Effect of Autologous Fibrin Glue on Lymphatic Drainage and Lymphocele Formation in Extended Bilateral Pelvic Lymphadenectomy in Robot-Assisted Radical Prostatectomy.

Abstract

Introduction: Postoperative lymphatic drainage and lymphocele formation is a common seen complication after extended pelvic lymph node dissection (ePLND) in robot-assisted radical prostatectomy (RARP) operation. The aim of this study was to evaluate autologous fibrin glue as an additional treatment option to reduce the volume of lymphatic drainage and prevent lymphocele development. Materials and Methods: A total of 75 patients undergoing transperitoneal RARP with ePLND between January and July 2018 were enrolled in this study. Thirty-five patients who received autologous fibrin glue enrolled to study group, another 40 patients who did not receive to control group. Autologous fibrin glue was applied over the PLND areas. Age, body mass index (BMI), pathologic stages, and number of removed lymph nodes (LNs) were compared. The main endpoint was to compare postoperative lymphatic drainage volume and lymphocele formation rate between groups. Results: There was not statistically significant difference between the groups with respect to age, BMI, Gleason score, T-stage, and number of removed LNs. Autologous fibrin glue resulted in 50% (110 mL vs 210 mL; p = 0.037) and 75% reduction of postoperative drainage volume (70 mL vs 270 mL; p = < 0.0001) in study group than control group at postoperative 2nd and 3rd days, respectively. The total drainage volume was also 50% reduced in study group (277 mL vs 577 mL; p = 0.004). The incidence of asymptomatic lymphocele was 20% (n = 7) and 37.5% (n = 15) in study and control groups, respectively (p = 0.112). One patient in control group developed symptomatic lymphocele. There were no immediate or late adverse effects in study group. Conclusion: Autologous fibrin glue application reduced postoperative lymphatic drainage, and also lymphocele formation rate after extended PLND in RARP operation.