Clinical Importance of a Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review and Meta-Analysis
- 10 February 2021
- journal article
- review article
- Published by S. Karger AG in Urologia Internationalis
- Vol. 106 (1), 28-34
- https://doi.org/10.1159/000512960
Abstract
Background: Robot-assisted radical prostatectomy (RARP) including pelvic lymph node dissection (PLND) is the current state of the art in surgical therapy of localized prostate cancer with intermediate or high risk. PLND in particular is associated with morbidity inherent to this method; the rate of symptomatic lymphoceles (sLCs), for example, ranges up to 10%. Objective: Various intraoperative modifications have been developed with the aim of reducing the sLC rate. Based on current studies, a peritoneal interposition flap (PIF) appears to be one of the most effective methods for this purpose. Under the criteria of a systematic review, 5 retrospective studies have been identified until now, 4 of which showed a positive effect of PIF on the sLC rate. Results and Limitations: A total of 1,308 patients were included in the aggregated analysis of these 5 studies. The amount of sLCs was 1.3% (8/604) and 5.7% (40/704) in the PIF and standard groups, respectively (p < 0.001). The resulting odds ratio (OR) was 0.23 (95% confidence interval [CI]: 0.05–0.99), taking into account a noteworthy heterogeneity of the 5 studies (Q = 9.47, p = 0.05; I2 = 58%). In addition, a prospective randomized and blinded study (Pianoforte trial) with corresponding sLC rates of 8.3% (9/108) versus 9.7% (12/124) (p = 0.820) exists. In this study, the OR was 0.85 (95% CI: 0.34–2.10, p = 0.722). Conclusion: Despite positive results from retrospective studies with indirect evidence, the role of the PIF in the reduction of sLC in RARP could not be conclusively assessed yet. The results of the first prospective randomized study do not show a positive effect of PIF, declaring a research gap for further studies with direct evidence.Keywords
This publication has 19 references indexed in Scilit:
- Can we predict who will need lymphocele drainage following robot assisted laparoscopic prostatectomy (RALP)?Journal of Robotic Surgery, 2019
- Impact of Surgical Approach on Patient-Reported Outcomes after Radical Prostatectomy: A Propensity Score-Weighted Analysis from a Multicenter, Prospective, Observational Study (The Pros-IT CNR Study)Urologia Internationalis, 2019
- Four-point Peritoneal Flap Fixation in Preventing Lymphocele Formation Following Radical ProstatectomyEuropean Urology Oncology, 2018
- Critical appraisal of nonrandomized studies—A review of recommended and commonly used toolsJournal of Evaluation in Clinical Practice, 2018
- P.L.E.A.T.—Preventing Lymphocele Ensuring Absorption Transperitoneally: A Robotic TechniqueUrology, 2017
- Prospective Randomized Trial Comparing Titanium Clips to Bipolar Coagulation in Sealing Lymphatic Vessels During Pelvic Lymph Node Dissection at the Time of Robot-assisted Radical ProstatectomyEuropean Urology, 2017
- The incidence and sequela of lymphocele formation after robot‐assisted extended pelvic lymph node dissectionBJU International, 2016
- Novel Technique Prevents Lymphoceles After Transperitoneal Robotic-assisted Pelvic Lymph Node Dissection: Peritoneal Flap InterpositionUrology, 2015
- Pelvic Lymph Node Dissection During Robot-assisted Radical Prostatectomy: Efficacy, Limitations, and Complications—A Systematic Review of the LiteratureEuropean Urology, 2013