Association between daily drainage volume and subsequent lymphedema after inguinal lymph node dissection for skin cancer

Abstract Background: Inguinal lymph node dissection (ILND) is essential for regional control of skin cancers but is frequently complicated by postoperative lymphedema (LE). However, early clinical indicators associated with subsequent LE development after ILND remain insufficiently characterized. Objectives: This study aimed to examine the association between postoperative daily drainage volume and subsequent LE development after ILND in patients with skin cancer. We hypothesized that postoperative daily drainage volume would be associated with subsequent LE development. Methods: We retrospectively reviewed 35 patients who underwent completion ILND for skin cancer. Postoperative daily drainage volume was compared between lesions that developed LE and those that did not. In addition, an exploratory stratified analysis was performed according to histological subtype. Results: Daily drainage volume was significantly higher in LE-positive lesions on postoperative days (POD) 7, 8, 11, and 14. In stratified analysis by histological subtype, increased daily drainage volume was observed only in patients with extramammary Paget’s disease (EMPD) who developed LE, but not in those with malignant melanoma or squamous cell carcinoma. EMPD lesions that developed LE showed increased drainage from POD7 onward and a greater early postoperative rate of change between POD2 and POD3, compared with those that did not develop LE. Conclusion: Daily drainage volume after ILND may serve as an early clinical indicator associated with subsequent LE development. As this parameter can be measured easily in routine clinical practice, it may provide clinically useful information for postoperative surveillance and management.