Frequency and Consequences of Lymphocele Formation After Extended Lymphdissection in Patients Undergoing Open Retropubic Prostatectomy

Abstract

It is known that any surgery can lead to the risk of development of the late postoperative complication – lymphocele, which can occur in a period from about 2 weeks to 6 months after surgery. The objective: to analyze the frequency of lymphocele formation and its outcomes after open retropubic prostatectomy (ORP) and extended lymph node dissection (ELND) in patients with localized prostate cancer (PC). Materials and methods. The study included patients after ORP and ELND who were observed after operation for a period more than 6 months. All operations were performed by the retropubic extraperitoneal access by one surgeon. All patients received low molecular weight heparins to prevent thromboembolic complications. In the postoperative period, patients had control ultrasound examination (USE), the frequency and outcomes of lymphocele were studied retrospectively. If the results of USE were normal, no imaging study was performed for the next 6 months. Results. The results of treatment of patients with localized PC were analyzed. The mean observe period was 16.2 months. Lymphocele developed in 4% of cases and was symptomatic in 1.5 % of men. In all patients, lymphocele was detected within 1 month after surgery. In 74% of cases, lymphocele regressed within 3 months after surgery according to results of USE. In 64% of patients with lymphocele more 3 months the symptoms associated with cystic infection that required adequate drainage developed. Patients with diabetes had a higher risk of infected lymphocele development. Other symptoms which were associated with lymphocele have been found rarely. Comparison of preoperative characteristics of the patients with and without lymphocele did not demonstrate reliable prognostic indicators of possible lymphocele formation in a retrospective analysis of these persons. Conclusions. The risk of the development of symptomatic lymphocele after open retropubic prostatectomy and extended lymph node dissection is quite rare. However, ultrasound examination for 3 months after surgery is considered appropriate. It is recommended to perform the percutaneous drainage of the pathological cavity under ultrasound control in case of the detection of symptomatic lymphocele, because this procedure is safe and effective.