.] / Diagnóstico y tratamiento de las complicaciones y secuelas relacionadas con la linfadenectomía: linforrea, linfocele y linfedema.

OBJECTIVES: To describe the available techniques to prevent and treat complications related with surgery involving lymphatic nodes and drainage: lymphorrea, lymphocele and lymphedema. METHODS: Bibliographic review and personal experience communication of different image-assisted techniques in the prevention and management of lymphatic related complications. RESULTS: We describe the conventional lymphography with ethiodized oil contrast (lipiodol) by lymphatic catheterization and intranodal percutaneous puncture used in diagnostics and interventional radiology; the gammagraphic lymphography with radioactive isotopes for diagnostic use; and the utilization of colorants/dyes (patent blue, V-blue, methylene blue, indocyanine green) for diagnostic and therapeutic procedures. CONCLUSIONS: Lipiodol lymphography offers well-defined radiologic images and it is useful in interventional radiology procedures. It has the inconvenience of lymphatics catheterization and is not available for surgical dynamic identification of lymphatics. Isotopic techniques are used for diagnostics and sentinel-node procedures. Colorants and dyes have several advantages: no need for catheterization, not expensive technology, price, availability, easy management. It allows the dynamic identification of lymphatics for surgical resolution of lymph-related complications.

OBJETIVOS: Describir los diferentes métodos de prevención y resolución de complicaciones y secuelas derivadas de actos quirúrgicos relacionados con el drenaje linfático ­ linforrea, linfocele y linfedema.MÉTODOS: Revisión de la literatura y comunicación de la experiencia personal de alternativas diagnósticas y terapéuticas con asistencia guiada de imagen. RESULTADOS: Describimos la linfografía mediante cateterización linfática e intranodal con aceite etiodizado (lipiodol) con fines diagnósticos y terapéuticos; la linfografía gammagráfica mediante el uso de isótopos radioactivos con fines diagnósticos; y el uso de colorantes -azul de isosulfan, azul patente, azul de metileno y verde de indocianina- con finalidad diagnóstica y terapeútica. CONCLUSIONES: La linfografía con lipiodol ofrece imágenes bien definidas y es útil en maniobras de radiología intervencionista. Presenta el inconveniente de precisar cateterismo linfático y la imposibilidad de su uso dinámico intraoperatorio. Las técnicas isotópicas son utilizadas con finalidad diagnóstica y en técnicas de biopsia de ganglio centinela. El uso de colorantes ofrece la ventaja de no precisar cateterismo linfático ni de tecnología compleja, precio, disponibilidad, facilidad de uso y de tratarse de una técnica dinámica que permite la identificación intraoperatoria para la resolución de las complicaciones mencionadas.

Prevention of lymphocele by using gelatin-thrombin matrix as a tissue sealant after pelvic lymphadenectomy in patients with gynecologic cancers: a prospective randomized controlled study.

OBJECTIVE: This prospective randomized controlled pilot study aimed to find whether gelatin-thrombin matrix used as a tissue sealant (FloSeal) can prevent the occurrence of pelvic lymphocele in patients with gynecologic cancer who has undergone pelvic lymphadenectomy. METHODS: Each patient, who undergo a laparotomic pelvic lymph node dissection on both sides, was randomly assigned for FloSeal application on 1 side of the pelvis. The other side of the pelvis without any product application being the control side. The amount of lymph drainage at each side of the pelvis was measured for 3 days, and computed tomography scans were obtained 7 days and 6 months after surgery for detection of pelvic lymphocele. RESULTS: Among 37 cases, the median amount of lymph drainage was significantly decreased in the hemi-pelvis treated with FloSeal compared to the control hemi-pelvis (p=0.025). The occurrence of lymphocele was considerably reduced in treated hemi-pelvis (8/37, 21.6%) compared with control hemi-pelvis (12/37, 32.4%) after 7 post-operative days (p=0.219), and more decreased in the treated hemi-pelvis (5/37, 13.5%) compared with control hemi-pelvis (9/37, 24.3%) after postoperative 6 months (p=0.344). CONCLUSION: The application of FloSeal as a tissue sealant in lymph nodes resected tissues can reduce the incidence of pelvic lymphocele in gynecologic cancer patients. A large randomized controlled study could confirm these preliminary results.