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

Abstract

To reveal an accurate incidence of lymphocele formation and its sequela following robot-assisted radical prostatectomy and extended lymph node dissection (eLND) in a contemporary prostate cancer cohort.Consecutive patients who underwent radical prostatectomy and eLND with robot-assistance and had a minimum follow-up of 3 months were included. All surgeries were performed by one surgeon through a transperitoneal approach, with patients uniformly receiving low molecular weight heparin. Patients were followed with serial ultrasound imagings based on a predetermined schedule for lymphocele surveillance. Incidence and sequela of lymphoceles were retrospectively assessed.A total of 521 patients were analyzed. Follow-up after surgery was 33.5 ± 22.8 months. Lymphocele developed in 9% and became symptomatic in 2.5%. All except one were detected on 1(st) month imaging; however, 76% regressed at 3-month ultrasound. 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 infected lymphocele. Other symptoms related to lymphocele were rare. Comparisons of patient characteristics between patients with and without lymphoceles did not demonstrate any significant prognostic indicators to predict the occurrence of lymphocele in neither univariate nor multivariate analysis in the present cohort.The incidence of symptomatic lymphocele after robot-assisted transperitoneal radical prostatectomy and eLND is rare. Obtaining an US imaging at 3 months after surgery seems feasible. Once a lymphocele is detected on 3 monthly US, discussing percutaneous external drainage with the patient appears to be wise, since it may prevent the development of symptomatic lymphocele in 2/3 of the patients. This article is protected by copyright. All rights reserved.