OncologyPredictors of Symptomatic Lymphocele After Lymph Node Excision and Radical Prostatectomy
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
References (18)
- et al.
Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis
J Urol
(2002) - et al.
Critical assessment of ideal nodal yield at pelvic lymphadenectomy to accurately diagnose prostate cancer nodal metastasis in patients undergoing radical retropubic prostatectomy
Urology
(2007) - et al.
Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer
Urology
(2006) - et al.
Intraoperative and perioperative morbidity of contemporary radical retropubic prostatectomy in a consecutive series of 1243 patients: results of a single center between 1999 and 2002
Eur Urol
(2003) - et al.
Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer
Eur Urol
(2006) - et al.
Is a limited lymph node dissection an adequate staging procedure for prostate cancer?
J Urol
(2002) - et al.
Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer
J Urol
(2004) - et al.
Prophylactic mini-dose heparin in patients undergoing radical retropubic prostatectomy: a prospective trial
Urology
(1992) - et al.
Is heparin contraindicated in pelvic lymphadenectomy and radical prostatectomy?
J Urol
(1997)
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