Complications and adverse events in lymphadenectomy of the inguinal area: worldwide expert consensus
Authors: Sotelo René , Sayegh Aref S , Medina Luis G , Perez Laura C , La Riva Anibal , Eppler Michael B , Gaona José , Tobias-Machado Marcos , Spiess Philippe E , Pettaway Curtis A , Lima Pompeo Antonio Carlos , Lima Mattos Pablo Aloisio , Wilson Timothy G , Villoldo Gustavo M , Chung Eric , Samaniego Aldo , Ornellas Antonio Augusto , Pinheiro Vladimir , Brazão Eder S , Subira-Rios David , Koifman Leandro , Zequi Stênio de Cassio , Pontillo Z Humberto M , Rodrigues Calixto José de Ribamar , Campos Silva Rafael , Smithers B Mark , Garzon Simone , Haase Oliver , Sommariva Antonio , Fruscio Robert , Martins Francisco , de Oliveira Pedro S , Levi Sandri Giovanni Battista , Clementi Marco , Astigueta Juan , Metwally Islam H , Bharathan Rasiah , Jindal Tarun , Nakamura Yasuhiro , Abdel Mageed Hisham , Jeevarajan Sakthiushadevi , Rodriguez Lay Ramón , García-Perdomo Herney Andrés , Rodríguez González Omaira , Ghodoussipour Saum , Gill Inderbir , Cacciamani Giovanni E 
Published: July 2024

Abstract

Background
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.

Methods
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.

Results
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.

Conclusion
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.