Reduction of postoperative morbidity after radical inguinal lymph node dissection in vulvar cancer using internal inguino-peritoneal drains

Aim: Vulvar cancer is a serious problem with increasing incidence over the last 20 years. In case of deeper infiltrating vulvar cancers and/or in case of involved sentinel lymphnodes however radical lymphonodectomy of either one or both groins is needed. Both superficial and deep lymphnodes are removed leading to a high frequency of perioperative morbidity as persisting inguinal seromas. The aim of the study was to evaluate a surgical method reducing inguinal seromas. Material: We performed a single-arm interventional study to evaluate a new surgical procedure by using a silicone drain connecting the groin to the abdominal cavity and to drain the inguinal lymphatic fluid to its original abdominal destination. Methods: Between March 2012 and March 2015 21 patients were recruited into the study and the drain was circularly placed from the whole inguinal area to the space of Douglas for 3 months. Patients were interviewed by an independent study nurse using a questionnaire to check patients' health, side effects and general compliance with the operation technique. Results: 81% of the patients were completely satisfied with the treatment, the others were moderately satisfied with the final result. In 72% of the patients no punctures of the groins were necessary, 28% received only 1 to 3 punctures. Conclusion: The peritoneal cavity seems to be a proper space for resorption of lymphatic fluid in vulva cancer patients and the drainage to the space of Douglas can reduce inguinal seromas. Randomized – controlled studies should proof the concept in patients after inguinal lymphatic dissection.