THE VOLUME OF POSTOPERATIVE DRAINAGE FLUID AS A POTENTIAL EARLY PREDICTOR OF LYMPHEDEMA AFTER LYMPH NODE EXCISION FOR METASTATIC MELANOMA

Abstract

Lymphedema (LE) following lymph node
dissection is a major problem for cancer
patients, and radiation therapy, extended
surgery, groin dissection, obesity, and older
age are well-established risk factors of LE.
We studied whether these risk factors are
further associated with high volumes of
postoperative drainage fluid after complete
lymph node dissection (CLND) for melanoma
metastases. Moreover, we examined whether
a high amount of drainage fluid after sentinel
lymph node biopsy (SLNB) can predict a high
amount of drainage fluid after subsequent
CLND. Using descriptive statistics and regression
analyses, we analyzed the cumulative
volumes of postoperative drainage fluid for
836 melanoma patients with lymph node
excision in the axilla or groin. In multiple
regression analyses, the well-established risk
factors of LE, i.e., increased body mass index,
older age, and ilioinguinal versus inguinal
versus axillary dissection predicted a high
drainage volume after CLND. Of note, a
high drainage fluid volume after SLNB also
predicted a high drainage volume after
subsequent CLND. In patients with groin
dissections, who are particularly susceptible to
swelling, extended iliac dissection, age above
60, and a cumulative drainage volume of more
than 100 ml in the preceding SLNB were
predictors of the cumulative drainage volume.
We find that common risk factors predict the
volume of postoperative drainage fluid after
CLND and postoperative LE. Further, high
postoperative drainage volume may therefore
function as a potential early predictor of LE
following CLND.