The incidence and sequela of lymphocele formation after robot‐assisted extended pelvic lymph node dissection

Abstract

ObjectiveTo determine an accurate incidence of lymphocele formation and its sequela after robot-assisted radical prostatectomy (RARP) and extended lymph node dissection (eLND) in a contemporary prostate cancer cohort. Patients and MethodConsecutive patients who underwent RARP and eLND and had a minimum follow-up of 3 months were included. All surgeries were performed by one surgeon via a transperitoneal approach, with patients uniformly receiving low-molecular-weight heparin. Patients were followed with serial ultrasonography (US) based on a predetermined schedule for lymphocele surveillance. Incidence and sequelae of lymphoceles were retrospectively assessed. ResultsIn all, 521 patients were analysed. The mean (SD) follow-up was 33.5 (22.8) months. Lymphocele developed in 9% and became symptomatic in 2.5%. All except one were detected at the 1-month postoperative US; however, 76% regressed by the 3-month US. If lymphocele persisted at 3 months, 64% developed symptoms associated with infection and required drainage. Having diabetes mellitus was significantly associated with a higher risk of developing an infected lymphocele. Other symptoms related to lymphocele were rare. Comparisons of patient characteristics between patients with and without lymphoceles did not show any significant prognostic indicators to predict the occurrence of lymphocele in neither univariate nor multivariate analysis in the present cohort. ConclusionThe incidence of symptomatic lymphocele after transperitoneal RARP and eLND is rare. However, during follow-up, US imaging at 3 months after surgery appears advisable. If a lymphocele is detected at the 3-month followup US discussing percutaneous external drainage with the patient appears to be wise, as it may prevent the development of a symptomatic lymphocele in two-thirds of such patients.

Incidence of and risk factors for lymphocele formation after lateral pelvic lymph node dissection for rectal cancer: a retrospective study

“…Pelvic lymphocele is typically found incidentally during routine CT follow-up after surgery; however, it is sometimes symptomatic, requiring treatment [9][10][11]21]. In gynaecology and urology, several studies have shown that pelvic lymphocele is one of the most common complications after pelvic lymphadenectomy [12,13,22,23]. There have been many studies reporting complications associated with LPND following rectal cancer surgery [24][25][26][27][28][29][30].…”

“…In gynaecological studies, the incidence of all lymphoceles and symptomatic lymphoceles has been reported to be 18-38% and 3.4-24.6%, respectively [9,13,14,[33][34][35]. In urology, these rates have been reported to be 8.8-26% and 3.9-9%, respectively [15,16,23,36]. In our study, the incidence of all lymphoceles and symptomatic lymphoceles was 30.6% and 9.2%, respectively, indicating that it is not a rare complication after rectal cancer surgery.…”

Delayed Infection of a Lymphocele following RARP in a Patient with Nonspecific Symptoms

“…Keskin et al [5] reported a quite high incidence of lymphoceles within 1 month after RARP when performing US follow-up after RARP; most of the lymphoceles (76%) had disappeared by 3 months. However, a significant number (64%) of the lymphoceles that did persist over 3 months after RARP became symptomatic.…”

Early recovery program in the radical surgical treatment of patients with prostate cancer: Experience of the specialized hospital

“…Наш опыт показывает, что длительная лимфорея и лимфокисты являются одними из причин увеличения сроков гос-питализации. При этом, по данным недавней работы M. S. Keskin и соавт., симптоматическое лимфоцеле развивается только в 2,5 % случаев после минимально инвазивной РПЭ, а необходимость дренирования воз-никает только в 1,3 % всех вмешательств [31]. Наши результаты продемонстрировали отсутствие различий в частоте отсроченного дренирования таза по поводу лимфокист между группами пациентов, которым интра операционно страховой дренаж устанавливали или нет.…”