title: High Incidence of Erysipelas After Surgical Treatment for Vulvar Carcinoma: An Observational Study.
abstract: OBJECTIVE
  Vulvar carcinoma is mainly treated surgically and has an overall good prognosis. Despite the development of minimally invasive surgical procedures in recent years, morbidity remains significant. The aim of the study was to determine the incidence and risk factors of erysipelas after surgical treatment for vulvar carcinoma.
  
  
  METHODS
  This retrospective observational study was performed within the Comprehensive Cancer Centre South. The study included patients (N = 116) who underwent surgery for primary vulvar carcinoma between 2005 and 2012. Patients with International Federation of Gynecology and Obstetrics stage IA and IV were excluded. Clinical and histopathological data were analyzed using logistic regression, χ(2) tests, Fisher exact tests, independent t tests, and nonparametric tests. Primary outcome was the incidence of postoperative erysipelas and determination of risk factors for erysipelas. Secondary outcome included other comorbidities.
  
  
  RESULTS
  A total of 23 patients (20%) with vulvar carcinoma had 1 or more episodes of erysipelas. The risk of developing erysipelas was significantly higher in patients who underwent lymph node dissection than in those who underwent sentinel node biopsy (36% [n = 12] and 14% [n = 11], respectively, P = 0.008) and in patients with lymphedema than in those without (30% [n = 7] and 12% [n = 11], respectively, P = 0.048). Patients with diabetes tended to have a higher incidence of erysipelas than those without (28% vs 18%, P = 0.27).
  
  
  CONCLUSIONS
  Erysipelas occurs frequently in patients who undergo surgical treatment for vulvar carcinoma. The risk of erysipelas is 3 times higher in patients who undergo lymph node dissection and in those with lymphedema than in those without, and it tends to be high in patients with diabetes.
authors.affiliation: *Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Hospital, Tilburg; †Department of Obstetrics, University Medical Center, Utrecht; ‡Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital, Nijmegen; §Comprehensive Cancer Centre South, Eindhoven; ∥Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven; and ¶Department of Epidemiology/Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
authors.forename: Maria E J
authors.initials: ME
authors.lastname: Leermakers
authors.forename: Noortje
authors.initials: N
authors.lastname: Pleunis
authors.forename: Dorry
authors.initials: D
authors.lastname: Boll
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hermans
authors.forename: Nicole P M
authors.initials: NP
authors.lastname: Ezendam
authors.forename: Johanna M A
authors.initials: JM
authors.lastname: Pijnenborg
mesh_terms: D000368:Aged; D004886:Erysipelas / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008209:Lymphedema / Q000453:epidemiology* / Q000209:etiology; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*