Inguinal lymph node dissection plays an important role in the management of melanoma, penile and vulval cancer. Inguinal lymph node dissection is associated with various intraoperative and postoperative complications with significant heterogeneity in classification and reporting. This lack of standardization challenges efforts to study and report inguinal lymph node dissection outcomes. The aim of this study was to devise a system to standardize the classification and reporting of inguinal lymph node dissection perioperative complications by creating a worldwide collaborative, the complications and adverse events in lymphadenectomy of the inguinal area (CALI) group.
A modified 3-round Delphi consensus approach surveyed a worldwide group of experts in inguinal lymph node dissection for melanoma, penile and vulval cancer. The group of experts included general surgeons, urologists and oncologists (gynaecological and surgical). The survey assessed expert agreement on inguinal lymph node dissection perioperative complications. Panel interrater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α.
Forty-seven experienced consultants were enrolled: 26 (55.3%) urologists, 11 (23.4%) surgical oncologists, 6 (12.8%) general surgeons and 4 (8.5%) gynaecology oncologists. Based on their expertise, 31 (66%), 10 (21.3%) and 22 (46.8%) of the participants treat penile cancer, vulval cancer and melanoma using inguinal lymph node dissection respectively; 89.4% (42 of 47) agreed with the definitions and inclusion as part of the inguinal lymph node dissection intraoperative complication group, while 93.6% (44 of 47) agreed that postoperative complications should be subclassified into five macrocategories. Unanimous agreement (100%, 37 of 37) was achieved with the final standardized classification system for reporting inguinal lymph node dissection complications in melanoma, vulval cancer and penile cancer.
The complications and adverse events in lymphadenectomy of the inguinal area classification system has been developed as a tool to standardize the assessment and reporting of complications during inguinal lymph node dissection for the treatment of melanoma, vulval and penile cancer.
BJS open. 2024 Jul 02 [Epub]
René Sotelo, Aref S Sayegh, Luis G Medina, Laura C Perez, Anibal La Riva, Michael B Eppler, José Gaona, Marcos Tobias-Machado, Philippe E Spiess, Curtis A Pettaway, Antonio Carlos Lima Pompeo, Pablo Aloisio Lima Mattos, Timothy G Wilson, Gustavo M Villoldo, Eric Chung, Aldo Samaniego, Antonio Augusto Ornellas, Vladimir Pinheiro, Eder S Brazão, David Subira-Rios, Leandro Koifman, Stênio de Cassio Zequi, Humberto M Pontillo Z, José de Ribamar Rodrigues Calixto, Rafael Campos Silva, B Mark Smithers, Simone Garzon, Oliver Haase, Antonio Sommariva, Robert Fruscio, Francisco Martins, Pedro S de Oliveira, Giovanni Battista Levi Sandri, Marco Clementi, Juan Astigueta, Islam H Metwally, Rasiah Bharathan, Tarun Jindal, Yasuhiro Nakamura, Hisham Abdel Mageed, Sakthiushadevi Jeevarajan, Ramón Rodriguez Lay, Herney Andrés García-Perdomo, Omaira Rodríguez González, Saum Ghodoussipour, Inderbir Gill, Giovanni E Cacciamani
Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA., Universidad de Santander, Instituto Uromédica, Bucaramanga, Colombia., Department of Urology, Instituto do Câncer Arnaldo Vieira de Carvalho, São Paulo, Brazil., Department of Genitourinary Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida, USA., The University of Texas, M.D. Anderson Cancer Center, Houston, Texas, USA., Department of Urology, Faculdade de Medicina do ABC, São Paulo, Brazil., Department of Urology, Associação Piauiense de Combate ao Câncer, Teresina, Piauí, Brazil., Department of Urology, Providence St. John's Cancer Institute, Santa Monica, California, USA., Department of Urology, Instituto Alexander Fleming, Buenos Aires, Argentina., Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia., Department of Urology, Servicio de Urología del Hospital Central del Instituto de Previsión Social, Asunción, Paraguay., Departamento de Urologia, Instituto Nacional do Câncer do Brasil (INCA), Rio de Janeiro, Brazil., Department of Urology, AC Camargo Cancer Center, São Paulo, Brazil., Department of Urology, Gregorio Marañon Universitary Hospital, Madrid, Spain., Serviço de Urologia, Hospital Municipal Souza Aguiar, Rio de Janeiro, Rio de Janeiro, Brazil., Department of Urology, AC Camargo Cancer Center-São Paulo, São Paulo, Brazil., Department of Urology, Sant Jaume of Calella Hospital, Barcelona, Spain., Department of Medicine II, Federal University of Maranhão, São Luís, Massachusetts, Brazil., Department of Urology, Hospital Universitário Presidente Dutra-HUPD/UFMA, São Luís, Maranhão, Brazil., University of Queensland, Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia., Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy., Department of Surgery, University Medicine Berlin-Charité, Berlin, Germany., Veneto Institute of Oncology Institute Oncology Veneto, Istituto Di Ricovero e Cura a Carattere Scientifico, Padova, Italy., Department of Medicine and Surgery, University of Milan Bicocca, Azienda Socio Sanitaria Territoriale Monza, Italy., Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal., Department of Surgery, ASL Frosinone, Frosinone, Italy., Department of Medicine, Health and Life, University of L'Aquila, L'Aquila, AQ, Italy., Department of Urology, Universidad Privada Antenor Orrego, Trujillo, Perú., Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt., Department of Gynaecological Oncology, Medical University of Vienna, Vienna, Austria., Department of Uro-oncology, Narayana Super Speciality Hospital, Howrah, India., Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan., Surgical Oncology Department, National Cancer Institute Cairo University, Cairo, Egypt., Department of Surgical Oncology, Regional Cancer Centre, Kanchipuram, Tamil Nadu, India., Clinic Urology Service, Complejo Hospitalario Metropolitano, Madrid, Panama., Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia., Chief of Surgical Department, Clínicas Caracas Hospital, Faculty of Medicine, Central University of Venezuela, Caracas, Venezuela., Sections of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.