Pelvic Lymphocysts Research Articles

Surgical treatment of localised pelvic lymphocyst infection after radiotherapy for endometrial cancer

Endometrial cancer is mainly treated clinically by surgery, supplemented by postoperative radiotherapy. Pelvic and abdominal lymph node dissection is usually an important part of surgery, and one of the most common postoperative complications is lymph node cysts. Infection of cysts is very rare in clinical practice and can be cured mainly by anti-infection and puncture drainage. However, in this case, the patient was found to have a pelvic abscess due to radiating pain in the left lower limb, and the infection of the local lymphocyst was found to have formed a pelvic abscess, and laparoscopic open drainage was performed after puncture drainage with no improvement in symptoms. The patient recovered after surgery.

A multicenter noninferior randomized controlled study of sentinel lymph node biopsy alone versus sentinel lymph node biopsy plus lymphadenectomy for patients with stage I endometrial cancer, INSEC trial concept

BackgroundUp to the present time, there has remained a lack of strong evidence as to whether sentinel lymph node biopsy can replace lymphadenectomy for early endometrial cancer. The traditional surgery for endometrial cancer includes pelvic lymphadenectomy and paraaortic lymph node resection, but complications often seriously affect patients’ quality of life. Two randomized controlled trials with large samples have proved that lymphadenectomy does not improve the overall recurrence rate and survival rate of patients. On the contrary, it increases the incidence of complications and even mortality. The current trial is designed to clarify whether sentinel lymph node biopsy can replace lymphadenectomy for early endometrial cancer patients with negative lymph nodes.MethodsThis study is a randomized, open-label, multicenter and non-inferiority controlled clinical trial in China. Potential participants will be patients with pathologically confirmed endometrial cancer at the Zhejiang Cancer Hospital, Jiaxing Maternity and Child Health Care Hospital, and the First Hospital of Jiaxing in China. The total sample size for this study is 722.Patients will be randomly assigned in a 1:1 ratio to two groups. Patients in one group will undergo sentinel lymph node biopsy + total hysterectomy + bilateral salpingo-oophorectomy ± paraaortic lymph node resection. Patients in the other group will undergo sentinel lymph node biopsy + total hysterectomy + bilateral salpingo-oophorectomy + pelvic lymphadenectomy ± paraaortic lymph node resection. The 3-year disease-free survival rate, overall survival rate, quality of life (use EORTC QLQ-C30 + QLQ-CX24), and perioperative related indexes of the two groups will be compared.ResultsWe expect to find that for patients with early endometrial cancer, the 3-year disease-free survival rate following sentinel lymph node biopsy with indocyanine green combined with near-infrared fluorescence imaging is similar to that following lymphadenectomy. The operation time, as well as incidence of pelvic lymphocyst, lymphedema of lower limb, and edema of vulva in patients who only undergo sentinel lymph node biopsy are expected to be significantly lower than in patients who undergo lymphadenectomy. The quality of life of patients who undergo sentinel lymph node biopsy alone will be significantly better than that of patients who undergo lymph node dissection.ConclusionThis will prove that the prognosis of sentinel lymph node biopsy alone with indocyanine green combined with near-infrared fluorescence imaging is not inferior to that of sentinel lymph node biopsy plus lymphadenectomy for early stage endometrial cancer with negative nodal assessment intraoperatively. In addition, sentinel lymph node biopsy alone with indocyanine green combined with near-infrared fluorescence imaging results in fewer surgical complications and gives patients better quality of life.Trial registrationchictr.org.cn, ChiCTR1900023161. Registered 14 May 2019, http://www.chictr.org.cn/edit.aspx?pid=38659&htm=4.

Laparoscopic Excision of Recurrent Pelvic Lymphocyst Following Pelvic Lymph Node Dissection for Clear Cell Carcinoma of Ovary

Study ObjectiveDemonstration of safe laparoscopic technique for definitive excision of recurrent pelvic lymphocyst developing following pelvic lymph node dissection for clear cell carcinoma of the ovary; overcoming the additional surgical challenges of close proximity to vital anatomical structures and dense post-operative adhesions.DesignSurgical video detailing a systematic approach to laparoscopic excision of pelvic lymphocyst - describing individual surgical steps and highlighting relevant anatomy.SettingSurgery was undertaken by a gynae-oncology consultant with one surgical assistant. The patient was positioned in modified Lloyd-Davis – with table height and stack adjusted for optimal ergonomics.Patients or ParticipantsA 68 year old lady underwent total abdominal hysterectomy, bilateral salpingo-oophrectomy and omentectomy in April 2018 for stage 1A clear cell carcinoma of ovary; followed by completion laparoscopic pelvic and para-aortic lymphadenectomy. The patient subsequently developed a right pelvic lymphocyst, causing pain. Pre-operative imaging described a 3.9 × 3.3 × 3 centimetre right pelvic lymphocyst, with internal septations and thick wall. Two attempts at percutaneous drainage were unsuccessful due to difficulty penetrating the cyst capsule and loculated interior.InterventionsLaparoscopic excision of pelvic lymphocyst was undertaken. Pneumoperitoneum was maintained at a pressure of 12mmHG throughout. The pelvic peritoneum overlying the lymphocyst was opened and plane developed using a combination of monopolar, bipolar and advanced energy devices. The ureter and iliac vessels were systematically identified to avoid inadvertent injury; and avascular pelvic spaces developed to aid cleavage of the capsule with minimal blood loss.Measurements and Main ResultsNo intra or post-operative complications occurred. Histopathology confirmed a benign lymphocyst. At post-operative review, the patient reported resolution of pain and improved mobility.ConclusionThis video demonstrates a safe laparoscopic approach to excision of a densely adherent pelvic lymphocyst, abutting important pelvic structures – facilitated by the step-wise identification of pelvic anatomy and relevant pelvic spaces.

Pelvic abscess: A late complication of abdominal trachelectomy for cervical cancer.

Only a few reports of pelvic abscess as a late complication of trachelectomy have been published to date. To evaluate the cases of pelvic abscess as a late complication of abdominal trachelectomy for cervical cancer. In June 2005, we began a clinical trial of abdominal trachelectomy at our institution. Written informed consent was obtained from all patients. We retrospectively reviewed the medical records of patients who underwent trachelectomy and extracted the data of patients who experienced pelvic abscess as a late complication. From June 2005 to September 2017, we performed 181 trachelectomies at our institution. In total, 15 pelvic abscesses occurred in 12 of these patients more than 1 month after trachelectomy. The median postoperative period before the onset of pelvic abscess was 51 months (range, 1-104 months). Among the 15 cases, abscess formed in the uterine adnexa in 12, in a pelvic lymphocyst in two, and in the uterus in one. Abscess drainage was performed in six cases. Three patients underwent laparotomy with salpingo-oophorectomy. It is possible that not only surgical removal of the uterine cervix but also the use of nonabsorbable suture in cervical cerclage and placement of an intrauterine device triggered post-trachelectomy infection. Pelvic abscess can occur as a late complication of abdominal trachelectomy.

Early and late morbidity of radical hysterectomy with lymphadenectomy in early-stage cervical cancer: A prospective multicentric cohort of 232 patients.

e17007 Background: The aim of this study was to assess the early and late post-operative morbidity of patients who have undergone a radical hysterectomy (RH) for early-stage cervical cancer. Methods: We retrospectively analyzed the data of two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I & II). Patients underwent a radical hysterectomy for early-stage cervical cancer between January 2005 and March 2012 in 23 French oncologic centers. Results: A total of 412 patients were enrolled and 284 had a radical hysterectomy. Data were complete for 232 patients: 115 by laparoscopic-assisted vaginal way, 80 patients by total laparoscopic way, 9 patients by total vaginal way, 22 patients by laparotomy and 6 patients by robot-assisted way. The median age was 44 years (range = 25-85 years). 89.6 % of patients had a stage IB1 disease. 72.4% were epidermoid carcinoma and 24.6% adenocarcinoma. Eighty-one patients (35%) had only a sentinel lymph node biopsy and 151 patients (65%) had an additional pelvic lymphadenectomy. There were 45 cases of urinary infections (19.4%), 17 cases of dysuria (7.3%), 10 cases of urinary incontinence (4.3%), and 6 cases of ureteral or vesical fistula (2.6%). The genito-femoral nerve was injured in 25 cases (10.7%) and the obturator nerve was injured in 22 cases (9.5%). There were 38 cases of limb lymphedema (16.3%) and 14 cases of pelvic lymphocyst (6%). Conclusions: These complications rates are similar with those found in the current literature. Urinary infections and limb lymphedema are the main complications of RH. The functional outcomes could be improved by applying nerve-sparing techniques. [Table: see text]

Functional and oncologic outcomes of radical trachelectomy in early-stage cervical cancer: A prospective multicentric cohort of 61 patients.

5529 Background: The aim of this study was to assess the post-operative morbidity of patients who have undergone a radical trachelectomy for early-stage cervical cancer and the oncologic outcomes. Methods: We retrospectively analyzed the data of two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I & II). Patients underwent a radical trachelectomy for early-stage cervical cancer between January 2005 and March 2012 from 8 French oncologic centers. Results: A total of 61 patients have undergone a radical trachelectomy: 41 patients by laparoscopic-assisted vaginal way, 7 patients by total laparoscopic way, 11 patients by total vaginal way and 2 patients by laparotomy. The median age was 33 years (range = 22-68 years). 88.5 % of patients had a stage IB1 disease. There were 63.9% of epidermoid carcinoma and 34.4 % of adenocarcinoma. Eighteen patients (29.5%) had only a sentinel lymph node biopsy and 43 patients (70.5%) had an additional pelvic lymphadenectomy. The median follow-up was 46 months (range = 0-85 months). Twenty patients (32.8%) had a urinary complication. There were 12 cases of urinary infections (19.6%), 6 cases of dysuria (9.8%), 3 cases of urinary incontinence (4.9%), and one case of ureteral fistula (1.6%). Nine patients had a major neurologic complication (14.7%): the genito-femoral nerve was injured in 4 cases (6.5%) and the obturator nerve was injured in 5 cases (8.2%). Sixteen patients (26.2%) presented a lymphovascular complication. There were 12 cases of limb lymphedema (19.7%) and 5 cases of pelvic lymphocyst (8.2%). During the follow-up, 3 patients (4.9%) had a local recurrence and two patients died : one from a breast cancer and one from a liver metastasis. Conclusions: The radical trachelectomy is a feasible and safe alternative option for young patient with a early-stage cervical cancer in order to preserve their fertility. See table. [Table: see text]

Laparoscopic treatment of early-stage endometrial cancer with and without uterine manipulator: Our experience and review of literature

ObjectiveThe aim of this study was to retrospectively compare in a series of 110 patients with early-stage endometrial cancer recurrence rate and surgical outcomes after total laparoscopic (LPS) hysterectomy with lymphadenectomy performed with or without uterine manipulator. Study design110 patients with clinical stage I endometrial cancer were enrolled in a retrospective study and underwent surgical staging comprised of LPS hysterectomy, bilateral salpingo-oophorectomy, and in all cases we performed systematic bilateral pelvic lymphadenectomy with uterine manipulator (Group 1, 55 patients) or without (Group 2, 55 patients). ResultsThe rate of positive cytology and LVSI did not significantly differ between Group 1 and Group 2. 1 patient of the Group 1 had a bladder injury and another patient of Group 2 had an ureteral stricture temporarily treated with a stent. 1 patient of the Group 1 had a bowel occlusion due to a port site hernia under the left 10 mm port, resolved with a bowel resection and an end-to-end anastomosis. In 1 patient of the Group 1 and 2 patients of Group 2 we observed a vaginal cuff dehiscence and in 1 case of Group 2 a pelvic lymphocyst was reported. Postoperative fever was reported in 3 patients of the Group 1 and in 5 patients of group 2 (p = 0.07). ConclusionsOur study confirms that use of uterine manipulator for laparoscopic treatment of endometrial cancer does not increase positive peritoneal citology, LVSI and recurrence rate.

Robotic infrarenal paraaortic and pelvic nodal staging for endometrial cancer: feasibility and lymphatic complications.

This study was designed to evaluate the feasibility and lymphatic complications of robotic pelvic and infrarenal paraaortic lymphadenectomy in endometrial cancer patients. All patients diagnosed with high risk endometrial cancer during the study period were identified (n = 212). Clinical prospective data, with reassessment of lymphatic complications, was analysed for all cases (n = 140) planned for a complete robotic nodal staging. The outcome measures were: success rate of infrarenal paraaortic lymphadenectomy, the rate of lymphatic complications and factors associated with nodal yield. Of the 212 women, an open or restricted robotic procedure was performed in 57 women (27%) and no operation in 15 (7%), the latter due to disseminated disease or comorbidity. In 140 women (66%) in whom staging was intended, the lymphadenectomy included the infrarenal area in 70%, was restricted to the inframesenteric area in 21% and aborted or incomplete in 9%. The median number of paraaortic nodes was 10 (range 2-39). An unsuccessful staging was associated with high BMI and the surgeon's inexperience. At 1 year, three patients (2%) had developed a grade two lower limb lymphedema. Eleven women (8%) demonstrated pelvic lymphocysts; seven (64%) resolved spontaneously. Only one paraaortic lymphocyst was found; this required drainage. No cases of chylous ascites occurred. An infrarenal robotic paraaortic lymphadenectomy is feasible in 70% of high risk endometrial cancer cases when intended (88% in non-obese patients operated by experienced surgeons), but is restricted in obese patients and by surgeon's inexperience.

Microbiology of Pelvic Lymphocyst Infection after Lymphadenectomy for Malignant Gynecologic Tumors.

Pelvic lymphocyst infection is a rare complication after lymphadenectomy for malignant gynecologic tumors. Although medical therapy is a useful addition to surgical drainage, the appropriate antibiotic regimen is unknown because few studies have examined the causative organisms. The purpose of this case series was to identify the micro-organisms infecting pelvic lymphocysts. This was a single-center, retrospective, case-series review conducted at a tertiary-care cancer center between October 2002 and March 2013. The participants included all patients who experienced their first pelvic lymphocyst infection after undergoing pelvic lymphadenectomy for cervical, endometrial, or ovarian cancer and exhibited positive lymphocyst fluid culture. Computed tomography- or sonography-guided percutaneous aspiration procedures were performed to obtain lymphocyst fluid for culture. During the study period, 878 patients underwent lymphadenectomy for gynecologic malignant tumors, and 13 developed a pelvic lymphocyst infection documented microbiologically. Cultures identified Staphylococcus aureus (three patients), S. epidermidis (one patient), Streptococcus agalactiae (three patients), Enterococcus (two patients), Escherichia coli (one patient), and anaerobic bacteria (three patients). They were all monomicrobial infections. Our study and other smaller ones suggest that lymphocyst infections following pelvic lymphadenectomy for malignant gynecologic tumors usually are monomicrobial and caused by gram-positive cocci, including Staphylococcus, Streptococcus, and Enterococcus, and anaerobes such as Bacteroides fragilis. These bacteria should be considered when selecting empiric antibiotic therapy.

Determinants of pelvic and para-aortic lymph node metastasis in endometrial cancer and its role in tailoring lymphadenectomy

Objectives: Complete lymphadenectomy may be omitted in selected cases in which the risk of lymph node spread is low (low-risk cancer). In this study, we aimed to study the various clinicopathologic variables affecting lymph node metastasis, to evaluate the incidence and distribution of pelvic lymph nodes (PLN) and paraaortic lymph node (PALN) metastases in endometrial cancer, and to study intraoperative and postoperative complications of pelvic and para-aortic lymphadenectomy. Methods: Our study included 78 patients with endometrial cancer between June 2005 and May 2011. The surgical procedure involved peritoneal cytology, total or radical hysterectomy, and bilateral salpingooophorectomywith pelvic and para-aortic lymphadenectomy. Statistical analysiswas performed using Fisher's exact probability test, and P b 0.05 was considered statistically significant. Results: Positive LN metastasis was diagnosed in 41% of patients: 23% with PLN and PALN metastasis, 10.3% with PLN metastasis only, and 7.7% with PALN metastasis only. The most commonly involved PLN groups were internal iliac and obturator LNs (67.9% and 61.5%). In the aortic area, the most commonly involved group (66.6%) was the preaortic LNs (supraand inframesentric). PLN and PALN metastasis in stages III and IV was significantly higher than in stages I and II. Myometrial invasion, cervical invasion, adnexal metastasis, and lymphovascular invasion were significantly correlated with PLN metastasis, while myometrial invasion, adnexal metastasis, and lymphovascular invasion were significantly correlated with PALN metastasis. Postoperative complications were observed in 50 patients (64.1%). The most common complication was pelvic lymphocysts in 46.1%. Ileus and deep venous thrombosis were seen in 7.6%. None of the complications resulted in death. Conclusions: Our findings suggest that systemic lymphadenectomy can be omitted in endometrial carcinoma patients who have favorable clinicopathological determinants (stage I, endometroid type, myometrial invasion b50%, and absence of lymphovascular invasion) because of low risk for LN metastasis and to avoid perioperative complications. However, these results should be confirmed in prospective large-scale, randomized clinical trials.

M211 A CASE OF PELVIC LYMPHOCYST CAUSING OBSTRUCTIVE ILEUS AFTER RADICAL SURGERY

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S600-S600 Poster presentations M211 A CASE OF PELVIC LYMPHOCYST CAUSING OBSTRUCTIVE ILEUS AFTER RADICAL SURGERY S.L. Nam, S.L. NamSearch for more papers by this authorG.-W. Lee, G.-W. LeeSearch for more papers by this authorK. Kim, K. KimSearch for more papers by this author S.L. Nam, S.L. NamSearch for more papers by this authorG.-W. Lee, G.-W. LeeSearch for more papers by this authorK. Kim, K. KimSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61403-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S600-S600 RelatedInformation

Lymphatic-Venous Anastomosis for the Radical Cure of a Large Pelvic Lymphocyst

Therapeutic efficacy of lymphatic-venous anastomosis (LVA) has been shown, but expansion of the indication is desirable because LVA is a procedure with low invasiveness and is applicable over a wide area. This is the first reported case of intractable pelvic lymphocyst for which LVA was effective. LVA may be useful for pelvic lymphocyst at an early stage after cancer resection and lymph node dissection.

Robot-assisted removal of a lymphocyst causing severe neuralgic pain and adductor atrophy.

Following a robot-assisted radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer, a 53-year-old woman was diagnosed with a 50-mm right-sided pelvic lymphocyst by the use of vaginal ultrasonography. She gradually developed intermittent increasingly severe neuralgic pain mimicking a meralgia paresthetica. A neurolysis was proposed by the neurosurgeons. Awaiting this intervention, a pelvic MRI revealed a partial atrophy of the ipsilateral adductor muscles and a probable entrapment of the obturator nerve by the lymphocyst as an alternative cause of the pain. Using a four-arm da Vinci-S-HD robot the lymphocyst, located deep in the right obturator fossa and surrounding the obturator nerve, was completely removed, sparing the partially atrophic obturator nerve. No bleeding occurred. The surgery time was 95min. At 10months' follow-up the patient was relieved of her pain with no signs of a new lymphocyst.

Influences of lymphatic vessel ligation in pelvic lymphadenectomy on postoperative lymphocyst formation--a randomized controlled trial

Pelvic lymphocysts are the most common postoperative complications of pelvic lymphadenectomy. Prevention of this disease is more important than treatment. This randomized study was to evaluate the preventive effect of lymph vessel ligation during pelvic lymphadenectomy on pelvic lymphocyst formation. A total of 39 patients with gynecologic malignancy, who had pelvic lymphadenectomy in the Second Affiliated Hospital of Sun Yat-sen University from July 2006 to January 2007, were randomized into the ligation group (19 patients) and the non-ligation group (20 patients). All patients had no heart disease, hepatopathy, nephronia, pneumonopathy, hypoproteinemia and no history of radiotherapy. All the patients were followed-up with sonographic evaluation and physical examination for lymphocysts and other postoperative complications at 1, 4, 12, and 24 weeks after operation. No significant differences were observed between the two groups in pathlogic type, age, height, weight, body surface area, body mass index (BMI), operation duration, estimated blood loss, time to the passage of flatus, total drainage volume, duration of drainage, and duration of hospital stay (P>0.05). The occurrence rate of lymphocysts was significantly lower in the ligation group than in the non-ligation group at one week after operation (26.3% vs. 60.0%, P<0.05). The rates were slightly lower in the ligation group than in the non-ligation group without significant differences after then (31.6% vs. 55.0% at the 4th week), (16.7% vs. 45.0% at the 12th week), (20.0% vs. 27.8% at the 24th week). No significant differences were observed in the occurrence of other postoperative complications between the two groups (P<0.05). Ligations of the deep inguinal lymph vessels, obturator lymph vessels, common iliac lymph vessels, and the lymph vessels at the crossing of the external iliac and the inter iliac vein can decrease the occurrence of postoperative lymphocysts in short-term period, and will not increase the occurrence of postoperative complications.

Ultrasound diagnosis of lymphocyst after pelvic limphonodes dissection and its clinical value

Objective To evaluate ultrasound diagnosis of lymphocyst after pelvic limphonodes dissection and its clinical application.Methods ultrasound manifestations of 30 cases of lymphoeyst with complete clinical information were studied retrospectively,in which 26 of 30 cases were proved pathologitally by operation or puncture ,and the other 4 cases were diagnosed clinically. Ultrasound findings of 35 pelvic lymphocysts proved by biopsy and pathology in 26 cases were studied and analyzed,Results In 25 cysts,the ultrasound findings were anechoic cysts with strip or oval shape,sharp margin,thin even walls,and short thread-like spurs protruded from the capsular wall .In 10 cysts,the cystic wall thickness was uneven,and the inner wall was coarse without spurs on ultrasound,There were typical characteristic of cyst findings on Lymphocyst,distributed inside pelvic wall along external iliac vessels Conclusions The morphologic characteristics of pelvic lymphocysts can be clearly showed on ultrasonography,along external iliac vessels,It is important to be familiar with these characteristics,so as to improve the diagnostic accuracy. Key words: Lymphocyst; Limphonode dissection; Ultrasonography; Pelvic malignant tumor

Management of symptomatic pelvic lymphocyst after radical pelvic or pelvic and paraaortic lymphadenectomy for cervical and endometrial cancer

Pelvic and paraaortic lymph node dissection, as part of the staging surgery for cervical and endometrial carcinoma, interrupts the afferent lymphatics. The high acceptance by the community of gyn-oncologists was after finding that laparoscopic lymphadenectomy can be performed in the majority of patients and is associated with low complication rate. Incidence of lymphocele formation and incidence of severe complications associated with lymphocele, such as infection, deep venous thrombosis, or urinary tract occlusion, were retrospectively evaluated in the past years (01.2001–01.2007) after surgery. From January 2001 to January 2007, 226 women underwent surgery including pelvic or pelvic and paraaortic lymphadenectomy for primary gynecological pelvic malignancies, of which 68 (30%) patients had cervical cancer and 158 (60%) patients had endometrial cancer; all of them were retrospectively analyzed. Patients with symptoms such as pain in the pelvic area, lymphedema, or suspicious cyst in the pelvis were sent to our clinic for further evaluation. The identification was made by physical examination and confirmed by US or CT. Twenty three out of 226 (10.2%) patients were diagnosed to have symptomatic pelvic lymphocyst. Additionally, two of the 23 patients had lymphedema, another two patients had lymphocyst infection, one patient had deep venous thrombosis, and one patient had ureteral stenosis. A partial (ventral) resection of the lymphocyst was performed. Median duration of hospital stay was 12.5 days and median duration of drainage was 10 days. Laparoscopic lymphocyst resection and drainage was successful in 22 patients. In one patient, a re-laparoscopy was necessary because of a recurrent lymphocyst formation 6 months after the operation. The laparoscopic lymphocyst resection is a safe and effective procedure and was applied in all 23 patients successfully.

Natural history of pelvic lymphocysts as observed by ultrasonography after bilateral pelvic lymphadenectomy

To determine, in patients who have undergone bilateral pelvic lymphadenectomy for gynecological cancer, the incidence of lymphocyst formation, their change in size with time, risk factors and correlation with symptoms. This was a prospective observational study of 108 patients undergoing bilateral pelvic lymphadenectomy for gynecological cancer in our unit. We performed serial three-dimensional (3D) ultrasound assessment at 2 and 6 weeks and 3, 6, 9 and 12 months after surgery. Before each ultrasound assessment, symptoms were recorded and a physical examination was performed. Forty-eight (44.4%) patients had unilateral or bilateral lymphocysts detected during the follow-up period; 26 were on the left side, 16 were on the right side and six were bilateral. In 39 (81.2%) of the patients, the lymphocysts were first noted 2 weeks after the operation. In nine (18.8%) the lymphocysts persisted until 12 months after surgery. There was no association between lymphocyst formation and diagnosis, type of operation performed, surgeon, operative blood loss, adjuvant radiotherapy and number of lymph nodes removed. Four lymphocysts were detected by physical examination before the ultrasound diagnosis. There was no association between lymphocyst and symptoms, including pain over the abdomen, pelvis, thigh, legs or back, lymphedema, fever or symptoms of cystitis. Only one patient developed an infection of the lymphocyst, which required surgical intervention. Lymphocyst formation is common following bilateral pelvic lymphadenectomy. Most patients with lymphocysts are asymptomatic and the development of major complications is rare.

Laparoscopic marsupialisation of pelvic lymphocysts following total abdominal hysterectomy and pelvic lymphadenectomy for endometrial cancer: A case report

Lymphocele formation, a common complication of pelvic lymphadenectomy, can produce considerable morbidity. Treatment is sometimes problematic. We treated a 54-year-old woman with a symptomatic lymphocele by laparoscopic marspialization.She developed hydronephrosis due to a retroperitoneal lymphocele following total abdominal hysterectomy and pelvic lymphadenectomy for endometrial cancer. Because conservative therapy, including percutaneous or transvaginal drainage, had a risk of bowel perforation, we chose laparoscopic marsupialisation under transvaginal ultrasonographic guidance. The 6-cm collection was opened, and the edges were cauterized and sutured with the surrounding peritoneum. The postoperative course was satisfactory and the hydronephosis resolved. This highly effective, minimally invasive procedure offers a significant advantage to the patient.

Late onset of pulmonary embolism caused by lymphocyst following pelvic lymphadenectomy

Herein is reported a case of late-onset pulmonary embolism following pelvic surgery, despite prophylactic measures in the perioperative period. Twenty-six days after hysterectomy and pelvic lymphadenectomy for endometrial carcinoma, an 83-year-old woman developed a pulmonary embolism. This was caused by pelvic lymphocyst, which, in turn, led to chronic compression of the right external iliac vein. This case strongly suggests that prolonged postoperative thromboembolic prophylaxis should be considered in elderly patients undergoing lymphocyst following pelvic surgery.

Laparoscopic marsupialisation of bilateral pelvic lymphocysts following radical hysterectomy and pelvic lymphadenectomy for cervical cancer: a case report

Laparoscopic marsupialisation of bilateral pelvic lymphocysts following radical hysterectomy and pelvic lymphadenectomy for cervical cancer: a case report