Assessment and Reporting of Perioperative Adverse Events and Complications in Patients Undergoing Inguinal Lymphadenectomy for Melanoma, Vulvar Cancer, and Penile Cancer: A Systematic Review and Meta-Analysis - Beyond the Abstract
Minimal changes to the technique have been proposed since the introduction of minimally invasive surgery for ILND over a decade ago. Studies have also shown that ILND is not always performed when indicated, based on the findings of the 2016 guidelines adherence study by Correa et al. This highlights the need to better understand the reasons for the underutilization of ILND.
Generally speaking, using a standardized system for reporting surgical complications is of utmost importance for several reasons. Firstly, it ensures improved accuracy as the system provides clear definitions and criteria for the identification and reporting of complications, reducing the possibility of misinterpretation and promoting consistency in the collection of information across studies. Secondly, standardized reporting enables better comparison of outcomes across different surgical procedures, centers, and patient populations, allowing researchers and clinicians to identify areas requiring improvement and track progress over time. Thirdly, it contributes to better patient care as tracking and analyzing complications helps healthcare providers identify trends and develop strategies to prevent and manage adverse events, ultimately improving patient outcomes and reducing the risk of harm. Lastly, accurate and standardized reporting of surgical complications is crucial for informed decision-making at the institutional, national, and international levels, guiding policies and regulations that promote patient safety and quality of care
The make a call to action for the proper standardization of ILND-related complications, at the Department of urology of the University of Southern California, in collaboration with other Centers worldwide, we have initiated the Complications and Adverse Events in Lymphadenectomy of the Inguinal Area (CALI) project, with the primary objective of reducing the morbidity associated with this procedure.
Our first step in this collaboration was to conduct a comprehensive evaluation of the existing literature to better understand the problem. The main research questions were: 1) How is the medical community reporting complications related to ILND, 2) what is the impact of the surgical technique on patient outcomes, and 3) what are the predictors for adverse events?
The systematic review of 296 publications revealed that the quality of complication reporting in the medical community could be improved. For example, we found that 75% of the studies reported less than 50% of the European Association of Urology (EAU) panel recommendations for reporting complications. To address this issue, we evaluated these publications using the Martin Criteria and EAU Guidelines and found that the reporting patterns improved over time, although they still require further improvement. Specifically, 79% of the studies failed to report readmissions and 70% of the time, a distinction between intraoperative and postoperative complications was not made.
The meta-analysis showed that minimally invasive surgery is overall less morbid, particularly for cutaneous and infectious complications. Furthermore, we identified high body mass index, diabetes, and the presence of more than one comorbidity as independent predictors of complications. Although not statistically significant, our data showed a potential association between smoking status, number of lymph nodes removed, and sartorius interposition with a higher risk of complications. These findings are in line with the overall consensus in the literature.
During the data collection, we encountered challenges in grouping classifications due to the wide heterogeneity of definitions for each complication. This led us to the conclusion that there is a need to improve the way we measure complications after ILND. To achieve more granular data, we must establish a common language for defining and reporting complications.
We are currently working on an international, cross-specialty consensus expert panel for this purpose, and we hope this will be a step towards improving the morbidity profile of patients undergoing ILND.
Written by: Luis G. Medina, Aref Sayegh, Michael Eppler, Giovanni E. Cacciamani, Rene Sotelo
Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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