Reducing complications after inguinal lymphadenectomy: complication rates and preventive strategies from a retrospective cohort study
Olof Peterffy, Ada TosovicAbstract
Introduction
Inguinal lymphadenectomy for metastatic melanoma is associated with substantial morbidity. Despite advances in immunotherapy, surgery remains an important treatment method for some patients. This study evaluated complication rates and identified potential preventive strategies.
Methods
A retrospective cohort study of 66 patients undergoing inguinal or ilioinguinal lymphadenectomy at Skåne University Hospital (2015–2024). Patient characteristics, perioperative management, and postoperative complications were analysed.
Results
Complications occurred in 94% of patients. Surgical-site infection (65%), seroma (56%), and lymphoedema (44%) were most common. Ilioinguinal lymphadenectomy was associated with increased infection risk (OR 4.8, 95% c.i. 1.24–18.63; P = 0.017). Negative pressure wound therapy (OR 0.21, 95% c.i. 0.07–0.63; P = 0.004) and postoperative antibiotic prophylaxis (OR 0.21, 95% c.i. 0.06–0.70; P = 0.008) were associated with markedly reduced infection rates. Prophylaxis did not increase total antibiotic exposure, due to reduced infection rates. Longer drain duration was associated with reduced seroma risk by 9% per day (P = 0.047), whereas drain output >200 ml/day before removal was associated with increased risk (OR 9.26, 95% c.i. 1.06–80.93; P = 0.028). No predictors for lymphoedema were identified. Preservation of the great saphenous vein had no impact on outcomes.
Discussion
Morbidity after inguinal lymphadenectomy remains high. However, clinically actionable measures—negative pressure wound therapy and postoperative antibiotic prophylaxis—substantially reduce infection risk, particularly in ilioinguinal procedures. Tailored drain management may further reduce seroma formation, where prolonged drain treatment can be beneficial for patients with large drain volumes. Effective strategies for lymphoedema prevention were not identified.