Incidence of and risk factors for lymphocele formation after lateral pelvic lymph node dissection for rectal cancer: a retrospective study

Ochiai, Kentaro; Kaneko, Manabu; Nozawa, Hiroaki; Kawai, Kazushige; Hata, Keisuke; Tanaka, Toshiaki; Nishikawa, Takeshi; Shuno, Yasutaka; Sasaki, Kazuhito; Hiyoshi, Masaya; Emoto, Shigenobu; Murono, Koji; Sonoda, Hirofumi; Ishihara, Soichiro

doi:10.1111/codi.14831

Cited by 16 publications

(7 citation statements)

References 38 publications

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“…Lymphocele sometimes causes severe complications when it compresses adjacent structures, including the urinary tract, vascular anatomy, or bowel. 15,16,27,28 Consistent with previous studies, 15 more than half of the patients (n = 18) in the present study were asymptomatic and diagnosed by routine follow-up CT scans. Among them, the lymphocele was spontaneously resolved in 13 patients and 5 patients still had the lymphocele at the last follow-up.…”

Section: Discussionsupporting

confidence: 92%

“…It usually develops within 3 to 8 weeks after surgery, but in some patients, it may occur 1 year after surgery. 15,16 The clinical manifestation is heterogeneous; in most patients, it was reported as clinically asymptomatic and was diagnosed during routine checkups. Lymphocele sometimes causes severe complications when it compresses adjacent structures, including the urinary tract, vascular anatomy, or bowel.…”

Section: Discussionmentioning

confidence: 99%

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Long-term Complications of Laparoscopic or Robotic Lateral Pelvic Node Dissection After Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Kim,

Choi,

Park

et al. 2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Rectal cancer patients who underwent lateral pelvic node dissection might be at higher risk of postoperative complications derived from technical complexity. However, little is known about the long-term complications after lateral pelvic node dissection. OBJECTIVES: To investigate the long-term complications of preoperative chemoradiotherapy, followed by total mesorectal excision with lateral pelvic node dissection for locally advanced rectal cancer. DESIGN: A retrospective analysis of a prospectively collected database. SETTINGS: This study was conducted in a tertiary cancer center. PATIENTS: Rectal cancer patients who underwent total mesorectal excision with lateral pelvic node dissection after preoperative chemoradiotherapy between 2011 and 2019 were analyzed. All operations were performed via a laparoscopic or robotic approach. MAIN OUTCOME MEASURES: Long-term complications were defined as adverse events that persisted or newly appeared ≥90 days after surgery and could be related to the surgery. RESULTS: A total of 164 patients underwent total mesorectal excision with lateral pelvic node dissection after preoperative chemoradiotherapy. Short- and long-term complication rates were 36.0% and 36.6%, respectively. Lymphocele was the most common long-term complication (17.7% of patients), and 11.6% had anastomotic leakage with chronic sinus. Of the patients with long-term complications, 20.7% of patients needed readmission for treatment. Of 29 patients with lymphocele, 13 (41.0%) experienced spontaneous absorption, and 11 (37.9%) required surgical or percutaneous catheter drainage or antibiotics use. Multivariate analysis showed pathologic pelvic node metastases (p = 0.008) and a higher number of unilateral harvested pelvic nodes (p = 0.001) were significantly associated with long-term complications. At the last follow-up (median duration of 43 months), 15.9% of patients had unresolved complications. LIMITATION: The retrospective design. CONCLUSIONS: Patients undergoing lateral pelvic node dissection experienced a higher frequency of long-term complications, but half of them had asymptomatic lymphoceles, most of which resolved spontaneously. However, further efforts should be paid to reduce anticipated complications related to lateral pelvic node dissection. See Video Abstract.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Long-term Complications of Laparoscopic or Robotic Lateral Pelvic Node Dissection After Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Kim,

Choi,

Park

et al. 2024

Diseases of the Colon &Amp; Rectum

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“…LLND was not a risk factor for chylous ascites in the current work, and despite many reports of lymphatic leakage after LLND, 26,27 few describe chylous ascites. One previous study demonstrated that triglycerides in the diet are absorbed into the lymphatic system as chylomicrons following conversion into monoglycerides and fatty acids in the small intestine.…”

Section: Discussioncontrasting

confidence: 49%

Incomplete lymphatic sealing around the inferior mesenteric artery is a risk factor for chylous ascites in robotic rectal cancer surgery

Ushigome

Takahashi

Maeda

et al. 2022

Asian J Endoscop Surgery

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Introduction Compared with laparoscopic surgery (LS), robotic surgery (RS) is considered to have acceptable outcomes in rectal cancer, but few reports have focused on chylous ascites in RS. The aim of this study was to investigate the incidence and etiology of chylous ascites after RS. Methods This retrospective study included 291 patients with rectal cancer who underwent RS (n = 165) or LS (n = 126) with high ligation of the inferior mesenteric artery (IMA). Propensity score matching (PSM) was performed to compare the two groups. Results \Dissection around the IMA was achieved using ultrasonic coagulating shears in most LS cases, and monopolar scissors in most RS cases, sometimes using bipolar vessel sealing device or bipolar forceps. The incidence of chylous ascites was 12.2% in RS and 4.1% in LS after PSM (P = .037). When limited to the RS group, multivariate analysis identified absence of lymphatic sealing at the left side of the IMA and shorter operative time as independent risk factors for chylous ascites. Except for duration of drain placement, no outcomes differed significantly with or without chylous ascites. One patient with chylous ascites developed later infection and required antibiotic treatment. Conclusion The incidence of chylous ascites is significantly higher in RS than in LS, and RS with incomplete lymphatic sealing around the IMA is a risk factor for chylous ascites in rectal cancer. Although outcomes for patients with chylous ascites were acceptable, adequate lymphatic sealing during dissection around the IMA is crucial to prevent chylous ascites in RS.

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“…63,78,79 Incidence of symptomatic lymphoceles was, however, correlated to the number of lymph nodes removed from patients with prostate cancer, which was also seen in patients with rectal cancer and gynecologic cancer undergoing pelvic lymph node dissection. 77,79,80 Factors associated with the development of lymphoceles in patients who underwent renal transplantation include the use of mammalian target of rapamycin (mTOR) inhibitors, laparoscopic procurement of graft, and the presence of more than one renal artery. 81…”

Section: Etiologymentioning

confidence: 99%

Chylous Ascites and Lymphoceles: Evaluation and Interventions

Santos

Moussa

2020

Semin intervent Radiol

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Kinmonth introduced lymphangiography in 1955 and it became an important tool in the diagnosis and treatment of malignant disease. The technique, based on bipedal approach, was difficult and time-consuming which limited its use in clinical practice. Cope is the father of percutaneous lymphatic interventions and he was the first person to access and intervene on the lymphatic system. After his initial work published on 1999, there has been an expansion of the lymphatic embolization techniques, particularly since the development of intranodal lymphangiography and advance lymphatic imaging. This article is focused on the evaluation and management of postoperative chylous ascites and lymphoceles. Their incidence is growing due to longer survival of cancer patients and more radical surgical approaches, leading to an increased morbidity and mortality in this patient population. Minimally invasive percutaneous lymphatic embolization is becoming a first-line therapy in patients with postoperative lymphatic leakage.

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Incidence of and risk factors for lymphocele formation after lateral pelvic lymph node dissection for rectal cancer: a retrospective study

Cited by 16 publications

References 38 publications

Long-term Complications of Laparoscopic or Robotic Lateral Pelvic Node Dissection After Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Long-term Complications of Laparoscopic or Robotic Lateral Pelvic Node Dissection After Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Incomplete lymphatic sealing around the inferior mesenteric artery is a risk factor for chylous ascites in robotic rectal cancer surgery

Chylous Ascites and Lymphoceles: Evaluation and Interventions

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