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The incidence and sequela of lymphocele formation after robot‐assisted extended pelvic lymph node dissection
Author(s) -
Keskin Mehmet Selcuk,
Argun Ömer Burak,
Öbek Can,
Tufek Ilter,
Tuna Mustafa Bilal,
Mourmouris Panogiotis,
Erdoğan Sarper,
Kural Ali Rıza
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13425
Subject(s) - lymphocele , medicine , sequela , surgery , lymph node , dissection (medical) , lymphadenectomy , incidence (geometry) , complication , physics , optics
Objective To 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 Method Consecutive 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. Results In 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. Conclusion The 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 follow‐up 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.