title: Optimal timing for drainage of infected lymphocysts after lymphadenectomy for gynecologic cancer.
abstract: BACKGROUND
  A lymphocyst (lymphocele) is a common complication of lymphadenectomy, which is a widely used surgical method for gynecologic cancers. In cases of infected lymphocysts, therapeutic strategies, including the timing and duration of antibiotics administration and cyst drainage, may vary depending on the physician. The aim of this study was to determine the optimal timing for drainage of lymphocysts infected with bacteria resistant to antibiotic treatment.
  
  
  METHODS
  Clinical data for 1175 patients who underwent a lymphadenectomy as part of surgery for a gynecologic malignancy between April 2000 and August 2012 at Osaka University Hospital, Osaka, Japan, were analyzed.
  
  
  RESULTS
  Of the 282 patients who developed a lymphocyst (24%), 35 with infected lymphocysts (12%) were analyzed. Lymphocyst infection was not associated with tumor origin, type of hysterectomy, or region of lymphadenectomy (P = 0.81, P = 0.59, and P = 0.86, respectively). The total treatment period of cases treated only with antibiotics tended to be shorter than that of cases treated with combined antibiotics and drainage, but the difference was not significant (P = 0.061). However, for severe cases which needed drainage, initiating the drainage by day 5 significantly shortened the total treatment period compared with cases started on or after day 6 (P = 0.042).
  
  
  CONCLUSIONS
  The appropriate time point for initiating lymphocyst drainage has been difficult to determine. The present study implies that for severe lymphocyst infections, where drainage is required in addition to antibiotics, the earlier the drainage is performed, the shorter the treatment period is. Further studies may be required to decide other optimal treatment strategies for infected lymphocysts.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Hiramatsu
authors.forename: Eiji
authors.initials: E
authors.lastname: Kobayashi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ueda
authors.forename: Tomomi
authors.initials: T
authors.lastname: Egawa-Takata
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuzaki
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kimura
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Sawada
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshino
authors.forename: Masami
authors.initials: M
authors.lastname: Fujita
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004322:Drainage / Q000379:methods / Q000592:standards; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008210:Lymphocele / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D061665:Time-to-Treatment / Q000592:standards*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents