Can we predict who will need lymphocele drainage following robot assisted laparoscopic prostatectomy (RALP)?

Bhat, Kulthe Ramesh Seetharam; Önol, Fikret Fatih; Rogers, T.; Moschovas, Marcio Covas; Jenson, Cathy; Rocco, B.; Patel, V.

doi:10.1016/s1569-9056(19)32713-7

Cited by 4 publications

(4 citation statements)

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“…Correspondingly, our data showed that patients who did not receive PLND were significantly less likely to develop SLC (P<0.001). As additional risk factors for SLC formation previous studies listed patients' age, BMI and the number of LNs removed (8,13,19). Our study, however, showed patients' BMI and their postoperative Gleason score to be the only statistically significant risk factors for SLC, with patients with high BMI (P<0.001) and patients with a high postoperative Gleason score (P=0.017) being more likely to experience SLC.…”

Section: Discussioncontrasting

confidence: 58%

Epidemiology and therapy of symptomatic lymphoceles after robot-assisted radical prostatectomy (RARP)

Goßler¹,

Hillinger²,

Burger³

et al. 2021

Transl Androl Urol

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Background: Lymphoceles are a common postoperative complication after radical prostatectomy with pelvic lymphadenectomy. Therapeutic options include cannulation and drainage (CD), drainage and instillation (DI), or laparoscopic fenestration (LF). The aim of this study was to investigate the epidemiology of symptomatic lymphoceles (SLC) and evaluate the treatment options. Methods:We retrospectively analysed all patients who underwent robot-assisted radical prostatectomy (RARP) at our clinic from January 1, 2014 to December 31, 2018. All documented lymphoceles of these patients were recorded and analysed with regard to symptoms, possible infection and the treatment option (or options) chosen.Results: We were able to include all 1,029 patients who underwent RARP in the aforementioned period of time. Of these, 18.1% were diagnosed with a lymphocele either when discharged or when readmitted and 6.9% experienced an SLC requiring treatment. Thirteen-point-seven percent of patients readmitted with SLC showed an accompanying thrombosis. Due to recurring or bilateral SLCs receiving different treatment options for each side, there was a total of 115 SLCs treated. CD was carried out in 102 cases. Twenty-pointsix percent of patients were sufficiently treated this way, the rest required further treatment or experienced recurrences not requiring further treatment. DI was carried out in 56 cases. Of those patients, 46.4% were sufficiently treated. LF was carried out in 54 cases (either after CD, or after DI, or primarily). Of those patients, 98.1% were treated sufficiently. LF had a statistically significant higher success rate compared to CD and DI (P<0.001 respectively). Conclusions:The study confirmed the significance of SLC as a common complication after RARP. LF turned out to be the most effective treatment option for SLC, while CD as well as DI have not been proven effective.

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Section: Discussioncontrasting

confidence: 58%

Epidemiology and therapy of symptomatic lymphoceles after robot-assisted radical prostatectomy (RARP)

Goßler¹,

Hillinger²,

Burger³

et al. 2021

Transl Androl Urol

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“…We also found that lymph node dissection was the only signi cant independent predictor of postoperative asymptomatic lymphocele development. Previous reports have shown that lymphocele incidence increases after extended pelvic lymph node dissection and with the number of lymph nodes removed (20)(21)(22)(23)(24). Although PDs are placed to prevent lymphoceles, their absence did not predict asymptomatic lymphocele development two weeks after surgery in this study.…”

Section: Discussioncontrasting

confidence: 62%

Examination of necessity for pelvic drain placement after robot-assisted radical prostatectomy

Iwamoto

Kadono

Yaegashi

et al. 2021

Preprint

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PurposeRadical prostatectomy is the gold standard treatment for clinically localised prostate cancer. Pelvic drain (PD) placement is commonly performed after RARP to prevent the formation of urinary cysts, pelvic hematomas and lymphoceles that would require further treatment. RARP has been reported to have few perioperative complications, and the need for PD placement is not clear. This study aimed to assess the need for PD placement after robot-assisted radical prostatectomy (RARP). MethodThis retrospective uncontrolled before-after study analysed the effect of PD placement on postoperative complications in patients who underwent RARP between May 2009 and April 2018.ResultsAll patients prior to October 1, 2016 had a PD placed; those after did not. Of the 308 study patients, 231 received a PD (PD group) and 77 did not (ND group). The incidence of ileus, urinary tract infection and anastomotic leak did not differ significantly between the groups; nor did the incidence of asymptomatic and symptomatic lymphocele at 2 weeks and 1 year after surgery. Multivariate analysis showed that lymph node dissection is a predictor of asymptomatic lymphocele development two weeks after surgery.ConclusionPD placement is not necessary after RARP. Future large-scale studies are required to identify patients that would benefit from PD placement.

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“…Still, some patients develop symptomatic lymphoceles (see above), requiring surgical intervention. Rates of symptomatic lymphoceles after PLND reported in the current literature vary from 0% to 16% (16,27,28). Thus, many preventive approaches have been proposed in the past (14,(29)(30)(31)(32).…”

Section: Discussionmentioning

confidence: 98%

Peritoneal Flap in Robot-Assisted Radical Prostatectomy

Bründl¹,

Lenart²,

Stojanoski³

et al. 2020

Deutsches Ärzteblatt International

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ith almost 61 000 new cases per year, prostate cancer (PCa) is the most common male cancer in Germany (1, 2). Of the potentially curative treatment options, radical prostatectomy with concomitant pelvic lymph node dissection (PLND) is the most commonly chosen surgical procedure (3-5). On the one hand, PLND remains the most accurate staging procedure for the detection of lymphatic metastasis and, on the other hand, the decision on which consecutive treatment should SummaryBackground: Lymphocele is the most common complication arising after pelvic lymph node dissection (PLND) in the setting of robot-assisted radical prostatectomy (RARP). The only data available until now on the utility of a peritoneal flap to prevent lymphocele were retrospectively acquired.Methods: A randomized, controlled, multi-center trial with blinded assessment of endpoints was carried out on 232 patients with prostate cancer who underwent RARP with PLND. The patients in the intervention group were given a peritoneal flap; in the control group, surgery was performed without this modification. The two joint primary endpoints were the rates of symptomatic lymphocele during the same hospitalization as the operative procedure (iT1) and within 90 days of surgery (iT2). The secondary endpoints were lymphocele volume, the need for treatment of lymphocele, complications requiring an intervention, and the degree of postoperative stress incontinence. German Clinical Trials Register number: DRKS00011115.Results: The data were evaluated in an intention-to-treat analysis, which, in this trial, was identical to an as-treated analysis. 108 patients (46.6%) were allotted to the intervention group. There were no statistically significant intergroup differences with respect to any clinical or histopathological criteria. A median of 16 lymph nodes were removed (interquartile range, 11-21). A symptomatic lymphocele arose in 1.3% (iT1) and 9.1% (iT2) of the patients, without any statistically significant difference between the two trial groups (p = 0.599 and p = 0.820, respectively). Nor did the groups differ significantly with respect to lymphocele volume (p = 0.670 on hospital discharge [T1], p = 0.650 90 days after surgery [T2]) or the type and frequency of need for subsequent surgical intervention (p = 0.535; iT2). 81.5% of all patients (n = 189) had no complications at all in the first three months after surgery. Nor were there any intergroup differences at 90 days with respect to the degree of stress urinary incontinence (p = 0.306) or complications (p = 0.486).Conclusion: A peritoneal flap after RARP was not found to influence the rate of postoperative lymphocele, whether asymptomatic or requiring treatment.

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Can we predict who will need lymphocele drainage following robot assisted laparoscopic prostatectomy (RALP)?

Cited by 4 publications

References 0 publications

Epidemiology and therapy of symptomatic lymphoceles after robot-assisted radical prostatectomy (RARP)

Epidemiology and therapy of symptomatic lymphoceles after robot-assisted radical prostatectomy (RARP)

Examination of necessity for pelvic drain placement after robot-assisted radical prostatectomy

Peritoneal Flap in Robot-Assisted Radical Prostatectomy

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