title: Risk factors for short- and long-term complications after groin surgery in vulvar cancer.
abstract: BACKGROUND
  The cornerstone of treatment in early-stage squamous cell carcinoma (SCC) of the vulva is surgery, predominantly consisting of wide local excision with elective uni- or bi-lateral inguinofemoral lymphadenectomy. This strategy is associated with a good prognosis, but also with impressive treatment-related morbidity. The aim of this study was to determine risk factors for the short-term (wound breakdown, infection and lymphocele) and long-term (lymphoedema and cellulitis/erysipelas) complications after groin surgery as part of the treatment of vulvar SCC.
  
  
  METHODS
  Between January 1988 and June 2009, 164 consecutive patients underwent an inguinofemoral lymphadenectomy as part of their surgical treatment for vulvar SCC at the Department of Gynaecologic Oncology at the Radboud University Nijmegen Medical Centre. The clinical and histopathological data were retrospectively analysed.
  
  
  RESULTS
  Multivariate analysis showed that older age, diabetes, 'en bloc' surgery and higher drain production on the last day of drain in situ gave a higher risk of developing short-term complications. Younger age and lymphocele gave higher risk of developing long-term complications. Higher number of lymph nodes dissected seems to protect against developing any long-term complications.
  
  
  CONCLUSIONS
  Our analysis shows that patient characteristics, extension of surgery and postoperative management influence short- and/or long-term complications after inguinofemoral lymphadenectomy in vulvar SCC patients. Further research of postoperative management is necessary to analyse possibilities to decrease the complication rate of inguinofemoral lymphadenectomy; although the sentinel lymph node procedure appears to be a promising technique, in 50% of the patients an inguinofemoral lymphadenectomy is still indicated.
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, HB Nijmegen, The Netherlands. F.Hinten@obgyn.umcn.nl
authors.forename: F
authors.initials: F
authors.lastname: Hinten
authors.forename: L C G
authors.initials: LC
authors.lastname: van den Einden
authors.forename: J C M
authors.initials: JC
authors.lastname: Hendriks
authors.forename: A G J
authors.initials: AG
authors.lastname: van der Zee
authors.forename: J
authors.initials: J
authors.lastname: Bulten
authors.forename: L F A G
authors.initials: LF
authors.lastname: Massuger
authors.forename: H P
authors.initials: HP
authors.lastname: van de Nieuwenhof
authors.forename: J A
authors.initials: JA
authors.lastname: de Hullu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003920:Diabetes Mellitus / Q000453:epidemiology; D004322:Drainage; D005260:Female; D006119:Groin / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D014846:Vulvar Neoplasms / Q000150:complications / Q000601:surgery*