Incidence of lymphoceles after robot‐assisted pelvic lymph node dissection

• Published in: BJU international Vol. 108; no. 7; pp. 1185 - 1189
• Main Authors: Orvieto, Marcelo A., Coelho, Rafael F., Chauhan, Sanket, Palmer, Kenneth J., Rocco, Bernardo, Patel, Vipul R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2011; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Dissection; Humans; Incidence; Lymph Node Excision - adverse effects; Lymph Node Excision - methods; Lymphatic Metastasis; Lymphatic system; lymphocele; Lymphocele - epidemiology; Lymphocele - etiology; lymphodeveatary complications; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Patients; pelvic lymph node; Pelvis; Prospective Studies; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Robotics; Nephrology; Cardiovascular disease; Epidemiology; Robotics; Urology; Lymphatic vessel disease; Incidence; Lymphocele; Lymphadenectomy; Pelvic ganglion; Treatment; Telemedicine; Surgery; Complication; pelvic lymph node; lymphodeveatary complications
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10094.x

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Lymphocele formation after open pelvic lymph‐node dissection is a known complication. However, reported incidences using the robotic approach are unclear and likely underestimated. The present study aims to better understand the true incidence of lymphocele formation after RARP. OBJECTIVE • To determine the incidence and predictive factors of lymphocele formation in patients undergoing pelvic lymph node dissection (PLND) during robot‐assisted radical prostatectomy (RARP). PATIENTS AND METHODS • Between April and December 2008, 76 patients underwent PLND during RARP for ≥cT2c, prostate‐specific antigen level ≥10, Gleason score ≥7 prostate cancer. • All patients were prospectively followed up with pelvic computed tomography 6–12 weeks after the procedure. • All patients received s.c. heparin preoperatively and postoperatively. PLND was limited to zones 1 and 2 as defined by Studer. • Plasma‐kinetic bipolar forceps were used for haemostasis during PLND. RESULTS • At a mean follow‐up of 10.8 weeks, 51% (39/76) of patients had developed a lymphocele. Of these 39 lymphoceles 32 (82%) were unilateral and seven (18%) were bilateral. • The mean (range) lymphocele size was 4.3 × 3.2 (1.5–12.3) cm; 41% of lymphoceles were <4 cm, 53.9% were 4–10 cm, and 5.1% were >10 cm in diameter. Six of the 39 lymphoceles (15.4%) were clinically symptomatic. The symptoms were as follows: pelvic pressure in five patients, abdominal distension with ileus in three patients, leg pain/weakness in one patient and costovertebral tenderness in one patient. Two lymphoceles required intervention. • On the logistic regression model the presence of nodal metastases, tumour volume in the prostate specimen and extracapsular extension (ECE) were independent risk factors for the development of a lymphocele. • There was no correlation between estimated blood loss, body mass index, pathological Gleason score or number nodes dissected and the presence of lymphocele. CONCLUSIONS • The incidence of lymphoceles was higher than anticipated given the believed protective effect of the transperitoneal approach against lymphocele formation. • The risk of lymphocele seemed to increase linearly with the presence of more extensive disease, particularly ECE and nodal involvement. • The benefit of PLND during RARP should be weighed against the elevated risk of lymphocele formation and its potential complications.