High BMI, Aggressive Tumours and Long Console Time Are Independent Predictive Factors for Symptomatic Lymphocele Formation after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection

Abstract

<b><i>Introduction:</i></b> Lymphocele (LC) formation is a common complication which may cause severe symptoms after robot-assisted radical prostatovesiculectomy (RARP) with concomitant pelvic lymph node dissection (PLND). Compared to open radical prostatectomy, the amount of data on potential risk factors for LC formation is still limited. The aim of the present study was to identify risk factors for symptomatic LC formation (sLC) after RARP with PLND. <b><i>Methods:</i></b> We used the data of a prospective multicentre series of 232 RARP patients which were treated between March 2017 and December 2017. The primary endpoint was the presence of sLC within 90 days. Asymptomatic LC (aLC) formation was also recorded. We evaluated clinical, perioperative, and histopathological criteria and compared their distribution in patients with and without post-operative sLC. Uni- and multivariable logistic regression analyses (MVAs) were performed to identify potential predictors for LC formation. Regarding the influence of patients’ BMI, 2 models were calculated: BMI continuously (model 1) and BMI dichotomized with cut-off 30 kg/m<sup>2</sup> (WHO definition, model 2). <b><i>Results:</i></b> Post-operative sLC was present in 21 patients (9.1%), while aLC was detected in 49 patients (21.1%) 90 days after RARP with PLND. Patients with sLC showed higher median baseline PSA levels (9.8 vs. 8.1 ng/mL), higher prevalence of obesity (BMI >30; 42.9 vs. 19.9%), and longer median console time (180 vs. 165 min) compared to patients without sLC. On MVA higher BMI {model 1: OR 1.145 (confidence interval [CI] 1.025–1.278); model 2: OR 2.761 (1.045–7.296)}, longer console time (model 1: OR 1.013 [1.005–1.021]; model 2: OR 1.013 [1.005–1.020]) and an ISUP grade ≥3 (model 1: OR 3.247 [1.182–8.917]; model 2: OR 2.791 [1.050–7.423]) were identified as independent predictors for sLC development. <b><i>Conclusion:</i></b> Patients with aggressive tumours and higher BMI should be informed about a potentially increased risk for sLC formation. In case of a long console time, a close and regular follow-up should be considered to check for LC development.

Percutaneous sclerotherapy with OK-432 for lymphocele after pelvic or para-aortic lymphadenectomy: preliminary results

“…The mean initial lymphocele size was 616 (range, 76–3295) mL. The mean drainage duration after sclerotherapy was 7.1 (Karcaaltincaba & Akhan, 2005a ; vanSonnenberg et al, 1986 ; Goßler et al, 2021 ; Heers et al, 2015 ; Zikan et al, 2015 ; Dodd et al, 1970 ; Ten Hove et al, 2021 ; Jensen et al, 1986 ; Karcaaltincaba & Akhan, 2005b ; Addo et al, 2018 ; Baek et al, 2016 ; Gill et al, 1995 ; Alago et al, 2013 ; Akhan et al, 2007 ; Chin et al, 2007 ; Filippiadis et al, 2017 ; Sacks et al, 2003 ; Kasahara et al, 2006 ; Ono et al, 2010 ; Takeda et al, 2006 ) days. Pearson’s correlation coefficient showed moderately negative correlation ( r = − 0.414) between the initial lymphocele size and drainage duration after sclerotherapy, but the association was not statistically significant ( p = 0.113) (Fig.…”

“…Lymphoceles can cause hydronephrosis, infection, abdominal pain, leg edema, and deep venous thrombosis (Karcaaltincaba & Akhan, 2005a ; vanSonnenberg et al, 1986 ). The incidence rate of symptomatic lymphoceles ranges from 2% to 9%, depending on the type of surgery (Goßler et al, 2021 ; Heers et al, 2015 ; Zikan et al, 2015 ). Asymptomatic lymphoceles resolve spontaneously without treatment (Dodd et al, 1970 ); however, symptomatic lymphoceles might require treatment.…”

Development and validation of novel nomogram to identify the candidates for extended pelvic lymph node dissection for prostate cancer patients in the robotic era

“…[1][2][3] However, some research reported perioperative adverse events associated with ePLND such as longer operation time, higher blood loss, longer hospital stays, and lymphocele. [4][5][6] Recent metaanalysis showed the incidence of perioperative complications in ePLND was significantly higher than in limited PLND (14.4% vs. 10.8%), with risk ratio of 1.61. 7 Also, previous report from Japan showed that ePLND is associated with significantly higher rate of grade 3-4 complications compared with limited PLND (4.4% vs. 1.7%).…”

“…Despite the controversial therapeutic effect of ePLND, the importance of diagnosing cancer stage to accurately identify pelvic lymph node invasion and consider further consecutive treatment options after surgery is considered in treatment guidelines 1–3 . However, some research reported perioperative adverse events associated with ePLND such as longer operation time, higher blood loss, longer hospital stays, and lymphocele 4–6 . Recent meta‐analysis showed the incidence of perioperative complications in ePLND was significantly higher than in limited PLND (14.4% vs. 10.8%), with risk ratio of 1.61 7 .…”

Percutaneous Sclerotherapy with OK-432 for Lymphocele after Pelvic or Para-aortic Lymphadenectomy: Preliminary Results

“…Lymphoceles can cause hydronephrosis, infection, abdominal pain, leg edema, and deep venous thrombosis (1,2). The incidence rate of symptomatic lymphoceles ranges from 2-9%, depending on the type of surgery (3)(4)(5). Asymptomatic lymphoceles resolve spontaneously without treatment (6); however, symptomatic lymphoceles require treatment.…”