Occurrence Of Lymphoceles Research Articles

Primary Lymphovenous Anastomosis After Extended Soft Tissue Resection in the Medial Thigh for Reduction of Lymphocele and Lymphedema.

Postoperative chronic lymphocele and lymphedema represent severe burdens for soft tissue sarcoma patients who are already physically handicapped after an extensive surgery and a long recovery time. Incidences are high in the upper medial thigh. We have shifted our focus to lymphedema and lymphocele risk reduction with immediate lymphovenous anastomosis (LVA) after sarcoma resection. We performed immediate lymphatic reconstruction in 11 patients after soft tissue sarcoma resection in the upper medial thigh. The postoperative course was followed up closely, and postoperative occurrence of lymphocele and lymphedema was clinically assessed. A literature search outlining the latest clinical data, current treatment strategy landscape, and their application into clinical practice was added to the investigation. A total of 19 LVA and 2 lympho-lymphatic anastomoses were performed in 11 patients immediately after tumor resection in an end-to-end manner. We found a postoperative lymphedema rate of 36% and a postoperative lymphocele rate of 27%. Mean follow-up time was 17 months. Average tumor volume was 749 cc. Our literature search yielded 27 articles reporting on immediate LVA in cancer patients. Incidences of secondary lymphedema after LVA for lymphedema prevention vary between 0% and 31.1%. Lymphocele prevention with LVA is poorly studied in sarcoma patients. Immediate lymphatic reconstruction improved the overall postoperative course of our patients. The current literature does not serve with high-quality studies about primary LVA preventing lymphedema and lymphocele formation. We conclude that this technique should be seen as an additional concept to achieve overall better postoperative outcomes in these challenging surgical settings. We strongly recommend to either anastomose or ligate severed lymphatics under the microscope primarily after sarcoma resection in the upper medial thigh area.

Kidney transplantation after pelvic radiotherapy: Increased morbidity?

IntroductionThe impact of pelvic irradiation on kidney transplant surgery is still unclear. The main objective of our study is to evaluate the feasibility and the safety of renal transplantation following pelvic radiotherapy. MethodsWe collected characteristics and kidney transplant data from patients with a history of pelvic cancer treated with pelvic irradiation between 2005 and 2021. These data were collected via the prospective information system “Computerized Data Validated in Transplantation” (DIVAT) and medical records. We carried out a comparative study with a non-irradiated matched control group to compare the data of intraoperative surgeries, complications reported postoperatively as well as survival of the graft and the patient. Patients were matched on age, sex, side of graft implantation, and graft rank. ResultsTwenty-four patients were collected with an average age of 65, 18 patients were treated for prostatic adenocarcinoma, 4 for gynecological cancer and 2 testicular cancers. Twenty-one patients were treated by radiotherapy, 3 by brachytherapy. Eight patients had a target dose on the iliac lymph nodes. The comparative study showed a significant difference in operative difficulty (n=15 versus n=1, P<0.01), operative duration (190min versus 149min, P=0.005), occurrence of lymphocele (P=0.041). Urinary anastomosis surgical techniques were different, 83.3% of control patients had an uretero-vesical anastomosis against 58.3% of patients with a history of irradiation (P=0.057) and about 29% of irradiated patients had an uretero-ureteral anastomosis. There was no other significant difference in per and postoperative criteria or survival. DiscussionA history of pelvic irradiation significantly increases the technical complexity of kidney transplantation without impacting safety and kidney graft survival. A history of pelvic irradiation should not be a contraindication to kidney transplant. Level of evidence3.

Peritoneal Flap Following Lymph Node Dissection in Robotic Radical Prostatectomy: A Novel "Bunching" Technique.

Pelvic lymph node dissection (PLND) is recommended while performing robot-assisted radical prostatectomy (RARP) for patients with localized intermediate or high-risk prostate cancer. However, symptomatic lymphoceles can occur after surgery, adding significant morbidity to patients. Our objective is to describe a novel Peritoneal Bladder Flap Bunching technique (PBFB) to reduce the risk of clinically significant lymphoceles in patients undergoing RARP and PLND. We evaluated 2267 patients who underwent RARP with PLND, dividing them into two groups: Group 1, comprising 567 patients who had the peritoneal flap (PBFB), and Group 2, comprising 1700 patients without the flap; propensity score matching carried out at a 1:3 ratio. Variables analyzed included estimated blood loss (EBL), operative time, postoperative complications, lymphocele formation, and the development of symptomatic lymphocele. The two groups exhibited similar preoperative characteristics after matching. There was no statistically significant difference in the occurrence of lymphoceles between the flap group and the non-flap group, with rates of 24% and 20.9%, respectively (p = 0.14). However, none of the patients in the flap group (0%) developed symptomatic lymphoceles, whereas 2.2% of patients in the non-flap group experienced symptomatic lymphoceles (p = 0.01). We have demonstrated a modified technique for a peritoneal flap (PBFB) with the initial elimination of postoperative symptomatic lymphoceles and promising short-term outcomes.

Risk Factors and Short-Term Prognosis of Lymphocele After Kidney Transplant.

Lymphocele is a frequent complication after kidney transplant and needs attention. This study was undertaken to analyze perioperative risk factors and short-term outcomes associated with lymphocele after kidney transplant. Our single-center study retrospectively analyzed 264 recipients of kidney allografts from January 2018 to October 2021. Patients were classified into 2 groups according to the occurrence of lymphocele. Perioperative clinical data and follow-up indicators were compared between groups. The incidence of lymphocele after kidney transplant was 19.7%. Univariate analysis showed that percentage of male patients, hypothermic machine perfusion proportion, and postoperative hemoglobin and albumin were lower and flow velocity of renal artery was higher in the lymphocele group compared with the control group. Multivariate logistic regression revealed that postoperative hemoglobin <95 g/L (odds ratio = 2.01; 95% confidence interval, 1.01-4.05; P = .03) was an independent risk factor and hypothermic machine perfusion (odds ratio = 0.27; 95% confidence interval, 0.08-0.96; P = .04) was a protective factor for the determination of lymphocele. Comparisons of related complications indicated that drainage tube and urinary catheter removal times were longer and urinary tract infection and moderate to severe anemia proportions were higher in the lymphocele group. Follow-up data showed that postoperative 1-month serum creatinine was higher and 1-month estimated glomerular filtration rate was lower in lymphocele group compared with the control group, but no significant differences were shown at 12 months. Postoperative hemoglobin may be a risk factor and hypothermic machine perfusion may be a protective factor for lymphocele after kidney transplant. Lymphocele only temporarily affects short-term kidney function, especially during hospitalization.

Lymphocele in Kidney Transplantation: A Comparison of Ligation and Non-ligation Technique of Iliac Lymphatic Dissection

To compare the incidence of lymphocele in kidney recipients following 2 lymphatic vessel division techniques: ligation and non-ligation. Retrospective reviews of the records of 402 patients with end-stage renal disease who underwent kidney transplantation from April 2015 to December 2019 at Siriraj Hospital. Four hundred two patients were included in the study: 54.9% of the patients were male, and the patient's mean age was 41 years. There were 25.1% and 74.9% that received kidney grafts from living and deceased donors, respectively. The preoperative renal replacement therapies were 83.3% hemodialysis, 12.9% peritoneal dialysis, and 3.7% preemptive transplantation. Two hundred forty-nine patients received lymphatic division with the ligation technique and 153 patients received the non-ligation. Lymphoceles were found in 31 cases (7.7%). Lymphocele occurrence in the ligation group was lower than in the non-ligation group: 5.2% compared to 11.8% (P value=.017). There were 22.6% of lymphoceles that had a spontaneous resolution with no treatment. The ligation of iliac lymphatic vessels during division reduced the incidence of lymphoceles non-ligation.

Effect of Peritoneal Fixation (PerFix) on Lymphocele Formation in Robot-assisted Radical Prostatectomy with Pelvic Lymphadenectomy: Results of a Randomized Prospective Trial

BackgroundSymptomatic lymphoceles present the most common complication of robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (ePLND). No surgical technique has so far shown success in reducing the incidence rate, but several retrospective studies have shown the beneficial effect of the fixation of the peritoneum. ObjectiveTo introduce a modification in the technique of fixing the peritoneum to the pubic bone and to confirm whether this intervention reduces the incidence of lymphoceles. Design, setting, and participantsA prospective randomized (1:1) single-center one-sided blind study was conducted in patients with localized prostate cancer (cT1-2cN0M0) indicated for RARP with ePLND operated between December 2019 and June 2021. In the intervention group, the free flap of the peritoneum was fixed to the pubic bone. In the control group, the peritoneal flap was left free without fixation. Surgical procedureIn the intervention group, the free flap of the peritoneum was fixed to the pubic bone (PerFix) so that lateral holes were left, allowing drainage of lymph from the pelvis into the abdominal cavity, where it would be resorbed. The iliac vessels and obturator fossa remained uncovered by the peritoneum and the bladder. MeasurementsThe primary objective was to evaluate the frequency of symptomatic lymphoceles during follow-up. The secondary endpoints were the radiological presence of lymphoceles on computed tomography of the pelvis carried out 6 wk after surgery, the volume of the lymphoceles, and the degree of severe (Clavien-Dindo ≥3) complications. Results and limitationsOf the 260 randomized patients, 245 were evaluated in the final analysis—123 in the intervention and 122 in the control group. The median follow-up was 595 d. There were no differences between the groups regarding clinical and pathological variables. The median of 17 nodes removed was the same in both groups (p = 0.961). Symptomatic lymphoceles occurred in 17 patients (6.9%), while in the intervention group these were found in three (2.4%) versus 14 (11.5%) in the control group (p = 0.011). The number of radiologically detected asymptomatic lymphoceles did not differ (p = 0.095). There was no significant difference in lymphocele volume between the two groups (p = 0.118). The rate of serious complications (Clavien 3a and 3b) was 4.8% in the intervention group and 9.1% in the control group (p = 0.587). A multivariate logistic regression model of symptomatic lymphocele occurrence was created with significant factors: body mass index (odds ratio [OR] = 1.1, 95% confidence interval [CI] = [1.03, 1.26], p = 0.012) and intervention (OR = 4.6, 95% CI = [1.28, 16.82], p = 0.02). ConclusionsFixation of the peritoneum (PerFix) reduced the incidence of symptomatic lymphoceles in RARP with ePLND. We found no difference in the frequency of asymptomatic lymphocele development. The volume of the detected lymphoceles was similar. Patient summaryIn this study, we compared the rate of development of postoperative complications using the peritoneal fixation technique with that of a nonfixation control group for robot-assisted radical prostatectomy with extended pelvic lymphadenectomy. Fixation of the peritoneum should obviate the development of severe complications in the postoperative period.

Comparative Study to Evaluate the Effect of Using an Electro-Thermal Bipolar Sealing Device and Conventional Ligation on the Incidence of Post-Renal Transplant Lymphoceles in Recipients

Background: Lymphocele development is a well-established complication following kidney transplant. Some devices, such as electrothermal bipolar sealing devices, have been found to reduce lymphatic drain following kidney transplantation. The aim of the study: The purpose of the study is to compare the usage of conventional lymphatic ligation with the electrothermal bipolar sealing device and its influence on the formation of lymphoceles after kidney transplantation surgery. Patients and methods: A cohort retrospective and prospective study was conducted from May 2015 to November 2020 at the Basrah renal transplantation center in Al-Sader Teaching Hospital, Basrah. One hundred and thirty anonymized patients with end-stage renal diseases were involved in the present study. They were categorized into two groups: group 1 (conventional ligation group) with 70 patients and group 2 (electrothermal bipolar sealing device group) with 60 patients. The groups were compared and matched for possible risk factors. Patients were followed up for six weeks with full laboratory investigation (complet blood count, renal function tests, and liver function tests) and medical and surgical assessments. Statistical package of social siences version 25 was used for the statistical analysis of the data. Confidence intervals of 95% were applied as the dependent interval in statistics, and p-values &lt; 0.05 were considered significant. Results: The mean age of the patients was parallel for both conventional ligation and electrothermal bipolar sealing device groups (34.69 ± 10.28 vs. 33.68 ± 10.35). The operative time (155.57 ± 17.9 vs. 140.33 ± 17.07), lymphocele development (12 (17.1%) vs. 4 (6.7%)), lymphatic drainage volume (974.57 ± 178.39 vs. 493.83 ± 163.65), and the days of drainage (8.28 ± 3.3 vs. 4.6 ± 1.4) showed statistically significant differences between the conventional ligation technique and the electrothermal bipolar sealing device technique (p &lt; 0.05). Conclusion: The cautery of bipolar vessels is advantageous when compared to conventional ligation in kidney transplant lymphatic dissection, reducing the risk of lymphocele occurrence, in addition to its feasibility, safety, and easy performance

Lymphocele after anterior lumbar interbody fusion: a review of 1322 patients.

Anterior lumbar interbody fusion (ALIF) is an effective surgical modality for many lumbar degenerative pathologies, but a rare and infrequently reported complication is postoperative lymphocele. The goals of the present study were to review a large consecutive series of patients who underwent ALIF at a high-volume institution, estimate the rate of lymphocele occurrence after ALIF, and investigate the outcomes of patients who developed lymphocele after ALIF. A retrospective review of the electronic medical record was completed, identifying all patients (≥ 18 years old) who underwent at a minimum a single-level ALIF from 2012 through 2019. Postoperative spinal and abdominal images, as well as radiologist reports, were reviewed for mention of lymphocele. Clinical data were collected and reported. A total of 1322 patients underwent a minimum 1-level ALIF. Of these patients, 937 (70.9%) had either postoperative abdominal or lumbar spine images, and the resulting lymphocele incidence was 2.1% (20/937 patients). The mean ± SD age was 67 ± 10.9 years, and the male/female ratio was 1:1. Patients with lymphocele were significantly older than those without lymphocele (66.9 vs 58.9 years, p = 0.006). In addition, patients with lymphocele had a greater number of mean levels fused (2.5 vs 1.8, p < 0.001) and were more likely to have undergone ALIF at L2-4 (95.0% vs 66.4%, p = 0.007) than patients without lymphocele. On subsequent multivariate analysis, age (OR 1.07, 95% CI 1.01-1.12, p = 0.013), BMI (OR 1.10, 95% CI 1.01-1.18, p = 0.021), and number of levels fused (OR 1.82, 95% CI 1.05-3.14, p = 0.032) were independent prognosticators of postoperative lymphocele development. Patients with symptomatic lymphocele were successfully treated with either interventional radiology (IR) drainage and/or sclerosis therapy and achieved radiographic resolution. The mean ± SD length of hospital stay was 9.1 ± 5.2 days. Ten patients (50%) were postoperatively discharged to a rehabilitation center: 8 patients (40%) were discharged to home, 1 (5%) to a skilled nursing facility, and 1 (5%) to a long-term acute care facility. After ALIF, 2.1% of patients were diagnosed with radiographically identified postoperative lymphocele and had risk factors such as increased age, BMI, and number of levels fused. Most patients presented within 1 month postoperatively, and their clinical presentations included abdominal pain, abdominal distension, and/or wound complications. Of note, 25% of identified lymphoceles were discovered incidentally. Patients with symptomatic lymphocele were successfully treated with either IR drainage and/or sclerosis therapy and achieved radiographic resolution.

Efficacy of Lymphatic Sealing Using the LigaSure in Kidney Transplantation: A Pilot Study

Iliac vessel lymphatic ligation is critical in kidney transplantation, because it is associated with the occurrence of lymphocele. Lymphocele can also affect the renal graft. This study aimed to evaluate the efficacy of lymphatic sealing using LigaSure (an electrothermal bipolar sealing device) in kidney transplantation as compared with conventional silk-tie ligation. This retrospective study included 100 consecutive patients from a prospectively registered database who underwent kidney transplantation at Seoul St. Mary's Hospital, South Korea, between December 1, 2019 and November 12, 2020. Comorbidities, primary renal disease, transplantation variables, surgical variables, and posttransplantation outcomes were compared between conventional and LigaSure lymphatic ligations. Subgroup analyses were performed by anastomosis pattern. The mean age of patients was 47.4 ± 12.40 (range, 24-73) years. The LigaSure and conventional groups comprised 50 (50%) patients. Hypertension history, number of anastomosed renal arteries, and anastomosis patterns differed significantly between groups (P < .05). No significant difference was found in postoperative outcomes. In the subgroup analysis, greater drain volume was found at postoperative day 1 in the end-to-end internal iliac artery-renal artery anastomosis group (P=.001) because the internal iliac artery dissection results in longer lymphatic ligation. Nevertheless, no differences in drain removal time (P=.528) or lymphocele incidence were found between subgroups. LigaSure is expected to benefit from surgery time and will be identified in subsequent studies. LigaSure can be safely and comfortably used for iliac lymphatic ligation in kidney transplantation. In conclusion, LigaSure lymphatic ligation is superior to conventional lymphatic ligation in kidney transplantation.

Does intraoperative application of TachoSil reduce the number of lymphoceles after pelvic lymphadenectomy?

The degree of lymphoceles prevention was assessed using collagen patches coated with human coagulation factors (TachoSil, Nycomed International Management GmbH, Zurich, Switzerland). The study enrolled 50 consecutive patients with endometrial and cervical cancer stages IB to II who had undergone open hysterectomy and pelvic lymphadenectomy (PL). In addition, the drainage volumes of 22 patients with hypertension were compared to that of the rest of the study population. Furthermore, occurrence of lymphocele in patients with endometrial and cervical cancer were compared after completion of adjuvant treatment. s: Patients were simultaneously randomized in two groups: as a control (side without TachoSil applied) and study group (side with TachoSil applied). All surgical parameters were collected, and patients underwent ultrasound examination on postoperative days 1, 6, and 30, and at the end of treatment. The TachoSil Group showed a lower drainage volume, 30 days after surgery, while outflow of fluid occurred in 11 (22%) of all TachoSil Group cases and 22 (44%) of all control group cases. Furthermore, two patients in the control group had symptomatic lymphocele, while the same number of cases was observed in the TachoSil Group. However, the TachoSil Group demonstrated a decreased tendency to lymphocele occurrence after the end of adjuvant therapy. Here, patients with the collagen patch developed lymphocele in 12% of all cases, as opposed to 18% without TachoSil. TachoSil is a useful support treatment option for reducing drainage volume and preventing lymphocele development after lymphadenectomy.

Retzius Sparing Prostatectomy Effect on Symptomatic Lymphocele Rates

To compare symptomatic lymphocele rates between standard and Retzius sparing prostatectomy approaches. From September 18, 2019 to July 15, 2020, robot assisted laparoscopic prostatectomies by 2 surgeons (1 using SP and other Xi) at a single institution were retrospectively reviewed. Symptomatic lymphoceles were diagnosed after the patient represented to the hospital with symptoms attributable to lymphocele and confirmed by abdominal CT scan. Statistical analysis was performed using R Studio (1.2). There were 81 prostatectomies performed during the study period. Of these, 50 were Retzius sparing and 31 were standard approach. The 2 groups were similar in age, BMI, grade group, nerves spared, and T stage. Retzius sparing prostatectomies had higher lymph node yield and were more often performed with Xi multiport. Symptomatic lymphoceles were entirely present in the Retzius sparing group, occurring in 18% of cases at a mean time of 34 days after surgery. Retzius sparing approach was a significant predictor of lymphocele occurrence with an odds ratio of 23.77 (95% CI, 2-3725). Retzius sparing prostatectomy was a significant predictor of symptomatic lymphoceles. Most of these cases required IR drainage and IV antibiotics as treatment. This is likely due to impairment of lymph reabsorption as the peritoneal lining remains approximated during Retzius sparing prostatectomy.

Four-point Peritoneal Flap Fixation in Preventing Lymphocele Formation Following Radical Prostatectomy

BackgroundSymptomatic lymphocele following radical prostatectomy (RP) and concomitant bilateral extended pelvic lymph node dissection (ePLND) has a significant impact on postoperative recovery and may sometimes require surgical intervention. ObjectiveTo report on the use of four-point peritoneal flap fixation (4PPFF) during RP to reduce lymphocele occurrence following PLND. Design, setting, and participantsBetween April 2010 and May 2017, 1358 patients underwent RP with concomitant bilateral ePLND. From this cohort, 193 patients who had undergone PNLD with 4PPFF were matched in a 1:1 ratio with respect to age, body mass index, initial PSA, and number of lymph nodes removed to patients who had undergone PLND without 4PPFF. Intervention4PPFF was performed by suturing the cut end of the ventral parietal peritoneum at four points (to the anterior and lateral pelvic side wall on both sides) following PLND so that the peritoneal surface was exposed to the iliac vessels and obturator fossa. Outcome measurements and statistical analysisAll patients underwent ultrasound on postoperative days 6, 28, and 90 to test for the presence of lymphocele. For univariate analysis, a χ2 test and analysis of variance were applied, as appropriate. Statistical significance was set at p<0.05, and all p values reported were two-sided. Results and limitationsThere were no significant differences between the two groups with respect to intraoperative blood loss, positive surgical margin rate, Gleason score, clinical stage, and number of positive cores. Asymptomatic lymphocele was observed in four patients (2.07%) in the 4PPFF group compared to 16 patients (8.3%) without 4PPFF (p=0.0058). Similarly, a significant difference in the incidence of symptomatic lymphocele was observed: two patients (1.03%) in the 4PPFF group versus nine patients (4.6%) without 4PPFF (p=0.0322). There were no differences in other complication rates between the two groups. The limitations of the study are its retrospective and nonrandomised nature, with postoperative follow-up based on ultrasound imaging rather than computed tomography because of ethical considerations, which could have caused observer bias. Conclusions4PPFF is a safe and effective procedure in preventing lymphocele occurrence in patients undergoing RP with PLND. The increase in exposure of the PLND raw area to the peritoneal surface following this procedure may aid in increased absorption of accumulating lymph fluid. Further prospective randomised multicentre studies are warranted to confirm our observations. Patient summaryWe report on the use of a surgical technique to decrease the collection of lymphatic fluid in the abdominal cavity following lymph node removal during radical removal of the prostate gland in patients with prostate cancer. Patients undergoing this procedure had significantly better outcomes when compared to patients operated on in the conventional approach.

Prevention of lymphocele by using gelatin-thrombin matrix as a tissue sealant after pelvic lymphadenectomy in patients with gynecologic cancers: a prospective randomized controlled study

ObjectiveThis prospective randomized controlled pilot study aimed to find whether gelatin-thrombin matrix used as a tissue sealant (FloSeal) can prevent the occurrence of pelvic lymphocele in patients with gynecologic cancer who has undergone pelvic lymphadenectomy.MethodsEach patient, who undergo a laparotomic pelvic lymph node dissection on both sides, was randomly assigned for FloSeal application on 1 side of the pelvis. The other side of the pelvis without any product application being the control side. The amount of lymph drainage at each side of the pelvis was measured for 3 days, and computed tomography scans were obtained 7 days and 6 months after surgery for detection of pelvic lymphocele.ResultsAmong 37 cases, the median amount of lymph drainage was significantly decreased in the hemi-pelvis treated with FloSeal compared to the control hemi-pelvis (p=0.025). The occurrence of lymphocele was considerably reduced in treated hemi-pelvis (8/37, 21.6%) compared with control hemi-pelvis (12/37, 32.4%) after 7 post-operative days (p=0.219), and more decreased in the treated hemi-pelvis (5/37, 13.5%) compared with control hemi-pelvis (9/37, 24.3%) after postoperative 6 months (p=0.344).ConclusionThe application of FloSeal as a tissue sealant in lymph nodes resected tissues can reduce the incidence of pelvic lymphocele in gynecologic cancer patients. A large randomized controlled study could confirm these preliminary results.

Incidence, Risk Factors and Management of Symptomatic Lymphoceles after Radical Retropubic Prostatectomy

IntroductionWe investigated the incidence, clinical course and risk factors for symptomatic lymphoceles after radical retropubic prostatectomy with pelvic lymph node dissection. Moreover, we explored parameters for the failure of percutaneous lymphocele drainage. MethodsThe incidence of symptomatic lymphoceles in patients with prostate cancer who underwent radical retropubic prostatectomy with pelvic lymph node dissection in our department between 2008 and 2013 was investigated retrospectively. The occurrence of lymphoceles was correlated with several clinical and histopathological parameters. In addition, logistic regression analysis was performed to assess the value of independent variables with regard to the development of symptomatic lymphoceles and failure of percutaneous drainage. ResultsA total of 599 consecutive patients treated with radical retropubic prostatectomy with pelvic lymph node dissection were included in the study, of whom symptomatic lymphocele had developed in 5%. Median time to diagnosis of symptomatic lymphocele was 22.5 days. Median time of percutaneous drainage was 16 days. Overall 43% of patients required surgical unroofing. On multivariate analysis age greater than 67 years (OR 3.27, p=0.005) and removal of more than 10 lymph nodes (OR 2.57, p=0.018) were independent predictors for the development of symptomatic lymphoceles. A significantly increased risk of percutaneous drainage failure was observed in patients who had a body mass index greater than 27 kg/m2 (OR 7.0, p=0.03), followed by a trend for those with a drainage volume of more than 375 ml 24 hours after puncture (OR 3.89, p=0.12). ConclusionsSymptomatic lymphocele will develop in 1 of 20 patients after radical retropubic prostatectomy with pelvic lymph node dissection. The number of lymph nodes removed constitutes an independent risk factor. Percutaneous drainage failure is associated with high body mass index and high drainage volume within the first 24 hours after puncture.

Prospective Randomized Trial Comparing Titanium Clips to Bipolar Coagulation in Sealing Lymphatic Vessels During Pelvic Lymph Node Dissection at the Time of Robot-assisted Radical Prostatectomy

Lymphocele is the most common complication after pelvic lymph node dissection (PLND). Over the years, various techniques have been introduced to prevent lymphocele, but no final conclusion can be drawn regarding the superiority of one technique over another. In this prospective study, 220 patients undergoing robot-assisted radical prostatectomy between 2012 and 2015 were randomized to receive titanium clips (group A, n=110) or bipolar coagulation (group B, n=110) to seal lymphatic vessels at the level of the femoral canal during extended PLND (ePLND). Ultrasound examination was used to detect lymphoceles at 10 and 90 d after surgery. Lymphocele was defined as any clearly definable fluid collection and was considered clinically significant when requiring treatment. There were no statistically significant differences between groups A and B regarding overall lymphocele incidence (47% vs 48%; difference −0.91%, 95% confidence interval [CI] −2.6 to 0.7; p=0.9) and the rate of clinically significant lymphocele [5% vs 4%; difference 0.75%, 95% CI, 0.1–3.2; p=0.7]. The two groups were comparable regarding mean (±SD) lymphocele volume (30±32 vs 35±39ml; p=0.6), lymphocele location (unilateral, 37% vs 35%, p=0.7; bilateral, 13% vs 14%, p=0.9), and time to lymphocele diagnosis (95% vs 98% on postoperative day 10; p=0.5). In conclusion, this trial failed to identify a difference in lymphocele occurrence between clipping and coagulation of the lymphatic vessels at the level of the femoral canal during robot-assisted ePLND for prostate cancer. Patient summaryIn this study we compared the frequency of postoperative complications after sealing lymphatic vessels from the leg to the abdomen using metallic clips or electrical coagulation during robot-assisted surgery for prostate cancer. We found no difference in postoperative complications between the two methods.

PD14-12 CLAVIEN IIIB COMPLICATIONS AFTER OPEN RETROPUBIC AND ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY IN A SINGLE HIGH-VOLUME CENTER

You have accessJournal of UrologyProstate Cancer: Localized II1 Apr 2014PD14-12 CLAVIEN IIIB COMPLICATIONS AFTER OPEN RETROPUBIC AND ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY IN A SINGLE HIGH-VOLUME CENTER Burkhard Beyer, Pierre Tennstedt, Katharina Boehm, Jonas Schiffmann, Alexander Haese, and Markus Graefen Burkhard BeyerBurkhard Beyer More articles by this author , Pierre TennstedtPierre Tennstedt More articles by this author , Katharina BoehmKatharina Boehm More articles by this author , Jonas SchiffmannJonas Schiffmann More articles by this author , Alexander HaeseAlexander Haese More articles by this author , and Markus GraefenMarkus Graefen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1289AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES For the surgical treatment of a localized prostate cancer (PCa) different techniques have been established. Still there are controversies about the rate of complications of these procedures. Since complications also depend on different treatment patterns in the respective institution and surgical experience it is important to investigate the effect of the respective approach in a setting in which both techniques are routinely offered as a high-volume procedure. Aim of our study was to assess the rates and reasons for re-interventions under general anesthesia (Clavien grade IIIb) in our high-volume center. METHODS We analyzed data from 7833 men treated either with open retropubic- (ORP) or robotic-assisted transperitoneal radical prostatectomy (RARP) for a localized PCa in our institution between January 2010 and August 2013. A pelvic lymph node dissection (pLND) was performed in intermediate- and high-risk PCa according to the D’Amico risk stratification. Complications were evaluated in a 90 days period. Complications were categorized according the revised Clavien Classification. Descriptive statistics were used to compare both intervention groups. RESULTS 6349 men received an ORP (81.1%), 1484 a RARP (18.9%). Out of these patients 120 (1.5%) needed a re-intervention in our institution due to a Clavien IIIb complication. Reasons for re-intervention were symptomatic lymphoceles in 62 (0.8%), acute bleedings/hematoma in 37 (0.5%), secondary wound closures in 12 (0.2%) and other causes in 9 (0.1%) cases of the entire cohort. Complications stratified in D’Amico risk classification are shown in in Table 1. CONCLUSIONS Lymphoceles are the most common complication in our cohort. In our high-volume center Clavien IIIb complications in ORP and RARP were comparable. Exclusive symptomatic lymphocele occurrence tends to be decreased in the RARP group. D'Amico classification low low intermediate intermediate high high p value RARP n=4 ORP n=17 RARP n=9 ORP n=47 RARP n=4 ORP n=39 0.06 Symptomatic lymphocele n (%) 1 (0.07) 4 (0.06) 3 (0.20) 26 (0.41) 1 (0.07) 27 (0.43) Bleedings/hematoma n (%) 2 (0.13) 8 (0.13) 4 (0.27) 13 (0.20) 1 (0.07) 8 (0.13) Secondary wound closures n (%) 0 (0.00) 3 (0.05) 0 (0.00) 6 (0.09) 1 (0.07) 2 (0.03) Other causes n (%) 1 (0.07) 2 (0.03) 2 (0.13) 2 (0.03) 1 (0.07) 2 (0.02) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e415 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Burkhard Beyer More articles by this author Pierre Tennstedt More articles by this author Katharina Boehm More articles by this author Jonas Schiffmann More articles by this author Alexander Haese More articles by this author Markus Graefen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Symptomatic Lymphoceles Following Cadaveric Renal Transplantation: Single Center Experience

Post-transplantation lymphoceles are uncommon but troublesome problems. This study aimed to describe our experience of diagnosing and managing post-renal transplantation lymphoceles. We performed a retrospective chart-review of 94 consecutive cadaveric renal transplant recipients from March 2005 to August 2012 and identified five cases of lymphoceles occurring after transplantation. The demographic characteristics, comorbidities, occurrence of lymphoceles, and treatment modalities were analyzed. Five (5.3%) patients developed symptomatic postoperative lymphoceles; among them, four were male adults. In 80% of cases, diagnosis was made within 3 months after surgery. None of the lymphoceles were found within the first month after transplantation. Treatment with ultrasound-guided percutaneous drainage had a high success rate (80%) and was performed as first line therapy in all cases. One case experienced persistent drainage and required laparoscopic treatment. The mean follow-up period was 26±8 months (range: 15 - 38 months). All patients had improved renal function after the drainage procedure. No procedure-related complication occurred. Lymphoceles following cadaveric renal transplantation often occur in the second or third months after cadaveric renal transplantation, and can usually be managed with percutaneous drainage procedures. Treatment of lymphoceles also improved graft functions in the current study.

Lymphocele – urological complication after renal transplantation

Renal transplantation is the best renal replacement treatment. It provides longer survival and a better quality of life. The outcome of renal transplantation is influenced by the occurrence of various complications, including urological. One of the most frequently occurring complications is lymphocele. Most cases of lymphocele develop during a period of several weeks after the procedure of transplantation. However, there are some literature reports concerning lymphocele diagnosis in the later period, even after several years. Most cases of lymphocele are asymptomatic and are diagnosed accidentally. Nevertheless, a large lymphocele may press the kidney, ureter, urinary bladder or neighbouring blood vessels, causing deterioration of renal function, leg oedema and thrombosis of iliac vessels. Among other complications there are infections. The cause of lymphocele is collection of the lymph drained from damaged lymph vessels surrounding iliac blood vessels and/or lymph vessels of the graft. Important factors predisposing to lymphocele are immunosuppressive treatment, including mTOR inhibitors, mycophenolic acid derivatives and high doses of glucosteroids. Factors favouring occurrence of lymphocele comprise obesity, diabetes, elderly age of recipient, long time of warm ischaemia, acute rejection episodes and delayed graft function. The authors describe presently available treatment methods including aspiration and percutaneous drainage, with or without sclerotisation, drainage using the Tenckhoff catheter andlaparoscopic or open fenestration. At present, laparoscopic fenestration is considered to be the most efficient and the safest method. However, there are clinical cases where open surgical treatment is necessary.

Laparoscopic lymphocele fenestration as first-line measure for gynecologic cancer patients after retroperitoneal lymph node dissection: 10-year analysis of safety, feasibility, efficacy, and recurrence rate.

e15566 Background: The occurrence of lymphoceles is a notorious complication occurring after retroperitoneal lymph node dissection (LND) frequently treated by repetitive percutaneous needle punctures associated with a high risk of wound infection or bowel injury. Methods: We analyzed 10 years of single-center experience with laparoscopic lymphocele fenestration as a first-line measure in gynecologic cancer 102 consecutive patients with a history of retroperitoneal LND (53.4 years; range: 22–80) who underwent laparoscopic lymphocele fenestration at our department between January 2001 and December 2010 for a symptomatic lymphocele. Results: A total of 132 lymphoceles have been fenestrated in 102 patients by laparoscopy, onaverage 5.3 months (SD: 6.3 months) after the initial LND. Mean follow-up of the patients was 60.4 months. Mean duration of surgery was 115.6 minutes and the average intra-operative blood loss per patient was 146 ml. Overall conversion rate to laparotomy was 7.8 %. The rate of intraoperative and postoperative minor and major complications was significantly higher in patients after pelvic plus paraaortic LND (23.8 %) compared to those after pelvic LND alone (3.6 %; p&gt;0.01). Two-year cumulative risk of lymphocelerecurrence was only 4.2 % with a total of 7 recurrences of lymphoceles observed. Conclusions: Laparoscopic lymphocele fenestration was safe and feasible as well as efficacious as a surgical first-line treatment option for symptomatic lymphocele following retroperitoneal LND in gynecological cancer patients with a particularly low recurrence rate.

Laparoscopic lymphocele fenestration after retroperitoneal lymph node dissection in gynecological cancer patients: Safety, feasibilty, efficacy, and recurrence rates.

e15502 Background: The occurrence of lymphoceles is a notorious complication occurring after retroperitoneal lymph node dissection (LND). In this largest series of patients with lymphoceles analyze...