title: [Risk factors for the development of lymphatic fistula after ilioinguinal lymph node dissection before isolated limb perfusion and its potential clinical relevance].
abstract: BACKGROUND
  After ilioinguinal radical lymph node dissection (RLND), the therapy for lymph fistulas constitutes a challenge. Risk factors for the genesis of lymph fistulas have not been sufficiently evaluated. We investigated possible factors that could influence the development of lymph fistulas in patients suffering from malignant melanoma after iloinguinal RLND.
  
  
  METHODS
  The analysis was related to patients with intransit and lymphonodal metastasised malignant melanoma of the lower limb, who underwent RLND and isolated limb perfusion (ILP). Prospective data acquisition from patients undergoing ilioinguinal RLND and ILP in a one-step approach was performed. The association of lymph fistulas to risk factors was calculated using chi-squared, linear-by-linear test and ROC curves. As possible risk factors we investigated the presence of prior surgery and diabetes mellitus type II in the medical history, chemotherapeutics, patient age and the body mass index (BMI).
  
  
  RESULTS
  Postoperative lymph fistula occurred in 11 of 108 patients (10.2%). A significant association to lymph fistulas was found in BMI (30.2± 7.0 kg/m (2), p<0.02). Other parameters, such as prior surgery (82% vs. 71%), diabetes mellitus type II (9% vs. 11.7%), chemotherapeutics and patient age (mean 67.8 vs. 62.4 years) showed no influence.
  
  
  CONCLUSIONS
  Our results indicate that the incidence of lymph fistulas after RLND and ILP of malignant melanoma of the lower limb was associated with an increased BMI. Thus, for the prevention of lymph fistulae, an initially alternative wound-closure dressing like vacuum assisted closure (V.A.C.) dressing could be of clinical relevance for obese patients.
authors.affiliation: Robert-Rössle-Klinik, Charité-Universitätsmedizin Berlin, Campus Buch, Klinik für Chirurgie und chirurgische Onkologie, Berlin, Germany.
authors.forename: Z
authors.initials: Z
authors.lastname: Mohr
authors.forename: C
authors.initials: C
authors.lastname: Hirche
authors.forename: S
authors.initials: S
authors.lastname: Gretschel
authors.forename: A
authors.initials: A
authors.lastname: Bembenek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D015992:Body Mass Index; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects*; D005260:Female; D005402:Fistula / Q000209:etiology*; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery; D007866:Leg; D008197:Lymph Node Excision / Q000009:adverse effects*; D008206:Lymphatic Diseases / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D047368:Tumor Burden; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage
chemical_list: D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan