Early drainage removal in the management of lymphatic leakage after robotic pelvic lymph node dissection

Abstract

BackgroundRadical prostatectomy (RP) and radical cystectomy (RC) with concurrent pelvic lymph node dissection (PLND) are considered as the curative surgical treatment options for localized prostate cancer (PC) or muscle‐invasive bladder cancer (BC). Regarding lymphatic leakage management after PLND, there is no standard of care, with different therapeutic approaches having been reported with varying success rates.MethodsSeventy patients underwent pelvic lymphadenectomy during robotic RP and RC with postoperative pelvic drainage volume more than 50 mL/day before the removal of drainage tube, were retrospectively evaluated in this study between August 2015 and June 2023. If the pelvic drainage volume on postoperative Day 2 was more than 50 mL/day, a drainage fluid creatinine was routinely tested to rule out urine leakage. We removed the drainage if the patient had no significant abdominal free fluid collection, no abdominal distension or pain, no fever, and no abdominal tenderness. After 1‐day observation of the vital signs and abdominal symptoms, the patient was discharged and followed‐up in clinic for 2 weeks after surgery.ResultsForty‐one cases underwent the early drainage removal even if the pelvic drainage volume was more than 50 mL/day. Among these forty‐one cases, twenty‐five drainage tubes were removed when drainage volume was more than 100 mL/day. All the forty‐one cases with pelvic drainage volume greater than 50 mL/day were successfully managed with the early drainage removal. No paracentesis or drainage placement was required. No re‐admission occured during the follow‐up period.ConclusionIt is safe to manage the high‐volume pelvic lymphatic leakage by early clamping of the drainage tube, ultrasonography assessment of no significant residual fluid in the abdominal and pelvic cavity, and then the early removal of the drainage tube.