PD43-01 RESULTS OF TWO RANDOMIZED TRIALS FOR THE PREVENTION OF LYMPHOCELES AFTER ROBOTIC PELVIC LYMPH NODE DISSECTION FOR PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2016PD43-01 RESULTS OF TWO RANDOMIZED TRIALS FOR THE PREVENTION OF LYMPHOCELES AFTER ROBOTIC PELVIC LYMPH NODE DISSECTION FOR PROSTATE CANCER Sean Henderson, Daniel Gilbert, Janice Rosenthal, Ronney Abaza, and Jatin Gupta Sean HendersonSean Henderson More articles by this author , Daniel GilbertDaniel Gilbert More articles by this author , Janice RosenthalJanice Rosenthal More articles by this author , Ronney AbazaRonney Abaza More articles by this author , and Jatin GuptaJatin Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1779AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lymphoceles (LC) occur in up to 30-50% of patients after pelvic lymph node dissection (PLND) for prostate cancer. Most are asymptomatic and go undetected as imaging after prostatectomy is infrequent, but serious infections can occur even months later. We performed 2 randomized studies to determine whether LC can be prevented with imaging of all patients to detect even silent LC. One trial involved a hemostatic agent (Arista®AH), and a second trial involved use of advanced electrosurgical bipolar energy (da Vinci® EndoWrist® One Vessel Sealer®). METHODS Patients undergoing robotic prostatectomy with PLND were enrolled into one of two studies with IRB approval. Each patient served as their own internal control with one PLND side randomly chosen for intervention. In study 1, Arista was placed over the field of PLND on one side randomized to treatment only after bilateral PLND was completed. In study 2, PLND was randomly performed in standard fashion using clips and standard instruments while the other side was performed with the Vessel Sealer instead of clips. All patients underwent screening CT scan 3 mos later with radiologists blinded to interventions. A significant LC was defined as a fluid collection ≥3cm in any plane. RESULTS No symptomatic lymphoceles occurred in either study. Of 100 patients enrolled in the Arista trial, 88 completed the study. Only 14 screening-detected LCs occurred with all unilateral (16% of patients or 8% of 176 PLND sides). Five occurred on the side where Arista was used vs 9 on untreated sides (5.7% vs 10.2%, p=0.248). There was no statistically significant difference in LC size (mean 4.6cm) between treated and untreated sides (p=0.44). Of 120 patients enrolled in the Vessel Sealer trial, 114 completed the study. LCs were identified in 21 patients (18%), one of which was bilateral (9% of 240 sides). Ten occurred on the Vessel Sealer side vs 12 on the standard side (8.8% vs 10.5%, p=0.41) with no difference in LC size (4.3cm vs 3.6cm, p=0.35). Operative time was the same for standard PLND vs Vessel Sealer (mean 11.3 vs 11.1min, p=0.62). CONCLUSIONS No difference in screening-detected LCs was seen using a hemostatic agent or an advanced bipolar energy device. This may guide surgeons on their use given the costs. The unusually low baseline LC rate compared with the literature underpowered the study and precluded statistical significance in the hemostat trial despite almost 50% LC reduction such that a larger study may be warranted. Also, while advanced energy did not reduce LCs, it was equally efficacious and efficient as use of clips. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e992-e993 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sean Henderson More articles by this author Daniel Gilbert More articles by this author Janice Rosenthal More articles by this author Ronney Abaza More articles by this author Jatin Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...