Introduction: Inguinal lymph node dissection (ILND) is an essential part of treatment in patients with lymph node metastases from penile cancer (PeCa), vulvar cancer (VC) and malignant melanoma (MM). However, ILND is associated with high complication rates. To our knowledge, no studies have evaluated complications in such a large cohort, across specialties. Therefore, the aim of this study is to assess the incidence and nature of postoperative complications after ILND and to identify potential predictors associated with the occurrence of complications in PeCa, VC and MM patients. Methods: In total, we retrospectively evaluated 324 patients (PeCa n=114, VC n=48 and MM n=162) who underwent 342 ILNDs in 381 groins between 2017 and 2021 in a single high-volume center. Template and operative technique was the same. The main difference between the 3 indications was their postoperative drainage management. In PeCa and MM a time-controlled drainage protocol is applied (removal 3 days after surgery) while in VC, the drain is removed when drain production is <50 ml (or after 30 days). Early ( <30 days) and late (30-90-days) postoperative complications were collected. Uni- and multivariate logistic regression were used to identify risk factors for early and late complications per groin. Results: In total, 837 complications were reported, of which 3.8% required surgical (open) revision and 21% required drainage. The most occurring complications were wound infection (33.3%) and lymphocele (31.8%). 335 groins (88.4%) developed =1 early complications of which lymphocele formation (43.4%) was the most common. Obesity (OR 2.81), higher drain production (OR 1.50) were significantly associated with a higher risk of early complications whilst volume-controlled drain removal (OR 0.95) with less complications. Between 30 to 90 days postoperatively, 188 groins (50.4%) developed =1 late complications, of which wound infection (45.9%) was the most frequently occurring. Obesity (OR 1.8), volume-controlled drain removal (OR 1.05) were significantly associated with a higher risk of late complications. Conclusions: Although ILND is associated with a high risk of complications, only 3.8% required surgical revision. While some of the identified risk factors cannot be easily influenced (e.g. obesity), postoperative drain management seems to be an important consideration. In this large cohort, volume-controlled drainage resulted in less (early) lymphocele formation, but was associated with more (late) wound infections. SOURCE OF Funding: No conflicts of interest to declare
