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• W2004379738 abstract "Purpose/Objective(s)Postoperative pelvic fluid collections are common in patients with staging laparotomy for gynecologic cancer and can result in infectious complications (20%) during radiation (RT)/chemotherapy. With recent development of less invasive robotic/laparoscopic lymph node staging approaches, the incidence and clinical significance of postoperative seroma has not been described. The purpose of this study was to evaluate frequency and type of postoperative seromas, and RT/chemotherapy-related morbidity in gynecologic cancer patients following robotic lymph node staging.Materials/MethodsRT planning CT/MRIs were reviewed to identify postoperative seromas in 23 patients (16 cervical, 7 endometrial cancer) who had pre-RT robotic/laparoscopic lymph node dissection. Location and configuration of each seroma were recorded, seromas were contoured and 3D volume was measured. RT dose, surgery-RT interval, number, size and fixation of resected lymph nodes, chemotherapy use and neutrophil nadir were correlated with short- and long-term morbidity.ResultsThe number of seromas ranged from none (30%), 1 (26%), 2 (30%), 3 (8%) to 4 (8%). Most occurred in the mid-external iliac (54%), followed by low external iliac (21%), para-aortic (18%) and common iliac area (6%). Most were round/oval in configuration (82%), followed by serpentine (9%), and dumbbell-shape (9%). Mean seroma size was 20.0 cm3 (range: 1.2 -131.5 cm3). Seroma size correlated with fixation and bulk of resected involved lymph nodes. Seromas of >50 cm3 were associated with lymph node size of >3 cm and/or fixation in 75%, compared to 7% fixation and 10% size >3 cm in seromas <50 cm3. Number of removed lymph nodes did not influence seroma size. All but 4 seromas (3 para-aortic, 1 low external iliac in uninvolved nodal regions) were completely included in the RT field. With median follow-up of 6.6 months, no local failures occurred in seroma regions excluded from the field. Complications occurred in only 1 of the 23 patients, who had 3 small seromas (14.1, 3.5 and 1.8 cm3) and a prolonged neutrophil nadir of 1.3 cells/mm3 and developed rapidly increasing seroma size and abscess/fever during RT. Symptoms resolved with drainage and antibiotics. There were no long-term complications.ConclusionsSeromas after robotic lymph node dissection are frequent and largely indolent clinically. Size is not related to complications, and is smaller than observed with laparotomy for nodal dissections (mean: 42 cm3).1 Seromas should be included into the RT field and monitored clinically without upfront interventions.Reference1.Mayr NA et al. Significance of postoperative seroma following lymph node dissection in patients with radiation/chemotherapy for gynecologic malignancies. Proceedings of RSNA 2003;423. Purpose/Objective(s)Postoperative pelvic fluid collections are common in patients with staging laparotomy for gynecologic cancer and can result in infectious complications (20%) during radiation (RT)/chemotherapy. With recent development of less invasive robotic/laparoscopic lymph node staging approaches, the incidence and clinical significance of postoperative seroma has not been described. The purpose of this study was to evaluate frequency and type of postoperative seromas, and RT/chemotherapy-related morbidity in gynecologic cancer patients following robotic lymph node staging. Postoperative pelvic fluid collections are common in patients with staging laparotomy for gynecologic cancer and can result in infectious complications (20%) during radiation (RT)/chemotherapy. With recent development of less invasive robotic/laparoscopic lymph node staging approaches, the incidence and clinical significance of postoperative seroma has not been described. The purpose of this study was to evaluate frequency and type of postoperative seromas, and RT/chemotherapy-related morbidity in gynecologic cancer patients following robotic lymph node staging. Materials/MethodsRT planning CT/MRIs were reviewed to identify postoperative seromas in 23 patients (16 cervical, 7 endometrial cancer) who had pre-RT robotic/laparoscopic lymph node dissection. Location and configuration of each seroma were recorded, seromas were contoured and 3D volume was measured. RT dose, surgery-RT interval, number, size and fixation of resected lymph nodes, chemotherapy use and neutrophil nadir were correlated with short- and long-term morbidity. RT planning CT/MRIs were reviewed to identify postoperative seromas in 23 patients (16 cervical, 7 endometrial cancer) who had pre-RT robotic/laparoscopic lymph node dissection. Location and configuration of each seroma were recorded, seromas were contoured and 3D volume was measured. RT dose, surgery-RT interval, number, size and fixation of resected lymph nodes, chemotherapy use and neutrophil nadir were correlated with short- and long-term morbidity. ResultsThe number of seromas ranged from none (30%), 1 (26%), 2 (30%), 3 (8%) to 4 (8%). Most occurred in the mid-external iliac (54%), followed by low external iliac (21%), para-aortic (18%) and common iliac area (6%). Most were round/oval in configuration (82%), followed by serpentine (9%), and dumbbell-shape (9%). Mean seroma size was 20.0 cm3 (range: 1.2 -131.5 cm3). Seroma size correlated with fixation and bulk of resected involved lymph nodes. Seromas of >50 cm3 were associated with lymph node size of >3 cm and/or fixation in 75%, compared to 7% fixation and 10% size >3 cm in seromas <50 cm3. Number of removed lymph nodes did not influence seroma size. All but 4 seromas (3 para-aortic, 1 low external iliac in uninvolved nodal regions) were completely included in the RT field. With median follow-up of 6.6 months, no local failures occurred in seroma regions excluded from the field. Complications occurred in only 1 of the 23 patients, who had 3 small seromas (14.1, 3.5 and 1.8 cm3) and a prolonged neutrophil nadir of 1.3 cells/mm3 and developed rapidly increasing seroma size and abscess/fever during RT. Symptoms resolved with drainage and antibiotics. There were no long-term complications. The number of seromas ranged from none (30%), 1 (26%), 2 (30%), 3 (8%) to 4 (8%). Most occurred in the mid-external iliac (54%), followed by low external iliac (21%), para-aortic (18%) and common iliac area (6%). Most were round/oval in configuration (82%), followed by serpentine (9%), and dumbbell-shape (9%). Mean seroma size was 20.0 cm3 (range: 1.2 -131.5 cm3). Seroma size correlated with fixation and bulk of resected involved lymph nodes. Seromas of >50 cm3 were associated with lymph node size of >3 cm and/or fixation in 75%, compared to 7% fixation and 10% size >3 cm in seromas <50 cm3. Number of removed lymph nodes did not influence seroma size. All but 4 seromas (3 para-aortic, 1 low external iliac in uninvolved nodal regions) were completely included in the RT field. With median follow-up of 6.6 months, no local failures occurred in seroma regions excluded from the field. Complications occurred in only 1 of the 23 patients, who had 3 small seromas (14.1, 3.5 and 1.8 cm3) and a prolonged neutrophil nadir of 1.3 cells/mm3 and developed rapidly increasing seroma size and abscess/fever during RT. Symptoms resolved with drainage and antibiotics. There were no long-term complications. ConclusionsSeromas after robotic lymph node dissection are frequent and largely indolent clinically. Size is not related to complications, and is smaller than observed with laparotomy for nodal dissections (mean: 42 cm3).1 Seromas should be included into the RT field and monitored clinically without upfront interventions. Seromas after robotic lymph node dissection are frequent and largely indolent clinically. Size is not related to complications, and is smaller than observed with laparotomy for nodal dissections (mean: 42 cm3).1 Seromas should be included into the RT field and monitored clinically without upfront interventions." @default.
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• W2004379738 title "Postoperative Seromas Following Robotic/Laparoscopic Lymph Node Dissection in Patients with Radiation/Chemotherapy for Gynecologic Cancers" @default.
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