Elsevier

Urology

Volume 75, Issue 3, March 2010, Pages 630-635
Urology

Oncology
Predictors of Symptomatic Lymphocele After Lymph Node Excision and Radical Prostatectomy

https://doi.org/10.1016/j.urology.2009.03.011Get rights and content

Objectives

To identify the prognostic factors of symptomatic lymphocele.

Methods

From January 2004, 359 patients underwent pelvic lymph node excision during radical prostatectomy at our center, of whom, 347 were followed up for ≥6 months.

Results

At a median follow-up of 14.5 months (range 6-54), 44 patients had developed a lymphocele (12.6%). In 26 patients (7.4%), it was symptomatic and required treatment. On univariate analysis, lymphocele was associated with the extension of the lymph node dissection, the number of nodes retrieved, and the presence of nodal metastasis. Patient age, year of surgery, surgeon, anticoagulant or antiplatelet oral therapy before and after the period of low-molecular-weight heparin prophylaxis, American Society of Anesthesiologists score, use of neoadjuvant hormonal therapy, preoperative prostate-specific antigen value, Gleason score, and pathologic stage were not influential. After adjusting for covariates, logistic regression analysis revealed that only the number of nodes was significantly associated with the onset of a symptomatic lymphocele. The risk of lymphocele seemed to increase linearly with the number of nodes retrieved, and the incidence of positive nodes reached a plateau when >10-13 nodes were harvested.

Conclusions

The benefit of more extensive nodal excision during radical prostatectomy should be weighed against the increased risk of lymphocele and its sequelae, including reintervention. In our series, no other factor, including previous anticoagulant or antiplatelet therapy, neoadjuvant hormonal therapy, and surgeon experience, influenced the incidence of symptomatic lymphocele.

Section snippets

Material and Methods

The data from 438 patients who had undergone RP from January 2004 were collected. The patient characteristics, age, comorbidities, American Society of Anesthesiologists physical status classification system (ASA) score, tumor characteristics, preoperative prostate-specific antigen (PSA) value, pathologic tumor stage, biopsy and prostatectomy specimen Gleason score, and surgical data (operating surgeon, number of lymph nodes removed) were recorded and reviewed.

Of the 438 patients, 359 underwent

Results

The characteristics of the series and the possible association with ePLND are reported in Table 1. ePLND was associated with the high-volume surgeon (P.P.), who performed about 78% of the ePLNDs, the year of surgery, an increased incidence of nodal metastasis (11% vs 2%), and a greater occurrence of symptomatic lymphocele (9.6% vs 2%) compared with lPLND. The incidence of ≥1 positive lymph nodes from the obturator fossa was 2% (2/98) and 4% (10/249) in patients who underwent lPLND and ePLND,

Comment

Lymphocele is by far the most frequent complication related to pelvic lymphadenectomy. Although the incidence of any ultrasound- or radiographically detected lymphocele ranges from 27% to 61%,12, 13 only a few become symptomatic. The incidence reported in clinical studies has varied from 2% to 9.1%.1, 3, 7, 8, 9, 10, 11 Lymphocele development is a major problem for the patient when it leads to sequelae relevant to health. In addition to secondary infection, these mainly include thromboembolic

Conclusions

Lymphocele is by far the most common complication of PLND. In our experience, increasing the number of nodes retrieved led to a greater probability of finding nodal metastasis, although a plateau was reached when 10-13 nodes were harvested. However, the incidence of symptomatic lymphocele, followed in most cases by laparoscopic or open reintervention, increased linearly. The benefit of more accurate nodal staging and cure deriving from ePLND should therefore be weighed against the increased

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